Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla / Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement

Objetivo. Evaluar la eficacia y seguridad de la administración de una dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla. Material y métodos. Estudio observacional prospectivo de la administración de ácido tranexámico en pacientes intervenidos de prótesis total primaria de rodilla desde noviembre de 2013 a febrero de 2015, en los que se utilizó un sistema de recuperación de sangre autóloga. Se incluyeron en el estudio 98 pacientes distribuidos en dos grupos de 49 pacientes según la exposición a la administración de ácido tranexámico. La variable principal del estudio fue el número de pacientes que precisaron autotransfusión del sistema de recuperación de sangre autológa. Resultados. No se registraron pérdidas durante el seguimiento. No hubo diferencias significativas entre ambos grupos con respecto a las variables preoperatorias y hospitalarias. Los valores medios de hemoglobina y hematocrito preoperatorios, a las 24 y 48 h postoperatorias eran similares en ambos grupos. El volumen medio de sangrado en el sistema de recuperación de sangre autóloga y la pérdida media estimada de sangre fue menor en los pacientes a los que se había administrado ácido tranexámico, siendo las diferencias significativas. Ningún paciente del grupo en el que se administró ácido tranexámico precisó autotransfusión sanguínea. No se precisó alotransfusión sanguínea en los pacientes de la cohorte. No se registraron eventos adversos relacionados con la administración del ácido tranexámico. Conclusiones. El uso de una dosis única 15 mg/kg de ATX intravenoso en PTR primaria ha presentado una tasa de no autotransfusión ni alotranfusión sanguínea del 100%, sin aumento en la incidencia de eventos trombóticos. Por ello recomendamos su utilización en este grupo de pacientes, con una indicación que debe ser individualizada, justificar su uso en la historia clínica y precisar del consentimiento informado del paciente. Nivel de evidencia III (AU)

Objective. To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Materials and methods. Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. Results. No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. Conclusions. Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory (AU)

[Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement]. / Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla.

OBJECTIVE: To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. MATERIALS AND METHODS: Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. RESULTS: No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. CONCLUSIONS: Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory.

Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda: caso clínico / Intravascular hypothermia for the management of Intracranial hypertension in acute liver failure: case report

Acute liver failure has a mortality rate in excess of 80 percent. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.

Tuberculosis miliar tras tratamiento con adalimumab / No disponible

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Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms.

OBJECTIVES: To assess the efficacy of posterior tibial nerve stimulation for treatment of lower urinary tract irritative symptoms (urgency, frequency, urge incontinence and pelvic pain). PATIENTS AND METHODS: 51 female patients with a mean age of 55 years were enrolled in the study. The patients presented with the following symptoms: Frequency/urgency 26 patients (50.98%), urge incontinence 22 (43.13%) and interstitial cystitis 3 patients (5.88%). The technique consists in administering low voltage electric stimulation via a 3-5cm needle placed above the tibial malleolus. Patients received weekly stimulations of 30 minutes for a 10-week period. Quality of life questionnaires and voiding diaries before and after treatment were completed. Moreover, the results were evaluated by patients. The variables analysed include: daytime and nighttime voiding frequency, daytime and nighttime voiding volume, daytime and nighttime leakage episodes and hypogastric pain. RESULTS: A statistically significant improvement was seen in all variables, especially remarkable in relation to frequency/urgency, impact on women quality of life and hypogastric pain, being less marked in relation to leakage episodes and voiding volume. CONCLUSIONS: Afferent nerve stimulation offers an alternative treatment for managing lower urinary tract irritative symptoms. However, it would be advisable to confirm the results obtained by means of long-term randomized, follow-up studies.

In vitro cytotoxicity of flavonoids against MK2 and C6 tumour cells.

The cytotoxic effect of five flavonoids isolated from the aerial parts of the Asteraceae family of plants were studied in vitro using LLC-MK2 and C6 glial cells. Agehoustin A was shown to be cytotoxic for both cells (71% or 67% cell death). Agehoustin B and artemetin, which lack a methoxy group at C-8 (RI), were not cytotoxic for the cells (19% and 16% cell death). The three flavonoids showed considerable suppressive effects on LLC-MK2 and C6 cell growth. Lucidin-dimethylether and gnaphaliin were also not cytotoxic for cells but they had no suppressive effect on cell growth. The results show a structure-cytostatic activity relationship. We suggest that the methoxy group on C-8 and on the B ring are responsible for death cell.

KRAS mutations are not predictive for progression of preneoplastic gastric lesions.

Individuals with atrophic gastritis (n = 863) were recruited to participate in a chemoprevention trial in Nariño, Columbia. The volunteers were randomly assigned to intervention therapies, which included antibiotic treatment for Helicobacter pylori infection, and then daily dietary supplementation with antioxidant micronutrients in a 2(3) factorial design. Biopsies were obtained according to a specified protocol from designated areas in the stomach for each individual at baseline (before intervention therapy), at year 3, and at year 6. A systematic sample of 160 participants was selected from each of the eight treatment combinations, and the first exon of KRAS was examined for mutations. At year 3, the data indicated that individuals with KRAS mutations in their baseline premalignant stomach biopsies were 3.74 times as likely to progress to a higher premalignant stage than those who lacked baseline mutations (P = 0.04; C. Gong et al., Cancer Epidemiol. Biomark. Prevy. 8:167-171, 1999). However, after 6 years, baseline KRAS mutations failed to predict histological progression. Also, KRAS mutation in 72-month biopsies did not predict histological progression.

Morphometric evaluation of gastric antral atrophy: improvement after cure of Helicobacter pylori infection.

OBJECTIVE: Our purpose was to find out if morphometric techniques can document long term changes in gastric antral atrophy after curing Helicobacter pylori infection with or without dietary supplementation with antioxidant micronutrients. METHODS: Study subjects were 132 adult volunteers from a Colombian region with high gastric cancer rates. Participants were randomly assigned to ascorbic acid, beta-carotene, and anti-H. pylori treatment, following a factorial design. Gastric biopsies were obtained at baseline and after 72 months of intervention. Atrophy was evaluated by a standard visual analog scale and by morphometry. RESULTS: Statistically significant changes in antral atrophy were detected with morphometric techniques after intervention in subjects who received anti-H. pylori treatment. A nonsignificant trend was also observed with visual scores. This effect was greater among those who were free of infection at the end of the trial. After accounting for the effect of anti-H. pylori treatment, no significant effect was noted for dietary supplementation with ascorbic acid and/or beta-carotene. CONCLUSIONS: We conclude that gastric atrophy improves significantly after long term control of H. pylori infection. This effect can be demonstrated both by conventional histological grading and by morphometry.

Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy.

BACKGROUND: Previous research has identified a high risk of gastric carcinoma as well as a high prevalence of cancer precursor lesions in rural populations living in the province of Nariño, Colombia, in the Andes Mountains. METHODS: A randomized, controlled chemoprevention trial was conducted in subjects with confirmed histologic diagnoses of multifocal nonmetaplastic atrophy and/or intestinal metaplasia, two precancerous lesions. Individuals were assigned to receive anti-Helicobacter pylori triple therapy and/or dietary supplementation with ascorbic acid, beta-carotene, or their corresponding placebos. Gastric biopsy specimens taken at baseline were compared with those taken at 72 months. Relative risks of progression, no change, and regression from multifocal nonmetaplastic atrophy and intestinal metaplasia were analyzed with multivariate polytomous logistic regression models to estimate treatment effects. All statistical tests were two-sided. RESULTS: All three basic interventions resulted in statistically significant increases in the rates of regression: Relative risks were 4.8 (95% confidence interval [CI] = 1.6-14.2) for anti-H. pylori treatment, 5. 1 (95% CI = 1.7-15.0) for beta-carotene treatment, and 5.0 (95% CI = 1.7-14.4) for ascorbic acid treatment in subjects with atrophy. Corresponding relative risks of regression in subjects with intestinal metaplasia were 3.1 (95% CI = 1.0-9.3), 3.4 (95% CI = 1.1-9.8), and 3.3 (95% CI = 1.1-9.5). Combinations of treatments did not statistically significantly increase the regression rates. Curing the H. pylori infection (which occurred in 74% of the treated subjects) produced a marked and statistically significant increase in the rate of regression of the precursor lesions (relative risks = 8.7 [95% CI = 2.7-28.2] for subjects with atrophy and 5.4 [95% CI = 1.7-17.6] for subjects with intestinal metaplasia). CONCLUSIONS: In the very high-risk population studied, effective anti-H. pylori treatment and dietary supplementation with antioxidant micronutrients may interfere with the precancerous process, mostly by increasing the rate of regression of cancer precursor lesions, and may be an effective strategy to prevent gastric carcinoma.

Antiviral effect of flavonoids on the dengue virus.

In the present study we analysed the possible antiviral effect on dengue viruses of different flavonoids extracted and identified at the Chemistry Institute, UNAM, from the Mexican plants Tephrosia madrensis, Tephrosia viridiflora and Tephrosia crassifolia. The flavonoids glabranine and 7-O-methyl-glabranine presented 70% inhibition on the dengue virus at a concentration of 25 microM, while methyl-hildgardtol A, hildgardtol A and elongatine had no effect on viral growth. Our results show that glabranine and 7-O-methyl-glabranine isolated from Tephrosia s.p. exert a dose-dependent inhibitory effect in vitro on the dengue virus.

Ion chromatographic determination of chloride in mustard sauces.

A new, simple, precise, and rapid ion chromatography (IC) method has been developed to determine chloride in mustard sauces using a mixture of phthalic acid, acetone, and water adjusted to pH 5.0 as eluent. Conductometric detection was carried out. The retention time for chloride was 1.5 min. Linearity was obtained up to a concentration level of 100 mg/L NaCl. The method was statistically evaluated for accuracy and precision after being used to assay the chloride from mustard sauces. Within the same samples, the chloride levels obtained by IC were compared with the sodium concentrations quantified by atomic absorption spectrophotometry.

KRAS mutations predict progression of preneoplastic gastric lesions.

Eight hundred sixty-three subjects with atrophic gastritis were recruited to participate in an ongoing chemoprevention trial in Nariño, Colombia. The participants were randomly assigned to intervention therapies, which included treatment to eradicate Helicobacter pylori infection followed by daily dietary supplementation with antioxidant micronutrients in a 2 x 2 x 2 factorial design. A series of biopsies of gastric mucosa were obtained according to a specified protocol from designated locations in the stomach for each participant at baseline (before intervention therapy) and at year three. A systematic sample of 160 participants was selected from each of the eight treatment combinations. DNA was isolated from each of these biopsies (n = 320), and the first exon of KRAS was amplified using PCR. Mutations in the KRAS gene were detected using denaturing gradient gel electrophoresis and confirmed by sequence analysis. Of all baseline biopsies, 14.4% (23 of 160) contained KRAS mutations. Among those participants with atrophic gastritis without metaplasia, 19.4% (6 of 25) contained KRAS mutations, indicating that mutation of this important gene is likely an early event in the etiology of gastric carcinoma. An important association was found between the presence of KRAS mutations in baseline biopsies and the progression of preneoplastic lesions. Only 14.6% (20 of 137) of participants without baseline KRAS mutations progressed from atrophic gastritis to intestinal metaplasia or from small intestinal metaplasia to colonic metaplasia; however, 39.1% (9 of 23) with baseline KRAS mutations progressed to a more advanced lesion after 3 years [univariate odds ratio (OR), 3.76 (P = 0.05); multivariate OR adjusted for treatment, 3.74 (P = 0.04)]. In addition, the specificity of the KRAS mutation predicted progression. For those participants with G-->T transversions at position 1 of codon 12 (GGT-->TGT), 19.4% (5 of 17) progressed (univariate OR, 2.4); however, 60.0% (3 of 5) of participants with G-->A transitions at position 1 of codon 12 (GGT-->AGT) progressed (univariate OR, 8.7; P = 0.004 using chi2 test).

Inducible nitric oxide synthase, nitrotyrosine, and apoptosis in Helicobacter pylori gastritis: effect of antibiotics and antioxidants.

Helicobacter pylori infection is a known risk factor for gastric cancer. We hypothesized that H. pylori infection would lead to the sustained production of the reactive nitrogen species nitric oxide and peroxynitrite as part of the host immune response. We further hypothesized that H. pylori infection would lead to increased apoptosis of gastric epithelial cells, possibly in response to free radical-mediated DNA damage. Using immunohistochemistry, we stained and scored gastric antral biopsies from 84 Colombian patients with nonatrophic gastritis before and after treatment for H. pylori infection. We examined expression of inducible nitric oxide synthase (iNOS); nitrotyrosine, a marker for peroxynitrite; and DNA fragmentation, a marker for apoptosis. Patients were treated with triple therapy (amoxicillin, 500 mg three times a day for 2 weeks; metronidazole, 400 mg three times a day for 2 weeks; and bismuth subsalicylate, 262 mg four times a day for 2 weeks, followed by 262 mg every day for 4-12 months). Eradication of H. pylori infection resulted in a significant reduction in iNOS and nitrotyrosine staining and a marginally significant reduction in apoptosis. Dietary supplementation with beta-carotene (30 mg every day for 4-12 months) resulted in a significant decrease in iNOS staining. Supplementation with ascorbic acid (1 g twice a day for 4-12 months) led to a significant reduction in nitrotyrosine staining. In patients supplemented with either ascorbic acid or beta-carotene, there was a trend toward a reduction in apoptosis, but this was not statistically significant. We conclude that H. pylori infection is accompanied by the formation of endogenous reactive nitrogen intermediates, which may contribute to DNA damage and apoptosis. In addition to antimicrobial therapy, dietary supplementation with beta-carotene and ascorbic acid may prevent the formation of these potential carcinogens.

Effect of beta-carotene supplementation on serum alpha-tocopherol concentration.

Conflicting reports of the effects of beta-carotene supplementation on serum alpha-tocopherol concentration led us to evaluated serum alpha-tocopherol in subjects with and without beta-carotene (30 mg/day) supplementation for up to 2 years duration in an ongoing chemoprevention trial. No adverse effect has been observed at any of the time periods examined.

The role of gerontological advanced practice nurses in geriatric care.

GAPNs have a significant role to play in the care of older people. They provide focused health screening, counseling, crisis intervention, and comprehensive care to this population. They serve as important advocates in directing appropriate utilization of resources and making referrals that promote continuity of care geared to the needs of older adults. GAPNs provide essential educational services to older clients, their families, and other nursing and health care professionals involved in their care. They are innovators in the field of gerontological nursing and geriatric care and initiate or collaborate in research aimed at improving the health status of older persons. GAPNs are true providers of geriatric care, with great potential for serving an increasingly aging society.

Specialized contacts of astrocytes with astrocytes and with other cell types in the hypothalamus of the hamster.

Adult hamsters were used for this electron microscopic study of the hypothalamic region. Specialized contacts between astrocytes and astrocytes, and between astrocytes and other cellular elements, are described and illustrated. The specialized inter-astrocytic junctions occur primarily in perivascular and subpial regions, but also in areas of high synaptic density. The junctions between astrocytic processes are of hemidesmosomal type. Astrocytes are connected to oligodendroglial cells by means of desmosomes, and to neuronal processes by means of zonulae occludens. The functional significance of these arrangements is discussed.

The fine structure of ependyma in the hypothalamus of the hamster (Cricetus cricetus).

The ciliated ependyma of the hypothalamus of the hanster (Cricetus cricetus) consists of a sheet of cells, the luminal surface of which is reflected over cilia and numerous microvilli. The lateral portions of the plasmalemma of contiguous cells are fused at some sites to from junctions of five layers, the zonula occludens. These fusions occur usually in continuity with other intercellular junctions, the zonula adhaerens. In the apical regions of the ependyma these fusions are almost spiralled. The nucleus is regularly oval and lying close to the basal plasmalemma. The cytoplasm contains a finely granular matrix, filamentous components close to the junctions. The endoplasmic reticulum is sparse. The Golgicomplex is confined to the supranuclear cytoplasm, and mitochondria, are more numerous in the apical than in the basal regions of ependymal cells; the mitochondria are generally rounded and have transverse cristae and granules. The apical regions of the cytoplasm contain the basal bodies of cilia; they form non-striated rootlets and the rootlet filaments tend to diverge, ending in a granular zone.

An ultrastructural study of the subependymal plate in the hamster.

The subependymal plate of the hypothalamus of the hamster has been studied in this work. Our observations with the electron microscope show that the basal surface of the ependymal cells in this area are situated directly over the astrocytic elements. Ultrastructural studies which indicate two types of glial cells in the subependymal plate contradicted by the results of the present investigation demonstrating one type of glial cells in the hypothalamic subependymal plate. This fact is interpreted as the final result of a glial differentiation in adult hamsters.