Catalytic amyloids for nucleotide hydrolysis.

The design of small peptides that assemble into catalytically active intermolecular structures has proven to be a successful strategy towards developing minimalistic catalysts that exhibit some of the unique functional features of enzymes. Among these, catalytic amyloids have emerged as a fruitful source to unravel many different activities. These assemblies can potentially have broad applications that range from biotechnology to prebiotic chemistry. Although many peptides that assemble into catalytic amyloids have been developed in recent years, the elucidation of convergent mechanistic aspects of the catalysis and the structure/function relationship is still a challenge. Novel catalytic activities are necessary to better address these issues and expand the current repertoire of applicability. In this chapter, we described a methodology to produce catalytic amyloids that are specifically active towards the hydrolysis of phosphoanhydride bonds of nucleotides. The design of potentially active amyloid-prone peptide sequences is explored using as template the active site of enzymes with nucleotidyltransferase activity. The procedures include an approach for sequence design, in vitro aggregation assays, morphological characterization of the amyloid state and a comprehensive methodology to measure activity in vitro using nucleoside and deoxynucleosides triphosphates as model substrates. The proposed strategy can also be implemented to explore different types of activities for the design of future catalytic amyloids.

Giant squamous cell carcinoma developed on a mesh-related enterocutaneous fistula: A case report.

INTRODUCTION: Squamous cell carcinoma degeneration on enterocutaneous fistulas (EF) is infrequent. There are some reports of malignant conversion in Crohn's disease-associated fistulas. Literature about the malignant development of mesh-related EF is even more limited. PRESENTATION OF THE CASE: A 66-year-old patient who developed necrotizing pancreatitis was managed through an open necrosectomy approach with a prolonged open abdomen that derived an incisional hernia which was repaired using a synthetic mesh. Years later, the patient was admitted to the service because of hypovolemic shock due to gastrointestinal bleeding. An abdominal wound with mesh exposition and cloudy discharge was observed. A high-output enterocutaneous fistula diagnosis was established. After an institutional surgical committee, a surgical approach was defined, a 60 cm en-block resection of the involved small bowel was done, and the surgical specimen was obtained for histopathological analysis. DISCUSSION: The use of prosthetic mesh in the case of incisional hernias is associated with a higher incidence of complications. However, there is no evidence of the development of squamous cell carcinoma developed on a mesh-related enterocutaneous fistula. This is a condition associated with Chron's disease and its diagnosis should be suspected by the exacerbation of local signs and symptoms. The scarce literature published suggests that this pathology can be managed by radical surgery and even chemoradiation, the last one required only for patients with associated Chron's disease. CONCLUSION: Squamous Cell Carcinoma developed on a mesh-related enterocutaneous fistula is a rare condition with no classic signs and symptoms that allow diagnostic identification.

Differences in the evolution and management of acute appendicitis in patients with COVID-19: a case-control study.

BACKGROUND: The COVID-19 pandemic has generated uncertainty about the management of appendicitis. AIM: The aim of this study was to evaluate differences in the evolution and treatment of acute appendicitis in patients with COVID-19 infection compared to patients without the infection. METHODS: A case-control study of adult patients hospitalized for acute appendicitis was performed, having as cases those who presented COVID-19. Data were extracted from the medical records. The logistic regression model was used to calculate crude (cOR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals (95% CI). RESULTS: We evaluated 38 cases and 76 controls, the mean age of the patients was 38.2 years (± 16.8), of whom 55.3% were women. Multivariate analysis showed, in cases, a lower probability of intraoperative findings (aOR: 0.21; 95% CI: 0.05-0.90) and a surgery time of more than 60 min (aOR: 0.21; 95% CI: 0.06-0.80), while there was a greater probability of management by open surgery (aOR: 3.83; 95% CI: 1.42-10.32) and a hospitalization time of more than 3 days after surgery (aOR: 3.33; 95% CI: 1.34-8.26). CONCLUSION: Significant differences were observed in terms of intraoperative findings, type of surgery, intraoperative time, and hospitalization time in patients with acute appendicitis and COVID-19.

ANTECEDENTES: La pandemia de COVID-19 ha generado incertidumbre sobre el manejo de la apendicitis. OBJETIVO: Evaluar las diferencias en la evolución y el tratamiento de la apendicitis en pacientes con COVID-19 en comparación con los pacientes sin la infección. MÉTODOS: Se realizó un estudio de casos y controles de pacientes adultos hospitalizados por apendicitis aguda, teniendo como casos aquellos que presentaron COVID-19. Los datos se extrajeron de las historias clínicas. Se utilizó el modelo de regresión logística para calcular las odds ratios (OR) crudas y ajustadas con sus respectivos intervalos de confianza del 95% (IC 95%). RESULTADOS: Se evaluaron 38 casos y 76 controles, la edad media de los pacientes fue de 38.2 años (± 16.8), de los cuales el 55,3% eran mujeres. El análisis multivariante mostró, en los casos, una menor probabilidad de hallazgos intra operatorios (ORa: 0,21; IC 95%: 0.05-0.90) y un tiempo de cirugía superior a 60 min (ORa: 0.21; IC 95%: 0.06-0.80), mientras que hubo una mayor probabilidad de manejo mediante cirugía abierta (ORa: 3.83; IC 95%: 1.42-10.32) y un tiempo de hospitalización superior a tres días tras la cirugía (ORa: 3.33; IC 95%: 1.34-8.26). CONCLUSIONES: Se observaron diferencias significativas en cuanto a los hallazgos intraoperatorios, el tipo de cirugía, el tiempo intraoperatorio y el tiempo de hospitalización en pacientes con apendicitis aguda y COVID-19.

Electroantennographic Responses of Wild and Laboratory-Reared Females of Xyleborus affinis Eichhoff and Xyleborus ferrugineus (Fabricius) (Coleoptera: Curculionidae: Scolytinae) to Ethanol and Bark Volatiles of Three Host-Plant Species.

Chemical ecology studies on ambrosia beetles are typically conducted with either wild or laboratory-reared specimens. Unlike laboratory-reared insects, important aspects that potentially influence behavioral responses, such as age, physiological state, and prior experience are unknown in wild specimens. In this study, we compared the electroantennographic (EAG) responses of laboratory-reared and wild X. affinis and X. ferrugineus to 70% ethanol and bark odors (host kairomones) of Bursera simaruba, Mangifera indica, and Persea schiedeana aged for 2, 24, and 48 h. Chemical analyses of each odor treatment (bark species x length of aging) were performed to determine their volatilome composition. EAG responses were different between laboratory-reared and wild X. ferrugineus when exposed to ethanol, whereas wild X. affinis exhibited similar EAG responses to the laboratory-reared insects. Ethanol elicited the strongest olfactory responses in both species. Among the bark-odors, the highest responses were triggered by B. simaruba at 48 h in X. affinis, and P. schiedeana at 24 and 48 h in X. ferrugineus. Volatile profiles varied among aged bark samples; 3-carene and limonene were predominant in B. simaruba, whereas α-copaene and α-cubebene were abundant in P. schiedeana. Further studies are needed to determine the biological function of B. simaruba and P. schiedeana terpenes on X. affinis and X. ferrugineus, and their potential application for the development of effective lures.

Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis (with video).

BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) is used for refractory gastroparesis (RG) with good early-term but variable mid- and long-term outcomes. Limited data exist about candidates and long-term clinical and predictive factors. Our aim was to evaluate the 4-year follow-up efficacy and predictive factors in patients with RG. METHODS: Confirmed RG patients were included and evaluated between April 2017 and December 2021. Gastroparesis Cardinal Symptom Index (GCSI) score, retention percentage at 4 hours (RP4H), mean half-emptying time (MHET), and the 36-item short-form survey (SF-36) were performed at 1, 6, 12, 18, 24, 30, 36, 42, and 48 months. RESULTS: After G-POEM, 374 patients with RG were included: 141 patients (37.7%) had diabetic gastroparesis (DG), 115 (30.7%) had idiopathic gastroparesis (IG), 102 (27.3%) had postsurgical gastroparesis (PSG), and 16 (4.3%) had other etiologies. After the 48-month evaluation, 102 patients completed follow-up (DG, 58; IG, 22; PSG, 18; other, 4). Before G-POEM, GCSI score, RP4H, and MHET were 3.84 ± .53, 44% (interquartile range [IQR], 11-68), and 246 minutes (IQR, 150-368), respectively, and after the 48-month evaluation improved to 2.1 ± .70 (P < .001), 15.5% (IQR, 0-36; P = .021), and 135 minutes (IQR, 67-290; P = .045), respectively. At the 48-month evaluation, clinical success was 77.5%. DG showed the best outcomes (DG vs IG vs PSG vs other: 86.5% vs 72.5% [P = .001] vs 72.1% [P = .003] vs 68.8% [P < .001]). Long-term success predictors were DG (odds ratio [OR], 5.113; 95% confidence interval [CI], 1.643-5.981; P = .035), early diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P = .042), nausea/vomiting (OR, 3.541; 95% CI, 1.881-5.511; P = .012), GCSI score at 6 months (1.5-2) (OR, 3.612; 95% CI, 2.122-5.317; P = .022), and RP4H <10% at 6 months (OR, 2.188; 95% CI, 1.435-4.233; P = .039). CONCLUSIONS: G-POEM is an effective 4-year treatment in patients with RG, especially in DG, establishing a potential first-line therapy in these patients. However, randomized controlled clinical trials are needed to confirm these results. (Clinical trial registration number: NTC03126513.).

Solventless Preparation of Thoria and Its Inclusion into SiO2 and TiO2: A Luminescence and Photocatalysis Study.

Thoria was prepared using a solid-state method from the macromolecular precursor Chitosan·Th(NO3)4 (chitosan) and PS-co-4-PVP·Th(NO3)4 (PVP). The morphology and the average size of ThO2 depend of the chitosan and PS-co-4-PVP polymer forming the precursor. Their photoluminescent properties were investigated, finding a dependence of their intensity emission maxima, with the nature of the precursor polymer. The photocatalytic activity of ThO2 toward the degradation of methylene blue was measured for the first time, finding a degradation of about 66% in 300 min. The inclusion of ThO2 into SiO2 and TiO2 was achieved by the solid-state pyrolysis of the macromolecular composites Chitosan·Th(NO3)4//MO2 and PS-co-4-PVP·Th(NO3)4//MO2, MO2 = SiO2 or TiO2. The ThO2 exhibits a homogeneous dispersion inside the silica, showing sizes of about 40 and 50 nm for the chitosan and PVP polymer precursors, respectively. The luminescent properties of the ThO2/SiO2 and ThO2/TiO2 composites were also studied, finding a decrease in intensity when introducing the SiO2 or TiO2 matrices. The photocatalytic behavior to methylene blue degradation of ThO2 and their composites ThO2/SiO2 and ThO2/TiO2 was investigated for the first time, with them in the following order: ThO2 > ThO2/TiO2 > ThO2/SiO2.

Características clínicas y morbimortalidad en cirugía abdominal de emergencia en pacientes con COVID-19 / Clinical characteristics, morbidity and mortality following an emergency abdominal surgery in patients with COVID-19

RESUMEN Objetivo: Presentar las características clínicas, análisis de laboratorio, diagnóstico, tratamiento y evolución de los pacientes portadores de la enfermedad por el virus SARS-CoV-2 operados en emergencia. Materiales y métodos: Estudio multicéntrico de tipo descriptivo y retrospectivo de 45 pacientes operados de emergencia por abdomen agudo quirúrgico con diagnóstico de COVID-19 activo, entre abril y agosto del 2020. Resultados: Se operó a 45 pacientes con enfermedad abdominal aguda. El 55,55 % fueron varones y el 44,44 %, mujeres, con una media de edad de 48,33 años. El método de diagnóstico de COVID-19 más frecuente fue la prueba serológica (88,88 %). A todos los pacientes se les realizó una tomografía pulmonar que fue informada como "sin alteraciones" en 31,11 % de los casos y con un consolidado bilateral en 48,88 %. Los diagnósticos más frecuentes fueron apendicitis aguda (64,44 %) y obstrucción intestinal (15,55 %). Las complicaciones postoperatorias se presentaron en 35,55 % de los casos (16 de 45 pacientes), las más frecuentes fueron la insuficiencia respiratoria (15,55 %) y la insuficiencia renal aguda (13,33 %). Dos pacientes (4,44 %) fallecieron a causa de la insuficiencia respiratoria severa. Conclusiones: El diagnóstico de COVID-19 se realizó con base en las pruebas serológicas y en los hallazgos de la tomografía axial computarizada pulmonar. La operación quirúrgica más frecuente fue la apendicectomía. Se encontró una morbilidad y mortalidad baja en relación a lo reportado en la literatura médica.

ABSTRACT Objective: To present the clinical characteristics, laboratory analyses, diagnosis, treatment and evolution of patients with SARS-CoV-2 infection who underwent an emergency surgery. Materials and methods: A multicenter, descriptive and retrospective study conducted in 45 patients who underwent an emergency surgery for acute (surgical) abdomen with a diagnosis of COVID-19 between April and August 2020. Results: Forty-five (45) patients with acute abdomen underwent surgery, out of which 55.55 % were men and 44.44 % were women, with a mean age of 48.33 years. The most frequently used diagnostic test for COVID-19 was the serology test (88.88 %). All the patients underwent a chest computed tomography scan which showed no alterations (31.11 %) and bilateral consolidation of the lungs (48.88 %). The most frequent diagnoses were acute appendicitis (64.44 %) and intestinal obstruction (15.55 %). Postoperative complications occurred in 16 patients (35.55 %). The most frequent complications were respiratory failure (15.55 %) and acute renal failure (13.33 %). Two patients (4.4 %) died due to severe respiratory failure. Conclusions: COVID-19 was diagnosed based on serology tests and chest computed tomography scan findings. The most frequent surgery was appendectomy. Low morbidity and mortality rates were observed in relation to those reported in the medical literature.

[Results of the application of the Protocol for Improved Recovery in Surgery (PREMEC) in the surgical treatment of colorectal cancer at the Edgardo Rebagliati National Hospital â€" EsSalud]. / Resultados de la aplicación del Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en el tratamiento quirúrgico del cáncer colorrectal en el Hospital Nacional Edgardo Rebagliati â€" EsSalud.

INTRODUCTION: Improvement in health care is reflected in achieving better results in quality indicators. For quite some time several programs have pursued a reduction of complications and length of stay. A program called Protocol for Improved Recovery in Surgery (PREMEC) has been implemeted at the colorectal surgery service. OBJECTIVE: The objective of this study is to show results of the implementation of PREMEC. MATERIALS AND METHODS: This is an observational study of two cohorts, 516 patients were included. One is a historic cohort (before the protocol) comprised by patients who underwent resective colonic and rectal surgery through an open approach from January 2017 to November 2018. The other prospective cohort includes patients treated under the PREMEC program from December 2018 through to March 2020. This cohort was divided into two groups according to the surgical approach, open and laparoscopic. All groups were compared regarding postoperative length of stay, complications, mortality and readmissions. RESULTS: Groups were similar in age, sex, cancer staging and type of surgery. Length of stay was 13.86 days (SD 7.86 days) for the pre-PREMEC group, 10.62 days (SD 5.4 days) for the PREMEC open group and 6.86 days (SD 2.7 days) for the PREMEC laparoscopic group. As for complications the PREMEC group showed a decrease in anastomotic leaks, Surgical Site Infection (SSI) and postoperative ileus. No differences were found regarding mortality, reoperations and readmissions. CONCLUSION: Implementation of the PREMEC program attained a decrease in length of stay, anastomotic leaks, SSI and postoperative ileus with no increase in mortality, reoperations or readmissions.

Resultados de la aplicación del Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en el tratamiento quirúrgico del cáncer colorrectal en el Hospital Nacional Edgardo Rebagliati - EsSalud / Results of the application of the Protocol for Improved Recovery in Surgery (PREMEC) in the surgical treatment of colorectal cancer at the Edgardo Rebagliati National Hospital - EsSalud

RESUMEN Introducción: La mejora en la atención de salud se ha visto reflejada en la obtención de mejores resultados de los indicadores de calidad. Desde hace mucho tiempo diversos programas buscan disminuir las complicaciones y la estancia postoperatoria. En el servicio de cirugía colorrectal se ha implementado un programa denominado Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en pacientes con diagnóstico de cáncer colorrectal. Objetivo: El objetivo del presente estudio fue presentar los resultados con la implementación del PREMEC. Materiales y método: Estudio observacional de dos cohortes. Se estudiaron 516 pacientes. Una es la cohorte histórica (antes del protocolo) conformada por pacientes operados con cirugía resectiva de colon y recto mediante abordaje abierto entre enero del 2017 y noviembre del 2018. La otra cohorte prospectiva estuvo conformadas por pacientes que fueron manejados de acuerdo al PREMEC desde diciembre del 2018 hasta marzo del 2020. Esta cohorte se dividió en dos grupos según el abordaje quirúrgico, abierto y laparoscópico. Se compararon los grupos entre sí, teniendo en cuenta las variables de estancia postoperatoria, complicaciones, mortalidad, reoperaciones y readmisiones. Resultados: Los grupos fueron similares en edad, sexo, estadio del cáncer y cirugía realizada. La estancia hospitalaria en el grupo antes del protocolo fue 13,86 (DS 7,86) días, en el grupo PREMEC abordaje abierto fue 10,62 (DS 5,4) días y el grupo PREMEC abordaje laparoscópico de 6,86 (DS 2,7) días. A nivel de las complicaciones en el grupo PREMEC se demostró la disminución de las fugas anastomóticas, Infecciones de Sitio Operatorio (IS0) e íleo postoperatorio. No se encontró diferencias en la mortalidad, reoperaciones y readmisiones. Conclusión: La implementación del PREMEC logró disminuir la estancia postoperatoria, las fugas anastomóticas, ISO e íleo postoperatorio, sin incremento de la mortalidad, reoperaciones y readmisiones.

ABSTRACT Introduction: Improvement in health care is reflected in achieving better results in quality indicators. For quite some time several programs have pursued a reduction of complications and length of stay. A program called Protocol for Improved Recovery in Surgery (PREMEC) has been implemeted at the colorectal surgery service. Objective: The objective of this study is to show results of the implementation of PREMEC. Materials and methods: This is an observational study of two cohorts, 516 patients were included. One is a historic cohort (before the protocol) comprised by patients who underwent resective colonic and rectal surgery through an open approach from January 2017 to November 2018. The other prospective cohort includes patients treated under the PREMEC program from December 2018 through to March 2020. This cohort was divided into two groups according to the surgical approach, open and laparoscopic. All groups were compared regarding postoperative length of stay, complications, mortality and readmissions. Results: Groups were similar in age, sex, cancer staging and type of surgery. Length of stay was 13.86 days (SD 7.86 days) for the pre-PREMEC group, 10.62 days (SD 5.4 days) for the PREMEC open group and 6.86 days (SD 2.7 days) for the PREMEC laparoscopic group. As for complications the PREMEC group showed a decrease in anastomotic leaks, Surgical Site Infection (SSI) and postoperative ileus. No differences were found regarding mortality, reoperations and readmissions. Conclusion: Implementation of the PREMEC program attained a decrease in length of stay, anastomotic leaks, SSI and postoperative ileus with no increase in mortality, reoperations or readmissions.

Operaciones abdominopélvicas de emergencia en pacientes con COVID-19 en el Hospital Edgardo Rebagliati Martins - EsSalud, Lima, Perú / Emergency abdominopelvic operations in patients with COVID-19at Hospital Edgardo Rebagliati Martins ­ EsSalud

Introducción. La pandemia COVID-19 que se declaró el 11 de marzo de este año, se extendió desde China a todo el mundo rápidamente, y la gran cantidad de pacientes infectados ha saturado nuestro precario sistema de salud, lo que ha obligado a restringir la actividad quirúrgica electiva y de emergencia. El objetivo del presente estudio fue describir las características clínicas y quirúrgicas de los pacientes con COVID-19 operados en el servicio de emergencia del Hospital Nacional Edgardo Rebagliati Martins - EsSalud. Método. Se realizó un estudio descriptivo, observacional y retrospectivo, donde se incluyeron los pacientes con diagnóstico de COVID-19 operados por el servicio de emergencia, entre el 6 de marzo y el 8 de junio de 2020. Se analizan las características clínicas, hallazgos en los exámenes diagnósticos y características quirúrgicas. Resultados. Se operaron de emergencia 26 pacientes y se realizaron 17 cesáreas, 4 apendicectomías, 2 resecciones intestinales con ostomía, una herniorrafia inguinal, una rafia vesical y una laparotomía exploradora. Todas tu-vieron abordaje abierto. Los síntomas más frecuentes fueron tos y fiebre; 23% los pacientes fueron asintomáticos. El diagnóstico de COVID-19 se confirmó con pruebas rápidas o serológicas. En el grupo de patología abdominal se elevaron la proteína C reactiva y el dímero D más que en el grupo de cesáreas. Se encontró una complicación (infección del sitio operatorio) y no se observó fallecimientos. Conclusión. La adopción de medidas restrictivas en la indicación quirúrgica de emergencia en los pacientes puede explicar la ausencia de complicaciones severas y fallecimientos en esta serie.

Introduction. The COVID-19 pandemic that was declared on March 11 of this year, spread from China to the entire world rapidly, and the large number of infected patients has saturated our precarious health system, which has forced to restrict the elective and emergency surgical activity. The objective of this study was to describe the clinical and surgical characteristics of patients with COVID-19 operated on in the emergency service of the Edgardo Rebagliati Martins National Hospital ­ EsSalud.Method. A descriptive, observational and retrospective study was performed, which included patients with a diagnosis of COVID-19 operated by the emergency service, between March 6 and June 8, 2020. The clinical characteristics, diagnostic tests and surgical findings were analyzed.Results. 26 patients underwent emergency surgery and 17 caesarean sections, four appendectomies, two intestinal resections with ostomy, an inguinal herniorrhaphy, a bladder raffia and an exploratory laparotomy were performed. All had an open approach. The most frequent symptoms were cough and fever; 23% of the patients were asymptomatic. The diagnosis of COVID-19 was confirmed with rapid or serological tests. In the abdominal pathology group, C-reactive protein and D-dimer were elevated more than in the cesarean section. A complication was found (infection of the surgical site) and no deaths were observed.Conclusion. The adoption of restrictive measures in surgical indications for emergency patients may explain the absence of severe complications and deaths in this series

Impact of Rearing Conditions on the Ambrosia Beetle's Microbiome.

Ambrosia beetles, along with termites and leafcutter ants, are the only fungus-farming lineages within the tree of life. Bacteria harbored by ambrosia beetles may play an essential role in the nutritional symbiotic interactions with their associated fungi; however, little is known about the impact of rearing conditions on the microbiota of ambrosia beetles. We have used culture-independent methods to explore the effect of rearing conditions on the microbiome associated with Xyleborus affinis, Xyleborus bispinatus, and Xyleborus volvulus, evaluating different media in laboratory-controlled conditions and comparing wild and laboratory conditions. Our results revealed that rearing conditions affected the fungal and bacterial microbiome structure and had a strong influence on bacterial metabolic capacities. We propose that the rearing conditions influence the ambrosia-associated fungal and bacterial communities. Furthermore, bacterial microbiome flexibility may help beetles adapt to different substrates.

Genomic Signals of Adaptation towards Mutualism and Sociality in Two Ambrosia Beetle Complexes.

Mutualistic symbiosis and eusociality have developed through gradual evolutionary processes at different times in specific lineages. Like some species of termites and ants, ambrosia beetles have independently evolved a mutualistic nutritional symbiosis with fungi, which has been associated with the evolution of complex social behaviors in some members of this group. We sequenced the transcriptomes of two ambrosia complexes (Euwallacea sp. near fornicatus⁻Fusarium euwallaceae and Xyleborus glabratus⁻Raffaelea lauricola) to find evolutionary signatures associated with mutualism and behavior evolution. We identified signatures of positive selection in genes related to nutrient homeostasis; regulation of gene expression; development and function of the nervous system, which may be involved in diet specialization; behavioral changes; and social evolution in this lineage. Finally, we found convergent changes in evolutionary rates of proteins across lineages with phylogenetically independent origins of sociality and mutualism, suggesting a constrained evolution of conserved genes in social species, and an evolutionary rate acceleration related to changes in selective pressures in mutualistic lineages.

Estudio doble ciego con ketoprofeno más clorzoxazona y diclofenaco en síndromes dolorosos de la columna vertebral / Double blind study of ketoprofen and chlorzoxazone versus diclofenac in spine painful syndromes

Con el objetivo de valorar la seguridad, tolerancia y eficacia de ketoprofeno más clorzoxazona vs diclofenaco en pacientes con síndrome doloroso de la columna vertebral, se realizó un estudio clínico doble ciego, prospectivo, longitudinal, controlados e inferencial. Para ellos, se incluyeron 50 pacientes que se distribuyeron en dos grupos: el A recibió dosis diaria de 50 mg de ketoprofeno más 250 clorzoxazona dos veces al día desde el inicio hasta el final del estudio, y el B 200 mg de diclofenaco al día. Se realizó examen clínico el día cero y 15 del tratamiento y luego periódicamente hasta un total de 12 semanas. Posterior a dicho periodo, en la primera evaluación se observó diferencia entre los grupos de tratamiento. En el grupo tratado con ketoprofeno más clorzoxazona disminuyó el dolor a la palpación, movimiento e inflamación y mejoró la función articular, no así con diclofenaco. Se observaron diferencias entre los dos grupos, tanto en el tratamiento como en respuesta sintomatológica que fueron significativas durante el estudio. Después de ocho semanas de tratamiento 70 por ciento del grupo con ketoprofeno más con diclofenaco. Estas sifras aumentaron hasta 95 por ciento de recuperacion casi completa en el grupo de ketoprofeno más clorzoxazona, mientras que 70 por ciento del grupo con diclofenaco no mejoró en absouluto como lodemuestran las estadísticas de respuesta. En ambos casos, la diferencia fue estadísticamente significativa. La tolerancia de ketoprofeno más clorzoxazona se consideró excelente. En ambos grupos se observaron incidencias similares de irritación gástrica en 4 por ciento de los casos. Estos resultados confirman la excelente seguridad, toleranacia y eficacia de ketoprofeno más clorzoxazona en el tratamiento del síndrome doloroso de la columna vertebral