Suplementación nutricional con omega 3 en retina: relación entre volumen y concentración en productos comerciales / Nutritional supplements with omega 3 in retinal disease: Relationship between volume and concentration in commercial products

OBJETIVO: Comparar las características morfométricas y la concentración de ácido docosahexaenoico (DHA) y ácido eicosapentanoico (EPA) de los diferentes suplementos nutricionales con omega 3 disponibles en el mercado para las dolencias de la retina. MATERIAL Y MÉTODOS: Estudio doble ciego, con observador único, de una muestra de diferentes comprimidos de suplementación de omega 3 comercializados en España. Se estudió tanto la longitud del comprimido como la concentración de omega 3 en total y de DHA y EPA por separado, utilizando para ello la cantidad proporcionada por el fabricante y el volumen de la cápsula calculado a partir del desarrollo de una fórmula específica para ello. RESULTADOS: Se incluyeron un total de 10 suplementos nutricionales diferentes. La media de omega 3 total, DHA y EPA fue de 383,10 ± 160,90; 210,72 ± 93,3 y 112,34 ± 140,98 mg, respectivamente. El tamaño medio de las cápsulas fue de 14,77 ± 0,19×8,13 ± 0,09 mm. La cápsula de menor tamaño fue la de Oftan mácula omega(R) (Esteve, Barcelona, España). Brudymacula(R) (Brudylab, Barcelona, España) y Brudyretina 1.5 g(R) (Brudylab, Barcelona, España) son las cápsulas con mayor cantidad de DHA. Nutrof omega(R) (Laboratorios Thea, Barcelona, España) es la que presenta menor concentración de omega 3, DHA y EPA por cápsula. CONCLUSIÓN: Existen diferencias importantes en cuanto a tamaño, volumen, cantidad y concentración de omega 3 y sus derivados entre los diferentes preparados comerciales. Solo el conocimiento de las características de los suplementos nutricionales nos permitirá la personalización de su indicación a nuestros pacientes

OBJECTIVE: To analyse the morphometric characteristics and the concentration of (docosahexaenoic acid) DHA and eicosapentaenoic acid (EPA) of the different nutritional supplements with omega 3 available on the market for retinal disease. MATERIAL AND METHODS: A double-blind study was conducted with a single observer, of the different omega 3 supplementation tablets sample marketed in Spain. The length of the tablet, the concentration of omega 3 in total, as well as DHA and EPA were studied separately using the amount provided by the manufacturer and the volume of the capsule calculated from the development of a specific formula for it. RESULTS: A total of 10 different nutritional supplements were included. The mean of total omega 3, DHA and EPA was 383.10 ± 160.90, 210.72 ± 93.3, and 112.34 ± 140.98 mg, respectively. The mean size of the capsules was 14.77 ± 0.19×8.13 ± 0.09 mm The smallest sized capsule was that of Oftan macula omega(R) (Esteve, Barcelona, Spain). Brudymacula(R) (Brudylab, Barcelona, Spain) and Brudyretina 1.5 g(R) (Brudylab, Barcelona, Spain) tablets contained more DHA, with Nutrof omega(R) (Thea Laboratories, Barcelona, Spain) having the lowest concentration of omega 3, DHA and EPA, per tablet. CONCLUSION: There are significant differences in size, volume, quantity, and concentration of omega 3 and its derivatives, between different commercial preparations. Only the knowledge of the characteristics of the nutritional supplements will enable us to provide a more personalised indication of their use for our patients

Nutritional supplements with omega 3 in retinal disease: Relationship between volume and concentration in commercial products. / Suplementación nutricional con omega 3 en retina: relación entre volumen y concentración en productos comerciales.

OBJECTIVE: To analyse the morphometric characteristics and the concentration of (docosahexaenoic acid) DHA and eicosapentaenoic acid (EPA) of the different nutritional supplements with omega 3 available on the market for retinal disease. MATERIAL AND METHODS: A double-blind study was conducted with a single observer, of the different omega 3 supplementation tablets sample marketed in Spain. The length of the tablet, the concentration of omega 3 in total, as well as DHA and EPA were studied separately using the amount provided by the manufacturer and the volume of the capsule calculated from the development of a specific formula for it. RESULTS: A total of 10 different nutritional supplements were included. The mean of total omega 3, DHA and EPA was 383.10±160.90, 210.72±93.3, and 112.34±140.98mg, respectively. The mean size of the capsules was 14.77±0.19×8.13±0.09mm The smallest sized capsule was that of Oftan macula omega® (Esteve, Barcelona, Spain). Brudymacula® (Brudylab, Barcelona, Spain) and Brudyretina 1.5 g® (Brudylab, Barcelona, Spain) tablets contained more DHA, with Nutrof omega® (Thea Laboratories, Barcelona, Spain) having the lowest concentration of omega 3, DHA and EPA, per tablet. CONCLUSION: There are significant differences in size, volume, quantity, and concentration of omega 3 and its derivatives, between different commercial preparations. Only the knowledge of the characteristics of the nutritional supplements will enable us to provide a more personalised indication of their use for our patients.

Afectación cardiovascular en pacientes con edema macular diabético tratados con ranibizumab intravítreo en la práctica clínica habitual / Cardiovascular involvement in patients with diabetic macular oedema treated with intravitreal ranibizumab in routine clinical practice

Objetivo: Analizar la afectación cardiovascular a corto plazo de los pacientes naïve con edema macular diabético, tratados con ranibizumab intravítreo, tanto pre- como postratamiento. Material y métodos: Estudio retrospectivo y descriptivo de pacientes con edema macular diabético con afectación central, que hubieran iniciado tratamiento con ranibizumab intravítreo en 2014 en el Hospital Universitario Nuestra Señora de Candelaria y el Hospital Universitario y Politécnico La Fe. Se siguieron hasta agosto de 2015, estudiando, entre otras variables, la prevalencia e incidencia de accidente cerebrovascular y de infarto agudo de miocardio. Resultados: De las 1.324 inyecciones de ranibizumab intravítreo que se administraron en 2014, solo 159 fueron como inicio de tratamiento, repartidas entre un total de 99 pacientes, ya que más de la mitad de ellos precisó tratamiento de ambos ojos (58,6%). El 58,4% de los pacientes fueron hombres, en la sexta década de la vida (X¯=65,93 años ± 11,24) y, en su mayoría, no fumadores (86,7%), diabéticos tipo 2 (91,9%), hipertensos (70,7%) y dislipidémicos (65,7%). Se encontraron 6 pacientes (6,1%) con infarto agudo de miocardio y 8 (8,1%) con accidentes cerebrovasculares (ACV) previos al inicio del tratamiento, y solo uno (1%) con accidente cerebrovascular posterior (p = 0,039). Conclusión: En nuestra experiencia el ranibizumab intravítreo en pacientes con edema macular diabético, con antecedentes de accidente cerebrovascular e infarto agudo de miocardio podría ser una alternativa segura (AU

Objective: To determine the cardiovascular events in naïve patients with diabetic macular oedema, before and after being treated with intravitreal ranibizumab. Material and methods: A retrospective and descriptive study was conducted on patients with diabetic macular oedema and foveal involvement, who started treatment with intravitreal ranibizumab in 2014 in the Hospital Universitario Nuestra Señora de Candelaria and the Hospital Universitario y Politécnico La Fe. During the follow-up until August 2015, a record was made of parameters, including the prevalence and incidence of stroke and myocardial infarction. Results: Among the 1,324 intravitreal ranibizumab injections administered in 2014, only 159 of them corresponded to treatment initiation in 99 patients, with more than half requiring treatment of both eyes. The study patients included 58.4% males, in the 6th decade of life (Mean = 65.93 ± 11.24 years), non-smokers (86.7%), type 2 diabetes (91.9%), hypertension (70.7%), and with dyslipidaemia (65.7%). Prior to treatment initiation, it was found that 6 patients (6.1%) suffered from an acute myocardial infarction, and 8 (8.1%) from stroke, and only one (1%) with post-stroke (P = .039). Conclusion: In our experience it seems that the intravitreal ranibizumab in diabetic macular oedema could be a safe alternative in patients with a history of stroke and myocardial infarction (AU)

Cardiovascular involvement in patients with diabetic macular oedema treated with intravitreal ranibizumab in routine clinical practice. / Afectación cardiovascular en pacientes con edema macular diabético tratados con ranibizumab intravítreo en la práctica clínica habitual.

OBJECTIVE: To determine the cardiovascular events in naïve patients with diabetic macular oedema, before and after being treated with intravitreal ranibizumab. MATERIAL AND METHODS: A retrospective and descriptive study was conducted on patients with diabetic macular oedema and foveal involvement, who started treatment with intravitreal ranibizumab in 2014 in the Hospital Universitario Nuestra Señora de Candelaria and the Hospital Universitario y Politécnico La Fe. During the follow-up until August 2015, a record was made of parameters, including the prevalence and incidence of stroke and myocardial infarction. RESULTS: Among the 1,324 intravitreal ranibizumab injections administered in 2014, only 159 of them corresponded to treatment initiation in 99 patients, with more than half requiring treatment of both eyes. The study patients included 58.4% males, in the 6th decade of life (Mean=65.93±11.24 years), non-smokers (86.7%), type 2 diabetes (91.9%), hypertension (70.7%), and with dyslipidaemia (65.7%). Prior to treatment initiation, it was found that 6 patients (6.1%) suffered from an acute myocardial infarction, and 8 (8.1%) from stroke, and only one (1%) with post-stroke (P=.039). CONCLUSION: In our experience it seems that the intravitreal ranibizumab in diabetic macular oedema could be a safe alternative in patients with a history of stroke and myocardial infarction.

Determination of residual dimethylsulfoxide in cryopreserved cardiovascular allografts.

Dimethylsulfoxide (DMSO) is a solvent which protects the structure of allografts during the cryopreservation and thawing process. However, several toxic effects of DMSO in patients after transplantation of cryopreserved allografts have been described. The aim of this study is to determine the residual DMSO in the cardiovascular allografts after thawing and preparation of cryopreserved allografts for clinical application following guidelines of the European Pharmacopoeia for DMSO detection. Four types of EHB allografts (aortic valve-AV, pulmonary valve-PV, descending thoracic aorta-DA, and femoral artery-FA) are cryopreserved using as cryoprotecting solution a 10% of DMSO in medium 199. Sampling is carried out after thawing, after DMSO dilution and after delay of 30 min from final dilution (estimated delay until allograft implantation). After progressive thawing in sterile water bath at 37-42 °C (duration of about 20 min), DMSO dilution is carried out by adding consecutively 33, 66 and 200 mL of saline. Finally, tissues are transferred into 200 mL of a new physiologic solution. Allograft samples are analysed for determination of the residual DSMO concentration using a validated Gas Chromatography analysis. Femoral arteries showed the most important DMSO reduction after the estimated delay: 92.97% of decrease in the cryoprotectant final amount while a final reduction of 72.30, 72.04 and 76.29% in DMSO content for AV, PV and DA, was found, respectively. The residual DMSO in the allografts at the moment of implantation represents a final dose of 1.95, 1.06, 1.74 and 0.26 mg kg-1 in AV, PV, DA and FA, respectively, for men, and 2.43, 1.33, 2.17 and 0.33 mg kg-1 for same tissues for women (average weight of 75 kg in men, and 60 kg in women). These results are seriously below the maximum recommended dose of 1 g DMSO kg-1 (Regan et al. in Transfusion 50:2670-2675, 2010) of weight of the patient guaranteeing the safety and quality of allografts.

Bacteriology testing of cardiovascular tissues: comparison of transport solution versus tissue testing.

Bacteriology testing is mandatory for quality control of recovered cardiovascular allografts (CVA). In this paper, two different bacteriology examinations (A tests) performed before tissue antibiotic decontamination were compared: transport solution filtration analysis (A1) and tissue fragment direct incubation (A2). For this purpose, 521 CVA (326 heart and 195 artery tissues) from 280 donors were collected and analyzed by the European Homograft Bank (EHB). Transport solution (A1) tested positive in 43.25 % of hearts and in 48.21 % of arteries, whereas the tissue samples (A2) tested positive in 38.34 % of hearts and 33.85 % of arteries. The main species identified in both A1 and A2 were Staphylococcus spp. in 55 and 26 % of cases, and Propionibacterium spp. in 8 and 19 %, respectively. Mismatches in bacteriology results between both initial tests A1 and A2 were found. 18.40 % of the heart valves were identified as positive by A1 whilst 13.50 % were considered positive by A2. For arteries, 20.51 % of cases were positive in A1 and negative in A2, and just 6.15 % of artery allografts presented contamination in the A2 test but were considered negative for the A1 test. Comparison between each A test with the B and C tests after antibiotic treatment of the allograft was also performed. A total decontamination rate of 70.8 % of initial positive A tests was obtained. Due to the described mismatches and different bacteria identification percentage, utilization of both A tests should be implemented in tissue banks in order to avoid false negatives.

[The identification of Mycobacterium tuberculosis strains using paper strips for the niacin technic]. / Identificación de cepas de Mycobacterium tuberculosis utilizando tiras de papel para la técnica de niacina.

Mycobacterium tuberculosis strains were identified using paper strips for niacin technique; these paper strips were made at the National Reference Laboratory on Tuberculosis and Mycobacteria of the IPK. Results were compared with the conventional niacin technique and a 100% of coincidence was obtained; advantages, sensitivity and firmness of this method are reported.

[Mycobacterium fortuitum: the determination of its susceptibility by the disk diffusion technic]. / Mycobacterium fortuitum: determinación de la susceptibilidad mediante la técnica de difusión por disco.

A study was carried out on 40 Mycobacterium fortuitum strains isolated from 39 symptomatic respiratory patients and 1 from a chronic skin ulcer, the susceptibility of whom to different antimicrobial agents was determined by the disk diffusion method. The strain showed sensitivity to aminoglucosides such as amikacin, gentamicin and kanamycin, and in all cases resistance to the penicillins ans cephalosporins used.