The gut microbiota profile in psoriasis: a Brazilian case-control study.

The pathogenesis of psoriasis, an immune-mediated chronic inflammatory skin disease, remains unclear. Studies have shown an association between psoriasis and intestinal inflammation; in this context, the influence of the gut microbiota on the immune response of psoriasis has become a focus of recent research. The present research evaluated the composition and diversity of the gut microbiota of 21 participants with psoriasis from a Brazilian referral dermatology service compared to 24 healthy controls. A stool sample was collected from each participant at the time of inclusion in the study, and the samples were analysed by sequencing the 16S rRNA gene. The recruitment of research participants involved matching between groups by sex, age, body mass index, comorbidities and smoking and the exclusion of several criteria that could potentially influence the gut microbiota and the interpretation of the data. There was an increase in the Dialister genus and Prevotella copri species in patients with psoriasis compared to the control group. A reduction in the Ruminococcus, Lachnospira and Blautia genera, as well as in the Akkermansia muciniphila species, was also verified in the psoriasis group compared to the control group. Furthermore, patients with psoriasis exhibited less gut microbiota diversity than controls.

El mundo celebra cien años de producción comercial de palma de aceite, el referente de Malasia / The World Celebrates One Hundred Years of Commercial Oil Palm Production, with Malaysia as a Benchmark

Malasia es el segundo país de Asia en implementar una iniciativa nacional de bioeco-nomía, y la palma de aceite viene jugando un rol clave en esta estrategia. Por un lado, por su con-tribución a la Estrategia Nacional de Biomasa, y por otro, con la consolidación de los procesos de investigación y desarrollo de productos diversi"cados y con alta agregación de valor. La generación de bioproductos para la industria química y el desarrollo de productos farmacéuticos, nutricionales y biocosméticos, así como la creación de bioservicios relacionados con la medicina celular y las células madre, son el futuro.

Malaysia was the second Asian country to implement a national bioeconomics initiative, where oil palm has been playing a key strategic role with its contribution, on the one hand, to the National Biomass strategy and, on the other hand, to the consolidation of research and development of diversi"ed and high value added products. _e development of bioproducts for the chemical industry, as well as of pharmaceutical, nutritional and biocosmetic products, and the creation of bioservices related to cellular medicine and stem cells, are the future.

Enucleación prostática con láser holmio y adenomectomía prostática retropúbica: análisis de morbilidad y consideraciones anestésicas / Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations

Objetivo: La enucleación prostática mediante láser de holmio (HoLEP) es una alternativa a la adenomectomía prostática para el tratamiento quirúrgico de la hipertrofia benigna de próstata. Analizamos nuestra curva de aprendizaje de dicha técnica y la comparamos de forma secundaria con las adenomectomías de próstata. Materiales y métodos: Estudio retrospectivo y comparativo donde se incluyeron los 100 primeros casos de HoLEP realizados en nuestro centro y los últimos 50 casos de adenomectomías retropúbicas. Se recogen los datos del paciente, de la intervención, del acto anestésico, de las variables perioperatorias, de las complicaciones anestésicas y de las variables postoperatorias con un seguimiento durante 6 meses. Se analizó la curva de aprendizaje sin mentor del HoLEP y se compararon las características del HoLEP en 2 fases diferenciadas (fase de aprendizaje y fase de estabilización) con las últimas adenomectomías retropúbicas de próstata realizadas. Resultados: La anestesia intradural fue la técnica más frecuente. Las necesidades de transfusión, el tiempo de estancia (p < 0,01) y la morbilidad postoperatoria fueron menores en los HoLEP que en las adenomectomías. Sin embargo, el grupo de las adenomectomías retropúbicas tenía un mayor volumen prostático inicial (p < 0,001) y un menor tiempo quirúrgico (p < 0,001). Se observó un mejor rendimiento quirúrgico (p < 0,001) y una menor incidencia de complicaciones en el Grupo HoLEP-B (superada ya la curva de aprendizaje) frente al grupo HoLEP-A. Conclusión: En nuestro centro el HoLEP se ha introducido como una opción válida frente a las adenomectomías retropúbicas abiertas, con muy buenos resultados en términos de morbilidad y reducción de estancia hospitalaria. Respecto a la curva de aprendizaje consideramos en torno a los 50 pacientes (sin mentor) como un punto de corte adecuado. La anestesia regional es una buena elección como técnica anestésica

Objective: Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. Materials and methods: A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. Results: Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P < .01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P < .001) and shorter surgical times (P < .001). Better surgical performance (P < .001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. Conclusion: In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique

Influencia del tipo de anestesia y del grado de urgencia en el dolor posoperatorio tras una cesárea / Influence of the type of anesthesia and the level of urgency in post-surgical pain after a cesarian

No disponible

Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations.

OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. MATERIALS AND METHODS: A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. RESULTS: Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. CONCLUSION: In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.

Herniación en mascarilla laríngea Supreme® (new cuff) / Herniation in Supreme® (new cuff) laryngeal mask

No disponible

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / Diagnosis and treatment of breakthrought pain: consensus document

Introducción y objetivos: el dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los distintos especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de cuatro sociedades científicas implicadas en el manejo del paciente oncológico handiseñado este documento. Métodos: tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan® en la que se debatieron las recomendaciones que incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). Resultados: el manejo del DIO requiere una anamnesis completa tanto del DIO como del dolor basal y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio, de efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. Conclusión: este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO (AU)

Introduction and objectives: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved in its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. Methods: After an initial search on the most relevant publicationsin BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan® methodology -a structured brainstorming technique- that produced a first version of theConsensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish IntercollegiateGuidelines Network) system. Results: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain. Conclusion: This Consensus can be a very useful tool to improve the quality of life in cancer patients, because it guidesthe clinician towards a better diagnose and treatment of BTcP (AU)

Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea / Intracameral fibrin glue in spontaneous corneal perforation

CASO CLÍNICO: Paciente varón de 70 años remitido a nuestro servicio por una perforación corneal en el ojo izquierdo (OI) de posible origen herpético. Se procedió a su reparación mediante la introducción de pegamento tisular de fibrina (Tissucol®) en cámara anterior, colocación de parche de membrana amniótica y lente terapéutica de gran diámetro. En el postoperatorio presentó cierre de la perforación y resolución de la fibrina intracameral sin daño endotelial. DISCUSIÓN: El pegamento tisular de fibrina puede ser utilizado en cámara anterior para tratar perforaciones corneales con excelentes resultados

CASE REPORT: A 70-year-old male was referred to our department due to a herpetic corneal perforation in the left eye. The perforation was healed with intracameral fibrin tissue sealant (Tissucol®), an amniotic membrane, and a large diameter soft contact lens. Postoperatively there were complete dissolution of the fibrin sealant and closure of the perforation without endothelial damage. DISCUSSION: Intracameral fibrin glue may be effective in the closure of corneal perforations

[Intracameral fibrin glue in spontaneous corneal perforation]. / Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea.

CASE REPORT: A 70-year-old male was referred to our department due to a herpetic corneal perforation in the left eye. The perforation was healed with intracameral fibrin tissue sealant (Tissucol(®)), an amniotic membrane, and a large diameter soft contact lens. Postoperatively there were complete dissolution of the fibrin sealant and closure of the perforation without endothelial damage. DISCUSSION: Intracameral fibrin glue may be effective in the closure of corneal perforations.

Anestesia y reanimación en un caso de placenta pércreta / Anaesthesia and recovery in a case of placenta percreta

La placenta pércreta es un subtipo de acretismo placentario, en el que este órgano invade la totalidad de la pared uterina, llegando a afectar a los órganos circundantes. Se trata de una afección de alto riesgo quirúrgico, que por lo general va a requerir una histerectomía obstétrica. Presentamos el caso de una gestante de 36 años, con diagnóstico de placenta pércreta con invasión de vejiga e intestino. Durante la intervención desarrolló un cuadro de shock hipovolémico, que precisó transfusión masiva de hemoderivados y apoyo inotrópico. Fueron necesarias 3 reintervenciones sucesivas debido a la hemorragia, realizándose, en una de ellas, embolización selectiva de las arterias hipogástricas. Precisó 13 días en Cuidados Intensivos. El volumen total de hemoderivados transfundidos fue de 43 concentrados de hematíes, 28 unidades de plasma y 8 pools de plaquetas. Se destaca la importancia del diagnóstico prenatal precoz, para poder llevar a cabo un planteamiento adecuado de la intervención, en la que se cuente con un equipo multidisciplinario (cirujanos generales, urólogos, cirujanos vasculares), además de anestesiólogos y obstetras experimentados(AU)

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians(AU)

Neumotórax bilateral y neumomediastino tras microcirugía transoral con láser y traqueotomía / Bilateral and pneumomediastinal pneumothorax after transoral laser microsurgery and tracheotomy

La microcirugía transoral con láser CO2 se ha convertido en una alternativa cada vez más empleada para el tratamiento del cáncer de laringe y faringe. Entre las ventajas que aporta frente a la cirugía abierta y la radioterapia, se encuentran su menor invasividad, mayor precisión, mejor preservación funcional del órgano y menor morbilidad asociada al procedimiento. No obstante, esta técnica quirúrgica no está exenta de complicaciones, algunas hasta ahora poco frecuentes, pero de gran trascendencia clínica. Presentamos el caso de una paciente que en el contexto de una microcirugía con traqueotomía por cáncer de laringe sufrió un enfisema subcutáneo, neumomediastino y neumotórax bilateral precisando de las medidas pertinentes para su control y estabilización, que se describen. Además, se realiza una revisión actual en la literatura, sobre las consideraciones anestésicas y las principales complicaciones perioperatorias de la microcirugía con láser(AU)

Transoral laser CO2 microsurgery is becoming an increasing used treatment option for cancer of the larynx and the pharynx. Amongst the advantages it has compared to open surgery and radiotherapy are, it less invasiveness, greater precision, better functional preservation of the organ, and less procedure-associated morbidity. However, this surgical technique is not without its complication, some being rare up until now, but with great clinical importance. We present the case of a patient subjected to microsurgery with a tracheotomy due to cancer of the larynx, who suffered a subcutaneous emphysema, and a bilateral and pneumomediastinal pneumothorax, requiring the appropriate measures for its control and stabilisation, which are described. A review was also performed of the current literature as regards anaesthetic considerations and the main peri-operative complications of laser microsurgery(AU)

Fentanilo en el dolor irruptivo oncológico / Fentanyl for breakthrough cancer pain

El control del dolor en el paciente oncológico es un aspecto importante en la calidad de la asistencia a las personas. El fármaco de elección en el tratamiento del DIO requiere una potencia adecuada y una muy rápida velocidad de absorción. Esta velocidad es un aspecto crítico. Las preparaciones de fentanilo, debido a su gran potencia, son probablemente los fármacos que el clínico debe emplear en el DIO, pero no todas las preparaciones de fentanilo presentan una cinética similar. Las propiedades farmacocinéticas del comprimido bucal de fentanilo (CBF) con tecnología OraVescent®, han mostrado una gran velocidad de absorción, mucho más rápida que otras preparaciones de opiáceos. Se dispone de evidencia suficiente que indica que la preparación de CBF es eficaz en los episodios de DIO. El CBF ha mostrado eficacia también en dolor irruptivo no relacionado con el cáncer (AU)

Pain control is an important aspect in the quality of the healthcare. The drug of choice in breakthrough pain control requires potency and a very fast rate of absorption. This speed is a critical aspect. The preparations of fentanyl, because of its great potency, probably are drugs that the clinician should use in patients with breakthrough pain, but not all fentanyl preparations have similar kinetics. The pharmacokinetic properties of fentanyl buccal tablets (FBT) powered by OraVescent® drug delivery technology have shown great speed of absorption, much faster than other preparations of opiates. There is evidence indicating that the preparation of FBT fentanyl is effective in episodes of cancer breakthrough pain(AU)

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / No disponible

Introducción y objetivos: El dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los diferentes especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de 4 sociedades científicas implicadas en el manejo del paciente oncológico, han diseñado este documento de consenso. Métodos: Tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO, se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan®, donde se debatieron las recomendaciones a incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). Resultados: El manejo del DIO requiere de una anamnesis completa, tanto del DIO como del dolor basal, y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio de acción, efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. Conclusión: Este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO (AU)

Introduction objectives: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved n its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. Methods: After an initial search on the most relevant publications in BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan® methodology –a structured brainstorming technique– that produced a first version of the Consensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish Intercollegiate Guidelines Network) system. Outcomes: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain (AU)

[Anaesthesia and recovery in a case of placenta percreta]. / Anestesia y reanimación en un caso de placenta pércreta.

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians.

[Bilateral and pneumomediastinal pneumothorax after transoral laser microsurgery and tracheotomy]. / Neumotórax bilateral y neumomediastino tras microcirugía transoral con láser y traqueotomía.

Transoral laser CO2 microsurgery is becoming an increasing used treatment option for cancer of the larynx and the pharynx. Amongst the advantages it has compared to open surgery and radiotherapy are, it less invasiveness, greater precision, better functional preservation of the organ, and less procedure-associated morbidity. However, this surgical technique is not without its complication, some being rare up until now, but with great clinical importance. We present the case of a patient subjected to microsurgery with a tracheotomy due to cancer of the larynx, who suffered a subcutaneous emphysema, and a bilateral and pneumomediastinal pneumothorax, requiring the appropriate measures for its control and stabilisation, which are described. A review was also performed of the current literature as regards anaesthetic considerations and the main peri-operative complications of laser microsurgery.

Bloqueo axilar del plexo braquial en un paciente con síndrome de Bardet-Biedl / Axillary brachial plexus block in a patient with Bardet-Biedl syndrome

No disponible

Taponamiento cardiaco como complicación infrecuente en la cateterización venosa central / Cardiac tamponade as a rare complication in central venous catheterisation

No disponible

Psoriasis dorsolumbar evolucionada: ¿anestesia regional o general? / Advanced dorsolumbar psoriasis: regional or general anaesthesia?

No disponible