Clinical and economic burden of acute exacerbations of idiopathic pulmonary fibrosis: a prospective observational study in Spain (OASIS study).

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a fatal progressive lung disease entailing significant impairment in health-related quality of life (HRQoL) and high socioeconomic burden. The course of IPF includes episodes of acute exacerbations (AE-IPF) leading to poor outcomes. This study aimed to compare management, costs and HRQoL of patients with AE-IPF to patients without AE-IPF during one year in Spain. MATERIALS AND METHODS: In a 12-month, prospective, observational, multicenter study of IPF patients, healthcare resource use was recorded and costs related to AE-IPF were estimated and compared between patients with and without AE-IPF. HRQoL was measured with the St. George's Respiratory Questionnaire (SGRQ), EuroQoL 5 dimensions 5 levels questionnaire (EQ-5D-5L), EQ-5D visual analogue scale (EQ-VAS) and the Barthel Index. RESULTS: 204 IPF patients were included: 22 (10.8%) experienced ≥ 1 acute exacerbation, and 182 (89.2%) did not. Patients with exacerbations required more primary care visits, nursing home visits, emergency visits, hospital admissions, pharmacological treatments and transport use (p < 0.05 for all comparisons). Likewise, patients with exacerbations showed higher annual direct health AE-IPF-related costs. In particular, specialized visits, emergency visits, days of hospitalization, tests, palliative care, transport in ambulance and economic aid (p < 0.05 for all comparisons). Exploratory results showed that patients with AE-IPF reported a non-significant but substantial decline of HRQoL compared with patients without AE-IPF, although causality can be inferred. CONCLUSION: We observed significantly higher resource use and cost consumption and lower HRQoL among patients suffering exacerbations during the study. Thus, preventing or avoiding AE-IPF is key in IPF management.

Feed supplementation with Ligilactobacillus salivarius PS21603 optimises intestinal morphology and gut microbiota composition in weaned piglets.

Post-weaning diarrhoea in piglets remains an important cause of economic losses for swine producers. Feed supplementation with probiotics is one of the alternatives to antibiotics used to reduce the impact of such gastrointestinal disease. The aim of the present study was to evaluate the effect of Ligilactobacillus salivarius PS21603 supplementation on the intestinal structure and the gut microbiota composition of weaned piglets. Safety and tolerance of L. salivarius PS21603 were previously evaluated in a 28-days study using 384 weaned piglets (28 ± 2 days old and 7.5 ± 1.5 kg) divided in three treatment groups: T1: Basal diet + L. salivarius PS21603 109 cfu/day, T2: Basal diet + L. salivarius PS21603 107 cfu/day, and T3: Basal diet (control group). For the present study, 16 piglets per treatment group were randomly selected and faecal samples were collected on day 0 (weaning) and 28 of study. At the end of study, three males and three females per treatment were euthanised. Intestinal morphometric values were measured after necropsy. Faecal counts of Escherichia coli were evaluated by culture techniques, and faecal microbiota composition was assessed by high-throughput sequencing. All data were analysed and compared between treatment groups. Supplementation with L. salivarius PS21603 caused an increase in the intestine length of piglets from T1 and in the villous height:crypt ratio of piglets from T2 (P < 0.05) compared to T3 on day 28. According to the Shannon Diversity Index, microbiota diversity increased on day 28 compared to day 0, with no significant differences observed between treatments. The main changes in the relative abundance of bacteria at the phylum, family, and genus levels were observed between different sampling time points. However, piglets from T1 and T2 had lower faecal E. coli counts than T3 on day 28 (P < 0.05). Moreover, supplementation with L. salivarius PS21603 modulated gut microbiota through a more optimal composition, reducing Escherichia and increasing Bifidobacterium relative abundance in piglets from T1 (P < 0.05) from the beginning to the end of the study. Therefore, the strain L. salivarius PS21603 has shown probiotic properties to be used as feed additive in the pig industry, along with good hygiene and farm management practices, for the prevention and/or treatment of post-weaning diarrhoea in piglets.

Assessment of the effects of prepartum anti-inflammatory therapies on type 1/type 2 immunity ratio using a rapid blood test.

The objective of this study was to assess (1) the effects of prepartum administration of anti-inflammatory therapies on type 1/type 2 immunity ratio using a rapid blood test (D2Dx immunity test; Nano Discovery Inc.), and (2) correlations between rapid blood test scores and daily milk yield in Holstein dairy cows. At 14 d before the expected calving date, cows (n = 64) and heifers (n = 23) were blocked by body condition score (optimal = 3.25-3.5; high ≥3.75) and parity (nulliparous, parous), and randomly allocated to one of 3 treatment groups (1) ASA (n = 29) = receive one oral treatment with administration of acetylsalicylic acid (4 boluses; 480 grain/bolus); (2) MEL (n = 31) = receive one oral administration with meloxicam (1 mg/kg of body weight), or (3) PLC (n = 27) = receive one oral treatment with 4 gelatin capsules filled with water. Blood samples were collected weekly starting 1 wk before treatment until 3 wk after calving for assessment of type 1/type 2 immunity ratio using a rapid blood test (i.e., D2Dx immunity test). A higher D2Dx score corresponds to a higher type 1/type 2 ratio. Furthermore, blood samples were collected within 72 h before and after calving by farm personnel. Daily milk yield for the first 60 d in milk (DIM) was collected from on-farm computer records. The data were analyzed using MIXED procedure of SAS (SAS Institute Inc.) as a randomized complete block design. On average enrolled cows received treatment administration 10 d before the actual calving date (standard deviation = 5.10 d). There was a tendency for a treatment by day interaction. Cows treated with ASA had higher type 1/type 2 ratio within 3 d after calving compared with MEL and PLC cows (ASA = 0.065 ± 0.002; MEL = 0.059 ± 0.002; PLC = 0.053 ± 0.002). Similarly, ASA and MEL cows had a higher type 1/type 2 ratio at 7 ± 3 DIM compared with PLC cows (ASA = 0.062 ± 0.002; MEL = 0.064 ± 0.002; PLC = 0.056 ± 0.002). Regardless of treatment, there was an interaction between parity and day. Parous cows had higher type 1/type 2 ratios compared with nulliparous cows at 14 ± 3 d before calving and at 7 ± 3, 14 ± 3, and 21 ± 3 d after calving. Furthermore, there was a positive correlation between D2Dx scores at 14 ± 3 DIM and average daily milk yield in the first 60 DIM. These results suggest that prepartum anti-inflammatory therapies may cause an increased shift in type 1 immunity around calving. Similarly, parous cows may have an increased shift in type 1 immunity after calving. Interestingly, higher type 1/type 2 ratios may be associated with higher milk yields in the first 60 DIM. Larger studies are needed to identify associations between the D2Dx immunity test and cow health and performance, as well as to assess the applicability of these types of tests in a conventional farm setting.

Exploring vaginal discharge scoring to assess clinical metritis severity: Comparison between intrauterine dextrose and systemic antibiotics treatments.

The objectives of this study were to assess: 1) differences in the metabolic status, systemic inflammation, daily milk yield, and daily rumination time between Holstein dairy cows with different vaginal discharge scores (VDS) in the first 7±3 DIM, and 2) effects of intrauterine dextrose infusion on metabolic status, systemic inflammation, daily milk yield and daily rumination time in dairy cows with VDS4 and VDS5. Cows (n=641) from a farm located in central Pennsylvania were screened at 7±3 DIM (study d 0) to assess vaginal discharge scores. Vaginal discharge was scored using a five-point scale (i.e., 1- clear fluid, 2- <50% white purulent fluid, 3- >50% white purulent fluid, 4- red-brownish fluid without fetid smell, and 5- fetid red-brownish watery fluid). Cows with VDS4 and VDS5 were blocked by parity and randomly assigned to one of two treatment groups: 1) CONV (VDS4 n=15; VDS5 n= 23): two injections of ceftiofur (per label; 6.6 mg/Kg) 72 h apart; and 2) DEX (VDS4 n=15; VDS5 n=22): three intrauterine infusions of a 50% dextrose solution (1 L/cow) every 24 h. Cows that presented a VDS 1, 2, and 3 were categorized as normal vaginal discharge animals (NOMVDS; n=35) and were randomly selected and matched by parity to CONV and DEX cows. Daily milk yield and rumination time for the first 150 DIM were collected from on-farm computer records. Blood samples were collected to assess haptoglobin (HP) and ß-hydroxybutyrate (BHB) concentrations at study d 0, d 7, and d 14 relative to enrollment. Subclinical ketosis was defined as having a BHB concentration >1.2 mmol/dL at any of the sampling points. The data were analyzed using the MIXED and GLIMMIX procedures of SAS as a randomized complete block design. When comparing cows with different VDS (i.e., NOMVDS, VDS4, VDS5) separately, cows with VDS5 had the highest concentration of HP at enrollment compared to cows with VDS4 and NOMVDS; however, cows with VDS4 had higher concentrations of HP compared to cows with NOMVDS. Cows with VDS4 or VDS5 had a higher incidence of subclinical ketosis compared to cows with NOMVDS (p=0.005; VDS4= 62.08±9.16%; VDS5=74.44±6.74%; NOMVDS=34.36±8.53%). Similarly, daily milk yield (p<.0001; VDS4=30.17±1.32 kg/d; VDS5=27.40±1.27 kg/d; NOMVDS=35.14±1.35 kg/d) and daily rumination time (p=0.001; VDS4=490.77±19.44 min; VDS5=465±16.67 min; NOMVDS=558.29±18.80 min) was lower for cows with VDS4 and VDS5 compared to cows with NOMVDS at 7±3 days in milk. When analyzing HP concentration between treatment groups in cows with VDS4 (p=0.70), VDS5 (p=0.25), or VDS4 and VDS5 combined (p=0.31), there was no difference in HP concentration by study d 14 between treatment groups. Interestingly, when only cows with VDS4 were considered for treatment, both treatments, DEX and CONV, increased the daily milk yield to the levels of NOMVDS cows by 14 days in milk. On the other hand, when only cows with VDS5 were considered for treatment, cows treated with DEX produced, on average, 4.48 kg/d less milk in the first 150 days in milk compared to cows treated with CONV or cows that had NOMVDS. Similarly, when cows with either VDS4 or VDS5 were considered for treatment, DEX treatment also impaired milk yield. These results suggest that cows with either VDS 4 or 5 have an altered inflammatory status, and decreased milk yield and rumination compared to cows with NOMVDS. Furthermore, DEX treatment may have similar effects on daily milk yield and metabolic status compared to CONV in cows with VDS4, while DEX is not recommended for cows with VDS5.

Immune-mediated hepatitis: Basic concepts and treatment.

Immunotherapy with immune checkpoint inhibitors (ICIs) has revolutionized advanced cancer management. Nevertheless, the generalized use of these medications has led to an increase in the incidence of adverse immune-mediated events and the liver is one of the most frequently affected organs. Liver involvement associated with the administration of immunotherapy is known as immune-mediated hepatitis (IMH), whose incidence and clinical characteristics have been described by different authors. It often presents as mild elevations of amino transferase levels, seen in routine blood tests, that spontaneously return to normal, but it can also manifest as severe transaminitis, possibly leading to the permanent discontinuation of treatment. The aim of the following review was to describe the most up-to-date concepts regarding the epidemiology, diagnosis, risk factors, and progression of IMH, as well as its incidence in different types of common cancers, including hepatocellular carcinoma. Treatment recommendations according to the most current guidelines are also provided.

Ligilactobacillus salivarius V4II-90 eradicates Group B Streptococcus colonisation during pregnancy: a randomised, double-blind, placebo-controlled trial.

Group B Streptococcus (GBS) is the leading cause of bacterial neonatal sepsis. This study aimed to confirm the effect of Ligilactobacillus salivarius V4II-90 on GBS colonisation during pregnancy. A randomised, multicentre, double-blind, placebo-controlled, parallel-group study was conducted in seven hospitals in Madrid, Spain. The sample was broken down into two groups with 20 participants each (n = 40) in order to show reduced GBS colonisation frequency in the probiotic versus the placebo group. Pregnant participants positive for vaginal-rectal colonisation before or during the 13th week of gestation were randomly assigned to either the placebo or the probiotic group. The probiotic, L. salivarius V4II-90 at 1 × 109 cfu/day was administered for 12 weeks, starting at week 21-23 of gestation. The primary outcome was the percentage of participants with vaginal and/or rectal GBS colonisation at the end of the intervention period (35 weeks of gestation). Secondary outcomes were changes in the microbial composition of vaginal and rectal exudates; premature delivery; premature rupture of membranes; intrapartum antibiotics; new-borns with early or late-onset GBS sepsis; adverse events (AEs); and GBS test results performed at the hospital at week 35 of gestation. Of the 481 participants included, 44 were vaginal-rectal colonised with GBS and randomised. 43 completed the study (20 in the probiotic group and 23 in the placebo group). After intervention, GBS was eradicated in six participants (27%) from the placebo group and in twelve participants (63%) from the probiotic group ( P = 0.030). None of the 185 AEs reported were identified as possibly, probably, or definitely related to the investigational product. In conclusion, oral administration of L. salivarius V4II-90 is a safe and successful strategy to significantly decrease the rates of GBS colonisation at the end of pregnancy and, therefore, to reduce the exposure of subjects and their infants to intrapartum antibiotic prophylaxis. Trial registered at ClinicalTrials.gov: number NCT03669094.

Memory and language risk assessment with Wada test in patients candidates for epilepsy surgery. / Evaluación de la memoria y el lenguaje mediante el test de Wada en pacientes candidatos a cirugía de epilepsia.

AIM: To determine post-surgical cognitive risk and associated factors according to lesion location in a sample of patients evaluated for epilepsy surgery with Wada test at the Fundacion Instituto Neurologico de Colombia. MATERIALS AND METHODS: An observational, retrospective, analytical study was completed in patients with drug-resistant temporal lobe epilepsy candidates for epilepsy surgery treated from 2001 to 2021, who completed the Wada test as part of the pre-surgical evaluation. A descriptive analysis of sociodemographic, clinical, imaging and neuropsychological variables was completed; a multivariate logistic regression was performed analyzing factors associated with resection risk in patients with left lesions. RESULTS A total of 369 patients were included, 54.74% of the cases were women, with a median age of seizure onset of 11 years. 92.66% of the cases had lesional epilepsy and 68.56% were secondary to hippocampal sclerosis. Left hemisphere was the most frequently affected (65.68%) being dominant for memory and language in most of the patients with a proportion of 42.82% and 81.3%, respectively. The median functional adequacy was 43.75 (IQR 0-75) and the functional reserve was 75 (IQR 25 -93.75). In 104 patients, the Wada test determined a resection risk. In patients with a left lesion, it was found that functional reserve (PRadjusted 0.99, CI 95% 0.9997-0.9998) and having a right hemispheric dominance for memory (PRadjusted 0.92, CI 95% 0.547-0.999) were protective factors for post-surgical resection risk. CONCLUSION: Wada test is a useful tool for surgical decision-making in patients with drug-resistant temporal lobe epilepsy. When considering cognitive risk, components such as memory dominance and functional reserve should be considered as protective factors for postsurgical cognitive function preservation in patients with left lesions.

TITLE: Evaluación de la memoria y el lenguaje mediante el test de Wada en pacientes candidatos a cirugía de epilepsia.Objetivo. Determinar el riesgo cognitivo posquirúrgico y factores asociados según la localización de la lesión en una muestra de pacientes evaluados para cirugía de epilepsia con el test de Wada en la Fundación Instituto Neurológico de Colombia. Materiales y métodos. Se realizó un estudio observacional, retrospectivo y analítico en pacientes con epilepsia farmacorresistente del lóbulo temporal candidatos a cirugía de epilepsia tratados entre 2001 y 2021, que completaron el test de Wada como parte de la evaluación prequirúrgica. Se realizó un análisis descriptivo de variables sociodemográficas, clínicas, imagenológicas y neuropsicológicas. Se realizó una regresión logística multivariada analizando factores asociados al riesgo de resección en pacientes con lesiones izquierdas. Resultados. Se incluyó a 369 pacientes, el 54,74% de los casos fueron mujeres, con una mediana de edad de inicio de las convulsiones de 11 años. El 92,66% de los casos presentó epilepsia lesional; de éstos, el 68,56% fue secundario a esclerosis hipocampal. El hemisferio izquierdo fue el más frecuentemente afectado (65,68%), y éste fue dominante para la memoria y el lenguaje en la mayoría de los pacientes, con una proporción del 42,82 y el 81,3%, respectivamente. La mediana de adecuación funcional fue de 43,75 (rango intercuartílico: 0-75) y la reserva funcional de 75 (rango intercuartílico: 25-93,75). En 104 pacientes, el test de Wada determinó un riesgo de resección. En pacientes con lesiones izquierdas se encontró que la reserva funcional (razón de prevalencia ajustada: 0,99; intervalo de confianza al 95%: 0,9997-0,9998) y tener dominancia del hemisferio derecho para la memoria (razón de prevalencia ajustada: 0,92; intervalo de confianza al 95%: 0,547-0,999) fueron factores asociados para determinar el riesgo de resección posquirúrgico en el test de Wada. Conclusión. El test de Wada es una herramienta útil para la toma de decisiones quirúrgicas en pacientes con epilepsia del lóbulo temporal farmacorresistente. Componentes como la dominancia de la memoria y la reserva funcional en el test de Wada deben considerarse como factores que se deben tener en cuenta en la predicción de la preservación de la función cognitiva posquirúrgica en pacientes con lesiones izquierdas.

Position paper on perioperative management and surgical risk in the patient with cirrhosis.

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Uso de sustancias psicoactivas como tratamiento de la psicosis / Use of psychoactive substances as a treatment for psychosis

Introducción: Los trastornos psicóticos se consideran problemas crónicos de salud mental. Aunque se ha demostrado que estos trastornos pueden presentarse con sintomatologías muy heterogéneas, el tratamiento farmacológico se basa en el uso de antipsicóticos típicos y atípicos, cuyo mecanismo de acción principal es el bloqueo dopaminérgico, limitando su efecto a la mejora de los síntomas positivos, sin mejorar el resto de la sintomatología y presentando una gran cantidad de efectos adversos graves. Por este motivo se están estudiando nuevas dianas terapéuticas distintas al sistema dopaminérgico. El objetivo principal de esta revisión es comprobar si estas sustancias psicoactivas utilizadas en la práctica clínica podrían aportar beneficios adicionales como tratamiento complementario para personas con trastornos psicóticos. Desarrollo: Para esta revisión sistemática se realizó una búsqueda bibliográfica en las bases de datos PsycINFO, Medline, Psicodoc, PubMed y Google Scholar. Se incluyeron 28 artículos en la revisión. Entre los principales resultados encontramos que el cannabidiol es más efectivo para mejorar los síntomas positivos y la psicopatología; el modafinilo, para los síntomas cognitivos, el funcionamiento motor y emocional y la calidad de vida; y la ketamina, para los síntomas negativos. Además, todas las sustancias presentaron un buen perfil de tolerabilidad y seguridad, especialmente en comparación con los antipsicóticos. Conclusión: Con los resultados obtenidos, se abre la posibilidad de tener una guía de actuación para los clínicos/profesionales de la salud sobre el uso del cannabidiol, el modafinilo y la ketamina como tratamiento adyuvante para pacientes con cuadros psicóticos.(AU)

Introduction: Psychotic disorders are considered chronic mental health issues. Although it has been demonstrated that these disorders can present with a wide range of symptoms, pharmacological treatment is based on the use of typical and atypical antipsychotics, whose main mechanism of action is dopaminergic blockade, limiting their effect to the improvement of positive symptoms, without improving the rest of the symptoms and giving rise to a large number of serious adverse effects. For this reason, new therapeutic targets other than the dopaminergic system are being studied. The main objective of this review is to test whether these psychoactive substances used in clinical practice could provide additional benefits as an adjunctive treatment for people with psychotic disorders. Development: For this systematic review, a literature search was conducted in the databases PsycINFO, Medline, Psicodoc, PubMed and Google Scholar. Altogether 28 articles were included in the review. One of the main findings is that cannabidiol is more effective for improving positive symptoms and psychopathology; modafinil, for cognitive symptoms, motor and emotional functioning and quality of life; and ketamine, for negative symptoms. In addition, all the substances showed a good tolerability and safety profile, especially in comparison to antipsychotics. Conclusion: The results obtained open up the possibility of having a guideline for clinicians/health professionals on the use of cannabidiol, modafinil and ketamine as adjunctive treatment for patients with psychotic conditions.(AU)

Alta prevalencia de covid19 asintomático en hemodiálisis. Aprendiendo dia a dia el primer mes de pandemia de covid19 / High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic

Los pacientes en diálisis son un grupo de riesgo de sufrir la infección por el SARS-CoV2 y posiblemente de tener más complicaciones, pero la información con la que contamos es escasa. El objetivo de este trabajo es describir la experiencia del primer mes de pandemia por SARS-Cov2 en una unidad hospitalaria de hemodiálisis (HD) que atiende al 2º distrito madrileño con más en incidencia de COVID19 (casi 1000 pacientes en 100000 h). Se presenta mediante un diario las acciones llevadas a cabo, la incidencia de COVID19 en pacientes y en el personal sanitario, algunas características clínicas y el resultado de un cribado entre todos los pacientes de la unidad. Al inicio, teníamos 90 pacientes en HD: 37(41,1%) han tenido COVID19, de los que 17 (45,9%) fueron diagnosticado spor síntomas detectados en el triaje o durante la sesión y 15 (40,5%) en un cribado realizado a posteriori en los que no se había hecho test diagnóstico por PCR-SARS-Cov2 hasta ese momento. El síntoma más frecuente fue la fiebre, el 50% presentó linfopenia y el 18,4% saturación de O2 < 95%. Precisaron ingreso hospitalario 16 (43,2%) y 6 fallecieron (16,2%). Encontramos un agrupamiento de contagio por turnos y también en aquellos que usaban transporte colectivo. En cuanto al personal, de las 44 personas involucradas, 15 (34%) presentaron sintomatología compatible y 4 (9%) tuvieron PCR SARS-Cov-2 positiva determinada por Salud Laboral y 9 (20%) precisaron algún periodo de Incapacidad Laboral Transitoria (ILT), y 5 fueron considerados casos probables

Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% < 95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health,9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID19 with a high percentage detected byscreening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19

Catéter de drenaje de líquido cefalorraquídeo: usos, técnica y complicaciones para el anestesiólogo / Spinal fluid drainage catheter: uses, technique, and complications for the anesthesiologist

Spinal drainage catheter installation is a procedure indicated essentially in the repair of aortic aneurysms and the neurosurgery setting. It is not always a simple procedure where dilemmas arise about the indication, technique, and complications. The following article reviews each of these topics.

La instalación de un catéter de drenaje espinal es un procedimiento indicado principalmente en la reparación de aneurismas aórticos y en el escenario de neurocirugía. No siempre es un procedimiento fácil de realizar donde surgen dudas sobre indicación, técnica y eventuales complicaciones. En el siguiente artículo revisamos cada uno de estos temas.

Medicina Regenerativa para Úlceras Crónicas: Aplicación Cutánea de Células Troncales Mesenquimales de Gelatina de Wharton / Regenerative Medicine for Chronic Ulcers: Cutaneous Application of Mesenchymal Stem Cells of Wharton's Jelly

Resumen El empleo de células mesenquimales ha emergido como una parte importante en la medicina regenerativa con efectos positivos en la recuperación de tejidos dañados o perdidos. Las úlceras crónicas incluyen lesiones cutáneas que afectan a una gran parte de la población con diabetes mellitus, (por ejemplo 9.14% desarrollan lesiones por pie diabético según ENSANUT 2016) y representan gastos económicos considerables, debido a la pobre calidad de vida que llevan los pacientes. El tratamiento convencional que se lleva a cabo en estos casos es a largo plazo, y los efectos benéficos generados que se presentan son limitados, ya que las lesiones reinciden por no contar con un tratamiento específico y regenerativo, solo paliativo. Es por ello que en este trabajo se obtuvieron y emplearon células troncales mesenquimales derivadas de gelatina de Wharton (CTM-GW) bajo los criterios propuestos por la Sociedad Internacional de la Terapia Celular. El tratamiento fue aplicado en dos pacientes con úlceras crónicas flebostáticas de diferentes condiciones médicas y se monitoreo a corto plazo, por lo que fue un estudio limitado. Los resultados mostraron que las CTM-GW indujeron la reconstrucción cutánea mediante formación de tejido de granulación, además de disminuir el proceso inflamatorio crónico en la zona de daño, lo que favoreció el índice de cierre de la herida. Por lo anterior, se propone la utilización de CTM-GW en úlceras flebostáticas crónicas como tratamiento en la regeneración de la estructura tisular con resultados a corto plazo.

Abstract Use of mesenchymal cells has emerged as an important part in regenerative medicine with positive effects in the recovery of damaged or lost tissues. Chronic ulcers include skin lesions that affect a large part of the population with diabetes mellitus, (for example, 9.14 develop diabetic foot according to ENSANUT 2016) and represent considerable economic expenses, due to poor quality of life in patients. The conventional treatment that is carried out in these cases is long term, and the generated beneficial effects that are presented are limited, since the injuries recur due to not having a specific and regenerative treatment, only palliative. That is why in this work they were obtained and used mesenchymal stem cells derived from Wharton's jelly (MSC-WJ) under the criteria proposed by the International Society for Cell Therapy. The treatment was applied in two patients with chronic ulcers phlebostatic of different medical conditions and short-term monitoring, so it was a limited study. The results showed that MSC-WJ induced skin reconstruction by tissue formation granulation, in addition to decreasing the chronic inflammatory process in the area of damage, which favored the index of wound healing. Therefore, the use of MSC-WJ in chronic phlebostatic ulcers is proposed as a treatment in the regeneration of the tissue structure with short-term results.

Follicular and luteal morphometry, progesterone concentration and early gestation in Holstein cows (Bos Taurus) at high altitude in the tropics (Colombia) / Morfometría folicular y luteal, concentración de progesterona y éxito de la gestación en vacas Holstein (Bos Taurus) en el trópico alto (Colombia)

Abstract Objectives. The aim of this study is to evaluate the relationship among ovulatory follicle (OF) size, corpus luteum (CL) volume, and progesterone (P4) serum levels with pregnancy success. Materials and methods. Nineteen Holstein cows located in Bogotá, Colombia with a history of 2 to 6 previous calving were used in the study. Following 40 day postpartum, two consecutive phases were evaluated as follows: 1) estrous cycle; 2) early pregnancy or return to estrus after Artificial Insemination (AI). Ultrasound exam was performed twice daily after first sign of estrus to evaluate OF diameter and CL volume, and serum P4 levels were evaluated on days 6, 9, 12 and 15 after ovulation. Cows were inseminated 12 hours post estrus signs and pregnancy was diagnosed 30 days post AI. Results. 47.36% of the cows were diagnosed as pregnant after AI. Pregnant cows had smaller OF diameters (17.85±2.39 mm) than non-pregnant females (21.10±2.86 mm) (p<0.05). Cows with smaller OF were more likely to become pregnant (OR=0.624, IC=95% (0.4-0.9) (p<0.05). There were non significant differences in the CL volume (p=0.10) and P4 serum values (p=0.39) between pregnant and no pregnant cows on days 6, 9, 12 and 15 post ovulation. Serum P4 levels were not correlated to CL size and reproductive status. Conclusions. This study shows that there was not significant difference in serum P4 levels and the CL volume when comparing pregnant with non-pregnant cows. A relationship was found between the OF diameter and the CL volume. Small OF diameter was a factor associated with early pregnancy.

Resumen Objetivo. Evaluar la relación entre el diámetro del folículo ovulatorio (FO), el volumen del cuerpo lúteo (CL), los niveles séricos de progesterona (P4) con el éxito de la gestación. Materiales y métodos. En 19 vacas Holstein que habían tenido 2 a 6 partos ubicadas en Bogotá, se evaluaron dos fases consecutivas a partir del día 40 postparto, la primera correspondió al ciclo estral y la segunda correspondió a la gestación temprana o repetición de celo. En cada fase se detectó el celo, se realizó ultrasonografía para evaluar el diámetro del FO, confirmar ovulación, y el volumen del CL los días 6, 9, 12 y 15; en estos días también se evaluó los niveles séricos de P4. En la segunda fase se realizó inseminación artificial (IA) y se diagnosticó la gestación 30 días post-IA. Resultados. El 47.36% de las vacas se diagnosticaron como gestantes y el 52.63% como no gestantes. Las gestantes presentaron diámetros de FO menores 17.85±2.39 mm al de las no gestantes (21.10±2.86 mm; p<0.05). Las vacas que presentaron diámetros de FO más pequeños tuvieron mayor posibilidad de quedar gestantes (OR=0.624, IC=95% (0.4-0.9) (p<0.05). Los animales gestantes y no gestantes presentaron similares volúmenes de CL (p=0.10) y niveles séricos de P4 (p=0.39) los días 6, 9, 12 y 15. Conclusiones. No hubo diferencias en los niveles séricos de p4 y el volúmen del CL. Vacas con FO de menor diámetro tuvieron mayor probabilidad de gestación. Otras variables como CL y niveles de P4 no fueron predictivos del éxito de la gestación.

Estudio poblacional de casuística y morbimortalidad de la prostatectomía radical en España / Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain

Introducción: No existe ningún estudio poblacional que contabilice en número de prostatectomías radicales (PR) realizadas España, ni la morbimortalidad de dicha intervención.Nuestro objetivo es estudiar la morbimortalidad de la PR en España desde el 2011 al 2015 y evaluar la variabilidad geográfica. Material y métodos: Diseñamos un estudio observacional retrospectivo de todos los pacientes intervenidos de PR en España durante cinco años consecutivos (2011-2015) a partir de los datos registrados en el Conjunto Mínimo Básico de Datos (CMBD).Hemos estudiado la distribución del número de casos y la variabilidad intercomunitaria en términos de morbilidad y de estancia hospitalaria, así como el impacto del volumen quirúrgico medio anual por cada centro en dichas variables. Resultados: Entre los años 2011-2015 se han realizado un total de 37.725 PR en 221 hospitales españoles públicos del sistema nacional de salud. La edad media de la serie fue 63,9 ± 3,23 años. El 50% de las PR se han realizado por vía abierta, y un 43,4% se han intervenido en hospitales de < 500 camas. Encontramos una gran variabilidad en la distribución de los casos intervenidos en las distintas Comunidades Autónomas (CCAA Las comunidades que realizan un mayor número de prostatectomías son Andalucía, Cataluña, Galicia y Madrid. La tasa de complicaciones a nivel nacional es de 8,6%, siendo las más frecuentes la hemorragia y necesidad de transfusión (5,3 y 4%, respectivamente). Encontramos importantes diferencias en las tasas de hemorragia y en la estancia hospitalaria entre las distintas CCAA, que se mantienen tras ajustar por las características del paciente y del tipo de hospital. Al estudiar el volumen quirúrgico anual de cada hospital vemos que el impacto en la tasa de hemorragia o transfusión es lineal sin embargo en la estancia a partir de 60 PR/año la estancia se mantiene estable en torno a cinco días. (AU)

Introduction: There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention.Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. Material and methods: We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD).We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. Results: Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9 ± 3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with < 500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year (AU)

Análisis del consumo simultáneo de medicamentos y plantas medicinales en población española mayor de 65 años / Appropriate or inappropriate use of simultaneous consumption of drugs and preparations of medicinal plants that makes the 65-year-old population in Spain

Objetivos: Analizar el uso apropiado o inapropiado de la utilización conjunta de medicamentos y preparados de plantas medicinales que realiza la población mayor de 65 años en la provincia de Guadalajara (España). Materiales y métodos: Estudio observacional, descriptivo, de corte transversal, realizado en Guadalajara (España) capital y provincia. La recogida de datos de los pacientes se efectuó durante los años 2012 y 2013. Siendo, por tanto, las variables dependientes usadas el porcentaje de consumo de Preparados de plantas medicinales y el porcentaje de consumo de medicamentos. La población diana fueron pacientes polimedicados mayores de 65 años, varones o mujeres, que residieran en sus casas o en Residencias de Ancianos y que voluntariamente decidieron participar en este trabajo. Resultados: Se incluyeron 384 pacientes, 129 fueron varones (33,60%). Consumieron plantas medicinales el 88,30%. Consumieron PCPM 183 (47,6%) y PIPM 339 que representó el 88,3%. Con consumo total de 852 infusiones al día, un promedio de 2,21 infusiones diarias. Se encontraron 22 asociaciones potencialmente peligrosas y 10 potencialmente beneficiosas. Conclusiones: Se ha puesto de manifiesto que ciertas asociaciones de planta-medicamento, pueden contribuir a mejorar la situación del paciente, pero también ha evidenciado la necesidad de una atención farmacéutica en el consumo de preparados de plantas medicinales en relación con la farmacoterapia que tiene prescrita, a fin de evitar combinaciones que pudieran reducir la eficacia de los tratamientos o incrementar el riesgo de otras alteraciones

Objective: To analyze the appropriate or inappropriate simultaneous use of drugs and preparations of medicinal plants that makes the population over 65 years old in the province of Guadalajara (Spain). Methodology: It was done an observational, descriptive, cross-sectional study, held in Guadalajara (Spain) both, capital and province. Patients’ data collection was carried out during the years 2012 and 2013. The dependent variables used were the percentage of medicinal plants preparations consumed and the percentage of medicines’ consumption. The target population was poly-medicated patients over 65 years old, men or women, that lived in their own homes or in residences for the elderly and decided to participate in this work voluntarily. Results: 384 patients were included, 129 were males (33.60%). 88.30% of them consumed medicinal plants. 183 consumed PCPM (47.6%) and 339, PIPM that represented 88.3%. There was a total consumption of 852 infusions per day, an average of 2.21 daily infusions. There were found 22 potentially dangerous associations and 10 potentially beneficial. Conclusions: There were identified potentially harmful associations and other beneficial drug-medicinal plant associations. It was concluded that pharmaceutical care is necessary for patients that take medicines and medicinal plants simultaneously in order to avoid combinations that could reduce treatments effectiveness or increase the risk of having other alterations

Ecotoxicidad aguda en Physa cubensis P. y Artemia salina L. de 8 antibacterianos con riesgo ambiental / Acute toxicity in Physa cubensis P. and Artemia salina L. of 8 antibiotics with environmental risk

Los productos farmacéuticos son ampliamente utilizados en todo el planeta. Existe una creciente preocupación por los efectos que los medicamentos consumidos y los desechos de estos producen en el ambiente. A pesar del gran uso de los antibacterianos no son muy investigados como contaminantes, prestándose mayor atención a la antibioresistencia por lo que el objetivo de la investigación fue evaluar la ecotoxicidad aguda de antibacterianos. Teniendo en cuenta el consumo de los antibacterianos y la predicción de sus concentraciones ambientales así como su ecoxicidad en Lactuca sativa L ya previamente determinados en anteriores investigaciones se determinó el riesgo ecotoxicológico en Artemia salina L. y Physa cubensis P. En el ensayo de Artemia salina la Ceftazidima se clasifica como muy tóxico con valor de CL50 de 0,060773 g/L, la Cefepima con valor de 0,993731 g/L como moderadamente tóxica y el resto de los antibacterianos evaluados se clasifican como no tóxicos. En los bioensayos en Physa cubensis Cefepima y Cefazolina ocasionaron la mayor mortalidad con CL50 de 0,000270 y 0,025684 g/L respectivamente y los que indujeron menor mortalidad fueron Vancomicina y Amoxicilina/Sulbactam con CL50 de 1,528440 y 1,055492 g/L. El vertimiento de residuos de antibacterianos puede ser causa de contaminación ambiental perjudicial para algunas especies (AU)

Pharmaceuticals are widely used all over the planet. There is growing concern about the effects that drugs and its residues produce in the environment. Despite the wide use of antibacterial, they are not very investigated as pollutants, paying greater attention to the antibiotic resistance, so the objective of this research was to evaluate the antibacterial acute ecotoxicity. Taking into account the antibacterial consumption and the prediction of their environmental concentrations as well as their ecotoxicity in Lactuca sativa L already determined in previous research, the ecotoxicological risk was determined in Artemia salina L. and Physa cubensis P. In the Artemia salina trial Ceftazidime is classified as very toxic with LC50 value of 0.060773g/L, Cefepime with value of 0.993731g/L is classified as moderately toxic and the rest of antibacterial evaluated are classified as non-toxic. In bio trials of Physa cubensis, Cefepime and Cefazolin caused the greatest mortality with LC50 0.000270 and 0.025684g/L respectively, and the ones that led lower mortality were Vancomycin and Amoxicillin/Sulbactam with LC50 of 1.528440 and 1.055492 g/L. The dumping of antibiotics residues can be the cause of environmental pollution, detrimental to some species (AU)

Sobrediagnóstico de enfermedad pulmonar obstructiva crónica en atención primaria. Prevalencia y condicionantes / Over-diagnosis of chronic obstructive pulmonary disease in Primary Care. Prevalence and determining factors

Introducción. El infradiagnóstico de la enfermedad pulmonar obstructiva crónica (EPOC) debido a un escaso uso de la espirometría en atención primaria es un hecho bien conocido, pero hay menos información sobre el fenómeno del sobrediagnóstico: pacientes con diagnóstico clínico de EPOC que realmente no tienen la enfermedad. Objetivo. Principal: estimar la prevalencia del sobrediagnóstico de EPOC en el ámbito de atención primaria. Secundarios: esclarecer factores asociados al fenómeno del sobrediagnóstico y aclarar si el perfil de tratamientos prescritos difiere en pacientes con diagnóstico incorrecto. Método. Estudio observacional, prospectivo y transversal. Se realizó espirometría a 206 sujetos con diagnóstico clínico de EPOC y tratados con fármacos inhalados a los que no se les había realizado nunca esta prueba, y se compararon las características y los tratamientos de los pacientes con diagnóstico correcto y erróneo. Resultados. La prevalencia del sobrediagnóstico en la población estudiada fue de 42,7%. Los principales factores asociados a un diagnóstico erróneo de EPOC fueron el sexo femenino (p<0,0001), la presencia de obesidad (p=0,009), la ausencia de hábito tabáquico (p<0,0001), una menor edad (p=0,001) y menor grado de disnea (p=0,001). Los anticolinérgicos de larga duración fueron prescritos más frecuentemente a pacientes con diagnóstico correcto. No hubo otras diferencias en tratamientos inhalados entre ambos grupos. Conclusiones. El sobrediagnóstico de EPOC en atención primaria es un hecho frecuente en pacientes con un diagnóstico clínico de la enfermedad. Existen características diferenciales entre sujetos correcta e incorrectamente diagnosticados. La espirometría es una herramienta esencial para reducir este fenómeno (AU)

Introduction. COPD under-diagnosis is common in Primary Health Care medicine, due to the low use of spirometry, but there is less information about over-diagnosis of the disease in patients that have a clinical diagnosis of COPD. Objective. The main objective of the study was to investigate the prevalence of COPD over-diagnosis in Primary Care medicine. Secondary objectives were to determine the factors associated with an incorrect clinical diagnosis of COPD and to analyse whether the pharmacological treatment is different for patients with correct or incorrect diagnosis. Method. A prospective, observational, cross-sectional study was conducted using the spirometry results of 206 patients with a clinical diagnosis of COPD, with no prior lung function testing, and who were treated with inhaled therapy. Characteristics and treatment of patients with a correct or incorrect COPD diagnosis were compared. Results. The prevalence of COPD over-diagnosis was 42.7% in the study population. Factors associated with an incorrect diagnosis were female sex (P<.0001), obesity (P=.009), absence of smoking history (P<.0001), lower age (P=.001), and less severe dyspnoea (P=.001). Long-acting muscarinic agents were more frequently prescribed to patients with a correct COPD diagnosis. There were no other differences regarding inhaled therapies between both groups. Conclusions. Over-diagnosis is a frequent phenomenon in patients with a clinical diagnosis of COPD managed in Primary Care medicine. There are different features between patients with a correct and incorrect diagnosis. Spirometry is an essential tool to reduce COPD over-diagnosis (AU)

Efecto del Medio Condicionado de la Línea Celular H9C2 Tratada con Dehidroepiandrosterona y Expuesta a Daño sobre la Motilidad de Células Troncales Mesenquimales / Effect of the Conditioned Medium from H9C2 Cell Line Treated with Dehydroepiandrosterone and Exposed to Damage on the Motility of Mesenchymal Stem Cells

RESUMEN: Las enfermedades cardiovasculares (ECV) son la principal causa de muerte a nivel mundial, donde la terapia con Células Troncales Mesenquimales (CTM) representa una alternativa para los pacientes que no logran recuperarse con los tratamientos actuales. El lograr que las CTM residentes se movilicen al órgano afectado representaría una ventaja para el manejo terapéutico de las ECV. La dehidroepiandrosterona (DHEA) es un precursor hormonal cuyos niveles disminuyen a lo largo de la vida, lo que se ha asociado al desarrollo de ECV. Diversos estudios han demostrado que el consumo de DHEA previene y mejora la condición cardiaca, aunque no se sabe si esto ocurre porque se ejerce un efecto en los cardiomiocitos y estos, a su vez, hacia las CTM. El objetivo del presente estudio fue determinar el efecto del medio condicionado procedente de la línea H9C2 pretratada con DHEA y sometida a daño, sobre la motilidad de CTM, llevando a cabo un ensayo de cierre de herida. El pretratamiento con DHEA y el daño en la línea H9C2, promueve la motilidad de CTM. El estímulo de la motilidad de CTM por un efecto indirecto de DHEA podría ser una estrategia terapéutica para el daño cardiaco.

ABSTRACT: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Mesenchymal Stem Cell (MSC) therapy is an alternative for patients who cannot recover with current treatments. Ensure movilization of MSC to the affected organs would represent an advantage for therapeutic management of CVD. Dehydroepiandrosterone (DHEA) is a hormone precursor whose levels decrease throughout life, which has been associated with the onset of CVD. Several studies have shown that DHEA consumption, prevents and improves heart condition, although it is not known if this is because an effect on cardiomyocytes is exercised on these cells and this, in turn, to CTM. The aim of this study was to determine the effect of conditioned medium from H9C2 cell line pretreated with DHEA and subjected to damage, on the motility of CTM, performing a wound healing assay. Pretreatment with DHEA and damage to H9C2 cell line, promotes motility of CTM. Stimulation of CTM motility by an indirect effect of DHEA could be a therapeutic strategy for heart damage.

Guías basadas en la evidencia para el uso de traqueostomía en el paciente crítico / Evidence-based guides in tracheostomy use in critical patients

OBJETIVOS: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. MÉTODOS: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network (LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTADOS: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B=3, 2C=3, 2D=4) y 9 negativas (1B=8, 2C=1). En 6 ocasiones no se pudieron establecer recomendaciones. CONCLUSIÓN: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used