Trends in preoperative carbohydrate load practice: A systematic review.

BACKGROUND: The preoperative carbohydrate load (PCL) is intended to improve surgical outcomes by reducing the catabolic state induced by overnight fasting. However, there is disagreement on the optimal PCL prescription, leaving local institutions without a standardized PCL recommendation. Results from studies that do not prescribe PCL in identical ways cannot be pooled to draw larger conclusions on outcomes affected by the PCL. The aim of this systematic review is to catalog prescribed PCL characteristics, including timing of ingestion, percentage of carbohydrate contribution, and volume, to ultimately standardize PCL practice. METHODS: A comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials were included if they studied at least one group of patients who were prescribed a PCL and the PCL was described with respect to timing of ingestion, carbohydrate contribution, and total volume. RESULTS: A total of 67 studies with 6551 patients were included in this systematic review. Of the studies, 49.3% were prescribed PCL on the night before surgery and morning of surgery, whereas 47.8% were prescribed PCL on the morning of surgery alone. The mean prescribed carbohydrate concentration was 13.5% (±3.4). The total volume prescribed was 648.2 ml (±377). CONCLUSION: Variation in PCL practices prevent meaningful data pooling and outcome analysis, highlighting the need for standardized PCL prescription. Efforts dedicated to the establishment of a gold standard PCL prescription are necessary so that studies can be pooled and analyzed with respect to meaningful clinical end points that impact surgical outcomes and patient satisfaction.

Bibliometric Indices As Indicators of Research Output: Analyzing Anesthesiologists as a Paradigm for Surgical Disciplines.

Anesthesiology is one of the increasingly competitive surgical specialties with a growing emphasis on scholarly activity. A metric of productivity and citation influence, the Hirsch index (h-index), can help identify mentors capable of guiding postgraduate trainees toward successful academic achievements. This study sought to determine associations between h-indices or m-quotients and manuscript publication in anesthesiology. Using the American Society of Anesthesiologists (ASA) website, accepted abstracts from the ASA Annual Meetings from 2019 to 2021 were screened (n=2146). The first author (FAHi) and senior author (SAHi) h-indices, as well as the first author (FAMq) and senior author (SAMq) m-quotients, were collected for each abstract using the Scopus database. Whether an accepted abstract was subsequently published as a manuscript in a peer-reviewed journal was also noted, along with the number of days between ASA presentation and publication date. Linear and logistic regression models were used for statistical analyses. In total, 348 (34.4%) of the 1012 eligible abstracts were published as manuscripts. Mean FAHi, SAHi, FAMq, and SAMq, were significantly higher for accepted ASA abstracts that were later published in peer-reviewed journals compared to accepted abstracts that were not published (p<0.001). FAHi, SAHi, FAMq, and SAMq had significant positive associations with odds of publication (p=0.002; p<0.001; p=0.006; p<0.001, respectively). There was no statistical significance between FAHi, SAHi, FAMq, or SAMq and the number of days between ASA presentation and publication. Our study uniquely demonstrates the positive, direct association between h-indices and m-quotients with the probability of publication in anesthesiology. We propose that bibliometric indices are adapted to provide a refined perspective of a physician-scientist's capabilities. Postgraduate trainees can use these indices to discern research mentors primed to foster academic excellence.

Descripción de polimorfismos genéticos en CYP3A5 y MDR-1 y su impacto en el rechazo agudo clínico de pacientes trasplantados de hígado del Hospital San Vicente Fundación Rionegro / Description of genetic polymorphisms in CYP3A5 and MDR-1 and their impact on clinical acute rejection in liver transplant patients at Hospital San Vicente Fundación Rionegro

Introducción. El tacrolimus es un medicamento inmunosupresor ampliamente usado en trasplante hepático, que presenta una gran variabilidad interindividual la cual se considera asociada a la frecuencia de polimorfismos de CYP3A5 y MDR-1. El objetivo de este estudio fue evaluar la frecuencia de los polimorfismos rs776746, rs2032582 y rs1045642 y su asociación con rechazo clínico y toxicidad farmacológica. Métodos. Se incluyeron pacientes inmunosuprimidos con tacrolimus a quienes se les realizó trasplante hepático en el Hospital San Vicente Fundación Rionegro entre 2020 y 2022, con supervivencia mayor a un mes. Se evaluaron las variables clínicas, rechazo agudo y toxicidad farmacológica. Se secuenciaron los genes de estudio mediante PCR, comparando la expresión o no en cada uno de los pacientes. Resultados. Se identificaron 17 pacientes. El 43 % de los pacientes se clasificaron como CYP3A5*1/*1 y CYP3A5*1/*3, entre los cuales se encontró asociación con aumento en la tasa de rechazo agudo clínico, al comparar con los pacientes no expresivos (100 % vs. 44 %, p=0,05); no hubo diferencias en cuanto a la toxicidad farmacológica u otros desenlaces. Se encontró el polimorfismo rs2032582 en un 50 % y el rs1045642 en un 23,5 % de los pacientes, sin embargo, no se identificó asociación con rechazo u otros eventos clínicos. Conclusiones. Se encontró una asociación entre el genotipo CYP3A5*1/*1 y CYP3A5*1/*3 y la tasa de rechazo clínico. Sin embargo, se requiere una muestra más amplia para validar estos datos y plantear modelos de medicina personalizada.

Introduction. Tacrolimus is an immunosuppressive drug widely used in liver transplantation, which presents great interindividual variability which is considered associated with the frequency of CYP3A5 and MDR-1 polymorphisms. The objective of this study was to evaluate the frequency of the rs776746, rs2032582 and rs1045642 polymorphisms and their association with clinical rejection and drug toxicity. Methods. Immunosuppressed patients with tacrolimus who underwent a liver transplant at the Hospital San Vicente Fundación Rionegro between 2020 and 2022 were included, with survival of more than one month. Clinical variables, acute rejection and pharmacological toxicity were evaluated. The study genes were sequenced by PCR, comparing their expression or not in each of the patients. Results. Seventeen patients were identified. 43% of the patients were classified as CYP3A5*1/*1 and CYP3A5*1/*3, among which an association was found with increased rates of clinical acute rejection when compared with non-expressive patients (100% vs. 44%, p=0.05). There were no differences in drug toxicity or other outcomes. The rs2032582 polymorphism was found in 50% and rs1045642 in 23.5% of patients; however, no association with rejection or other clinical events was identified. Conclusions. An association was found between the CYP3A5*1/*1 and CYP3A5*1/*3 genotype and the clinical rejection rate. However, a larger sample is required to validate these data and propose models of personalized medicine.

An overview of local anesthetics in over-the-counter products.

Over-the-counter (OTC) local anesthetics have historically been used to alleviate pain in several common conditions including toothache and sore throat. With a rise in chronic conditions and an aging population, there has been an increase in associated chronic pain-related disorders. Individuals with chronic pain often seek OTC treatments for quick and accessible pain relief. There are several common OTC local anesthetics, including benzocaine, lidocaine, and dibucaine, which are readily available to patients in several formulations. In order to appropriately advise patients on the use of local anesthetics, it is important to understand their key characteristics, including the mechanism of action, clinical properties, pharmacokinetics, clinical applications, and adverse reactions, which may occur.

Cocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence.

Cocaine consumption has increased over the last decade. The potent sympathomimetic effects of the drug can lead to serious neurovascular complications in the form of ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). This systematic review and meta-analysis were designed to describe the clinical features and outcomes of patients suffering from IS, ICH, or SAH occurring in the context of cocaine use. The PubMed, Embase, Cochrane, and Web of Science libraries were queried in December 2022. Studies were included if they provided information regarding the epidemiology, clinical presentation, or outcomes in cocaine-associated strokes. Odds ratios (OR) were pooled using a random-effects model. A total of 36 papers were included. Strokes associated with cocaine use were more prevalent in younger populations and those of African American descent. Cocaine use increased the odds of IS, ICH, or SAH (OR = 5.05, p < 0.001). The odds of mortality (OR = 1.77, p = 0.0021), vasospasm (OR = 2.25, p = 0.0037), and seizures (OR = 1.61, p < 0.001) were also worse when strokes were associated with cocaine use. In addition to counseling patients on the benefits of drug cessation, clinicians should remain vigilant of the potential complications in patients who are hospitalized with cocaine-associated strokes.

Targeted Temperature Management After Cardiac Arrest in COVID-19 Patients.

There is a paucity of evidence regarding the utility of targeted temperature management (TTM) in COVID-19 patients who suffer cardiac arrest. This systematic review and meta-analysis aimed to use the available data of how temperature predicts outcomes in COVID-19 patients and the association between active cooling and outcomes in non-COVID-19 cardiac arrest patients to give recommendations for the utility of TTM in COVID-19 survivors of cardiac arrest. The PubMed, Embase, and Web of Science databases were queried in August 2022 for two separate searches: (1) temperature as a predictor of clinical outcomes in COVID-19 and (2) active cooling after return of spontaneous circulation (ROSC) in non-COVID-19. Forest plots were generated to summarize the results. Of the 4209 abstracts screened, none assessed the target population of TTM in COVID-19 victims of cardiac arrest. One retrospective cohort study evaluated hyperthermia in critically ill COVID-19 patients, two retrospective cohort studies evaluated hypothermia in septic COVID-19 patients, and 20 randomized controlled trials evaluated active cooling in non-COVID-19 patients after ROSC. Risk of death was higher in COVID-19 patients who presented with hyperthermia (risk ratio [RR] = 1.87) or hypothermia (RR = 1.77; p < 0.001). In non-COVID-19 victims of cardiac arrest, there was no significant difference in mortality (RR = 0.94; p = 0.098) or favorable neurological outcome (RR = 1.05; p = 0.41) with active cooling after ROSC. Further studies are needed to evaluate TTM in COVID-19 victims of cardiac arrest. However, given the available evidence that hyperthermia or hypothermia in COVID-19 patients is associated with increased mortality as well as our findings suggesting limited utility for active cooling in non-COVID-19 cardiac arrest patients, we posit that TTM to normothermia (core body temperature ∼37°C) would most likely be optimal for the best outcomes in COVID-19 survivors of cardiac arrest.

Avances en tuberculosis en el 54° congreso chileno de enfermedades respiratorias. 1ra parte: nuevos esquemas acortados para tuberculosis drogoresistente ¿son adecuados para todos? / New shortened schemes for drug-resistant tuberculosis: are they suitable for everyone?

En esta presentación se realiza un recorrido a través de los diferentes esquemas terapéuticos de la tuberculosis drogo-resistente. Se muestra como los investigadores utilizan los nuevos fármacos disponibles y desarrollan diferentes esquemas cada vez más acortados y de administración por vía oral exclusiva, con la intención de lograr una mayor eficacia de curación de la tuberculosis resistente, con menos efectos colaterales y menor letalidad. La búsqueda de esquemas con una duración similar a las terapias de casos sensibles de tuberculosis (esquemas primarios de 6 meses) es el objetivo principal. Las pruebas moleculares como el Xpert ayudan enormemente a seleccionar los esquemas de terapia, según el perfil de susceptibilidad de los casos (resistencia a isoniazida, rifampicina, fluorquinolonas y combinaciones). Las terapias actuales de la tuberculosis drogo-resistente se basan en nuevos fármacos como fluorquinolonas, bedaquilina y linezolid, pero otros fármacos como pretomanid y delamanid también están siendo recomendados.

This presentation takes a tour through the different therapeutic schemes of drug-resistant tuberculosis. It shows how researchers use the new drugs available and develop different increasingly shortened schedules and exclusive oral administration, with the intention of achieving greater efficacy in curing resistant tuberculosis, with fewer side effects and lower lethality. The search for regimens with a duration similar to therapies of sensitive cases of tuberculosis (primary regimens of 6 months) is the main objective. Molecular tests, such as Xpert, greatly help in selecting therapy regimens, according to the susceptibility profile of the cases (resistance to isoniazid, rifampicin, fluorquinolones and combinations). Current drug-resistant tuberculosis therapies are based on new drugs such as fluorquinolones, bedaquiline and linezolid, but other drugs such as pretomanid and delamanid are also being recommended.

Predicting leptomeningeal disease spread after resection of brain metastases using machine learning.

OBJECTIVE: The incidence of leptomeningeal disease (LMD) has increased as treatments for brain metastases (BMs) have improved and patients with metastatic disease are living longer. Sample sizes of individual studies investigating LMD after surgery for BMs and its risk factors have been limited, ranging from 200 to 400 patients at risk for LMD, which only allows the use of conventional biostatistics. Here, the authors used machine learning techniques to enhance LMD prediction in a cohort of surgically treated BMs. METHODS: A conditional survival forest, a Cox proportional hazards model, an extreme gradient boosting (XGBoost) classifier, an extra trees classifier, and logistic regression were trained. A synthetic minority oversampling technique (SMOTE) was used to train the models and handle the inherent class imbalance. Patients were divided into an 80:20 training and test set. Fivefold cross-validation was used on the training set for hyperparameter optimization. Patients eligible for study inclusion were adults who had consecutively undergone neurosurgical BM treatment, had been admitted to Brigham and Women's Hospital from January 2007 through December 2019, and had a minimum of 1 month of follow-up after neurosurgical treatment. RESULTS: A total of 1054 surgically treated BM patients were included in this analysis. LMD occurred in 168 patients (15.9%) at a median of 7.05 months after BM diagnosis. The discrimination of LMD occurrence was optimal using an XGboost algorithm (area under the curve = 0.83), and the time to LMD was prognosticated evenly by the random forest algorithm and the Cox proportional hazards model (C-index = 0.76). The most important feature for both LMD classification and regression was the BM proximity to the CSF space, followed by a cerebellar BM location. Lymph node metastasis of the primary tumor at BM diagnosis and a cerebellar BM location were the strongest risk factors for both LMD occurrence and time to LMD. CONCLUSIONS: The outcomes of LMD patients in the BM population are predictable using SMOTE and machine learning. Lymph node metastasis of the primary tumor at BM diagnosis and a cerebellar BM location were the strongest LMD risk factors.

Síndrome metabólico postrasplante hepático en pacientes del Centro Especializado San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017 / Metabolic syndrome after liver transplant in patients at the Specialized Center San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017

Se revisaron las historias clínicas de todos los pacientes con trasplante hepático atendidos en el Centro Especializado San Vicente Fundación entre enero de 2013 y junio de 2017, para determinar la frecuencia de síndrome metabólico (SM) postrasplante. En instrumento validado se registraron datos sociodemográficos, antecedentes patológicos, antecedentes toxicológicos, complicaciones y criterios ATP III. Se utilizó OpenEpi 3,01 para análisis estadístico; se consideró significancia estadística con p<0,05. De 102 historias clínicas revisadas, se analizaron 73 que cumplieron criterios de inclusión (sin diagnóstico de SM pretrasplante y con información completa para el instrumento). La mayoría de los pacientes eran hombres (59%), adultos mayores (64%) y casados (62%). La frecuencia de SM postrasplante fue 66%; hubo asociación significativa entre SM y antecedentes de hipertensión arterial y diabetes. Se confirma que el SM es una complicación frecuente de los trasplantados hepáticos y los antecedentes de hipertensión y diabetes son los factores asociados más frecuentes.

The medical records of all liver transplant patients attended at the Centro Especializado San Vicente Fundación between January 2013 and June 2017 were reviewed in order to determine the frequency of post-transplant metabolic syndrome (MS). We collected sociodemographic data, pathological history, toxicological history, complications, and ATP III criteria in a validated instrument. The statistical analysis was carried out with OpenEpi 3.01; p<0.05 was considered as statistically significant. Of the 102 reviewed medical records, 73 met the inclusion criteria (no MS diagnosis prior to transplant and complete information for the instru­ment) and were analyzed. Most patients were male (59%), older adults (64%) and married (62%). The frequency of MS after liver transplant was 66%. The association between MS and history of hypertension and diabetes was significant. We confirmed that MS is a frequent complication in liver transplant recipients and that history of hypertension and diabetes are the most frequent associated factors.

Risk Factors of Second Local Recurrence in Surgically Treated Recurrent Brain Metastases: An Exploratory Analysis.

BACKGROUND: A first local recurrence is common after resection or radiotherapy for brain metastasis (BM). However, patients with BMs can develop multiple local recurrences over time. Published data on second local recurrences are scarce. This study aimed to report predictors associated with a second local recurrence in patients with BMs who underwent a craniotomy for a first locally recurrent BM. METHODS: Patients were identified from a database at Brigham and Women's Hospital in Boston. Hazard ratios and 95% confidence intervals for predictors of a second local recurrence were computed using a Cox proportional hazards model. RESULTS: Of 170 identified surgically treated first locally recurrent lesions, 74 (43.5%) progressed to second locally recurrent lesions at a median of 7 months after craniotomy. Subtotal resection of the first local BM recurrence was significantly associated with shorter time to second local recurrence (hazard ratio = 2.09; 95% confidence interval, 1.27-3.45). Infratentorial location was associated with a worse second local recurrence prognosis (hazard ratio = 2.22; 95% confidence interval, 1.24-3.96). CONCLUSIONS: A second local recurrence occurred after 43.5% of craniotomies for first recurrent lesions. Subtotal resection and infratentorial location were the strongest risk factors for worse second local recurrence prognosis following resection of first recurrent BM.

Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy-a systematic review, pairwise meta-analysis, and network meta-analysis.

BACKGROUND: Optimal reconstruction materials for cranioplasty following decompressive craniectomy (DC) remain unclear. This systematic review, pairwise meta-analysis, and network meta-analysis compares cosmetic outcomes and complications of autologous bone grafts and alloplasts used for cranioplasty following DC. METHOD: PubMed, Embase, and Cochrane were searched from inception until April 2021. A random-effects pairwise meta-analysis was used to compare pooled outcomes and 95% confidence intervals (CIs) of autologous bone to combined alloplasts. A frequentist network meta-analysis was subsequently conducted to compare multiple individual materials. RESULTS: Of 2033 articles screened, 30 studies were included, consisting of 29 observational studies and one randomized control trial. Overall complications were statistically significantly higher for autologous bone compared to combined alloplasts (RR = 1.56, 95%CI = 1.14-2.13), hydroxyapatite (RR = 2.60, 95%CI = 1.17-5.78), polymethylmethacrylate (RR = 1.50 95%CI = 1.08-2.08), and titanium (Ti) (RR = 1.56 95%CI = 1.03-2.37). Resorption occurred only in autologous bone (15.1%) and not in alloplasts (0.0%). When resorption was not considered, there was no difference in overall complications between autologous bone and combined alloplasts (RR = 1.00, 95%CI = 0.75-1.34), nor between any individual materials. Dehiscence was lower for autologous bone compared to combined alloplasts (RR = 0.39, 95%CI = 0.19-0.79) and Ti (RR = 0.34, 95%CI = 0.15-0.76). There was no difference between autologous bone and combined alloplasts with respect to infection (RR = 0.85, 95%CI = 0.56-1.30), migration (RR = 1.36, 95%CI = 0.63-2.93), hematoma (RR = 0.98, 95%CI = 0.53-1.79), seizures (RR = 0.83, 95%CI = 0.29-2.35), satisfactory cosmesis (RR = 0.88, 95%CI = 0.71-1.08), and reoperation (RR = 1.66, 95%CI = 0.90-3.08). CONCLUSIONS: Bone resorption is only a consideration in autologous cranioplasty compared to bone substitutes explaining higher complications for autologous bone. Dehiscence is higher in alloplasts, particularly in Ti, compared to autologous bone.

Aura Type and Outcome After Anterior Temporal Lobectomy.

OBJECTIVE: Temporal lobe epilepsy (TLE) is one of the most common causes of medically refractory focal epilepsy. Anterior temporal lobectomy (ATL) leads to improved seizure control in patients with medically refractory TLE. Various auras are associated with TLE; however, the relationships between aura type and outcome after ATL are poorly understood. Our objective was to investigate the associations among clinical features, aura type, and seizure outcome after ATL. METHODS: The records of patients who underwent ATL between 1993 and 2016 at a single institution (N = 174) were retrospectively reviewed. Demographic and clinical variables were compared among aura types using analysis of variance and logistic regression analysis. A multiple regression analysis was conducted to determine whether aura type predicted seizure outcome after ATL. RESULTS: Mesial temporal sclerosis (MTS) on magnetic resonance imaging inversely correlated with cephalic auras (P = 0.0090). Affective auras (P = 0.014) and somatosensory auras (P = 0.021) were correlated with findings of MTS on pathology, whereas this finding was inversely correlated with the presence of auditory auras (P = 0.0056). On multiple regression analysis, predictors of worse seizure outcome after ATL were cephalic auras (P = 0.0048), gustatory auras (P = 0.029), visual auras (P = 0.049), and tonic-clonic seizures (P = 0.047). Fewer preoperative antiepileptic medications (P = 0.0032), and presence of multiple auras (P = 0.011) were associated with better outcome. CONCLUSIONS: Cephalic auras, gustatory auras, and visual auras were associated with worse seizure outcome after ATL.

Statins and Gliomas: A Systematic Review of the Preclinical Studies and Meta-Analysis of the Clinical Literature.

BACKGROUND: Gliomas represent most common primary brain tumors. Glioblastoma (GBM) is the most common subtype and carries a poor prognosis. There is growing interest in the anti-glioma properties of statins. The aim of this study was to conduct a systematic review of the preclinical literature and to meta-analyze existing clinical studies to determine what benefit, if any, statins may confer in the context of glioma. METHODS: The PubMed, Embase, Cochrane, and Web of Science libraries were queried in May 2021. Preclinical studies were included if they investigated the anti-cancer effects of statins in glioma in vitro and in vivo. Clinical studies were included if they reported incidence rates of glioma by statin use, or mortality outcomes among GBM patients by statin use. Pooled point estimates were calculated using a random-effects model. RESULTS: In total, 64 publications, 51 preclinical and 13 clinical, were included. Preclinical studies indicated that statins inhibited glioma cell proliferation, migration, and invasion. These effects were time- and concentration-dependent. Synergistic anti-glioma effects were observed when statins were combined with other anti-cancer therapies. Clinical observational studies showed an inverse, albeit non-statistically significant, association between statin use and incidence rate of glioma (HR = 0.84, 95% CI 0.62-1.13, I2 = 72%, p-heterogeneity = 0.003, 6 studies). Statin use was not associated with better overall survival following GBM surgery (HR = 1.05, 95% CI 0.85-1.30, I2 = 30%, p-heterogeneity = 0.23, 4 studies). CONCLUSION: Statins were potent anti-cancer drugs that suppressed glioma growth through various mechanisms in vitro; these effects have translated into the clinical realm, clinically but not statistically, in terms of glioma incidence but not GBM survival.

Metabolic syndrome after liver transplant in patients at the specialized Center San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017. / Síndrome metabólico postrasplante hepático en pacientes del Centro Especializado San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017.

OBJECTIVES.: Motivation for the study: there is a lack of studies in Latin America on the frequency of metabolic syndrome in patients who receive liver transplants. Main findings: two-thirds (66%) of patients who received liver transplantation between 2013 and 2017 at the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, subsequently presented metabolic syndrome. Implications: this study confirms that liver transplant recipients very frequently develop metabolic syndrome; however, the frequency found by this study (66%) was almost double that reported in other regions of the world, suggesting that patients from the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, may present some additional condition. The medical records of all liver transplant patients attended at the Centro Especializado San Vicente Fundación between January 2013 and June 2017 were reviewed in order to determine the frequency of post-transplant metabolic syndrome (MS). We collected sociodemographic data, pathological history, toxicological history, complications, and ATP III criteria in a validated instrument. The statistical analysis was carried out with OpenEpi 3.01; p<0.05 was considered as statistically significant. Of the 102 reviewed medical records, 73 met the inclusion criteria (no MS diagnosis prior to transplant and complete information for the instru-ment) and were analyzed. Most patients were male (59%), older adults (64%) and married (62%). The frequency of MS after liver transplant was 66%. The association between MS and history of hypertension and diabetes was significant. We confirmed that MS is a frequent complication in liver transplant recipients and that history of hypertension and diabetes are the most frequent associated factors.

OBJETIVOS.: Motivation for the study: there is a lack of studies in Latin America on the frequency of metabolic syndrome in patients who receive liver transplants. Main findings: two-thirds (66%) of patients who received liver transplantation between 2013 and 2017 at the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, subsequently presented metabolic syndrome. Implications: this study confirms that liver transplant recipients very frequently develop metabolic syndrome; however, the frequency found by this study (66%) was almost double that reported in other regions of the world, suggesting that patients from the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, may present some additional condition. Se revisaron las historias clínicas de todos los pacientes con trasplante hepático atendidos en el Centro Especializado San Vicente Fundación entre enero de 2013 y junio de 2017, para determinar la frecuencia de síndrome metabólico (SM) postrasplante. En instrumento validado se registraron datos sociodemográficos, antecedentes patológicos, antecedentes toxicológicos, complicaciones y criterios ATP III. Se utilizó OpenEpi 3,01 para análisis estadístico; se consideró significancia estadística con p<0,05. De 102 historias clínicas revisadas, se analizaron 73 que cumplieron criterios de inclusión (sin diagnóstico de SM pretrasplante y con información completa para el instrumento). La mayoría de los pacientes eran hombres (59%), adultos mayores (64%) y casados (62%). La frecuencia de SM postrasplante fue 66%; hubo asociación significativa entre SM y antecedentes de hipertensión arterial y diabetes. Se confirma que el SM es una complicación frecuente de los trasplantados hepáticos y los antecedentes de hipertensión y diabetes son los factores asociados más frecuentes.

Costs Associated With Early Vascular and Biliary Complications in Liver-Transplanted Patients in a Hospital in Antioquia, Colombia 2019: A Case Series.

OBJECTIVES: Vascular and biliary complications associated with liver transplants involve high morbidity and mortality as well as cost overrun for health systems. Efforts to prioritize their prevention require not only clinical information but also information on costs that reflect the economic burden on health systems. The objective of this study was to describe cost overrun incurred from early vascular and biliary complications after liver transplant. METHODS: This cases series included liver transplant patients treated at the San Vicente Foundation University Hospital, Rionegro, Antioquia, from January 1, 2013, to December 31, 2018. All liver transplant patients treated during the above period were included; the absence of clinical records on the variables of interest was considered the exclusion criterion. A probabilistic analysis of patient cost was performed. Monte Carlo simulations as well as a 1-way sensitivity analysis per transplant cost component were performed. RESULTS: Records from 154 patients were assessed. The average patient age was 56.9 (SD 10.9) years; 42.9% of patients were women. Of all, 36.4% patients were classified as Child C, and the average Model for End-Stage Liver Disease score was 19.6. The average cost for patients without complications was $27 834.82, whereas that for patients with early vascular complications was $36 747.83 and for those with early biliary complications was $38 523.74. CONCLUSION: Early vascular and biliary complications after liver transplant increase healthcare costs, with the increase being significant in patients with biliary complications.

Multiwall and bamboo-like carbon nanotubes from the Allende chondrite: A probable source of asymmetry.

This study presents multiwall and bamboo-like carbon nanotubes found in samples from the Allende carbonaceous chondrite using high-resolution transmission electron microscopy (HRTEM). A highly disordered lattice observed in this material suggests the presence of chiral domains in it. Our results also show amorphous and poorly-graphitized carbon, nanodiamonds, and onion-like fullerenes. The presence of multiwall and bamboo-like carbon nanotubes have important implications for hypotheses that explain how a probable source of asymmetry in carbonaceous chondrites might have contributed to the enantiomeric excess in soluble organics under extraterrestrial scenarios. This is the first study proving the existence of carbon nanotubes in carbonaceous chondrites.

Infección por el virus de la Hepatitis B en el embarazo / Infection by the Hepatitis B virus in pregnacy

Resumen Introducción: la infección por el virus de la hepatitis B constituye un importante problema de salud pública a nivel mundial, pues genera una gran carga de morbilidad y mortalidad relacionada con cirrosis y hepatocarcinoma. En áreas de alta prevalencia la transmisión vertical constituye una fuente importante de infección. Objetivo: revisar la presentación de la infección por virus de la hepatitis B en el embarazo y ofrecer pautas para el manejo de esta entidad. Metodología de búsqueda: se realizó una búsqueda bibliográfica en las bases de datos Pubmed, LILACS, SciELO y el motor de búsqueda Google Scholar, de artículos publicados hasta agosto de 2017, utilizando los términos hepatitis B virus AND infection AND pregnancy. Se restringió la búsqueda a artículos de los últimos quince años, en inglés y español, incluyendo artículos de revisión, estudios clínicos controlados y metaanálisis. Se obtuvieron en total 535 manuscritos para revisión, de los cuales 52 fueron referenciados. Desarrollo del tema: los hijos de madres seropositivas para el antígeno de superficie de la hepatitis B deberían recibir inmunoglobulina y vacunación contra la hepatitis B en las primeras doce horas de nacimiento, lográndose reducir la tasa de transmisión vertical desde más del 90% a menos del 10%. La terapia antiviral, al ser administrada en el tercer trimestre de gestación, puede prevenir la falla inmunoprofiláctica, y debería utilizarse en madres con alto riesgo de trasmisión vertical. Datos recientes apuntan acerca de la seguridad de Tenofovir en el embarazo, siendo actualmente el medicamento de elección. Conclusiones: el tamizaje universal en la gestante para la infección por el virus de la hepatitis B es una medida costoefectiva para reducir la transmisión vertical. Los niveles elevados de antígeno de superficie del virus de la hepatitis B y la carga viral materna, así como la presencia de antígeno e, se asocian a mayor riesgo de transmisión vertical. La combinación de inmunoglobulina y vacunación para hepatitis B, administradas dentro de las doce horas posteriores al nacimiento, se asocian a reducción de la tasa de transmisión vertical. El Tenofovir es la mejor opción terapéutica como terapia antiviral iniciado en las semanas 28-32 de gestación en aquellas gestantes con alto riesgo de transmisión de la infección. MÉD.UIS. 2018;31(2):49-56.

Abstract Introduction: infection by the hepatitis B virus represents an important worldwide public health problem, since it generates a large burden of morbidity and mortality related to cirrhosis and hepatocellular carcinoma. In areas of high prevalence, vertical transmission is a major source of infection. Objective: to review the presentation of the infection by the Hepatitis B virus during pregnancy and offer guidelines to treat this entity. Search methodology: a bibliographic search was made through Pubmed, LILACS and SciELO databases, and Google Scholar search engine, of articles published until august 2017, using the terms hepatitis B virus AND infection AND pregnancy. The search was restricted to articles of the last fifteen years, in english and spanish, including review articles, controlled clinical trials and meta-analysis. A total of 535 articles were obtained for review, from which 52 were referenced. Results: children from seropositive mothers for the surface antigen of hepatitis B should receive immunoglobulin and vaccination against hepatitis B in the first twelve hours after birth, reducing the vertical transmission rate from more than 90% to less than 10%. Antiviral therapy on the third gestational trimester can prevent immunoprophylactic failure, and should be used on mothers at high risk of vertical transmission. Recent data point towards tenofovir's safety during pregnancy, being the treatment of choice. Conclusions: universal screening on pregnant women for the hepatitis B virus infection is a cost-effective measure to reduce vertical transmission. High hepatitis B virus surface antigen levels and mother's viral load, as well as antigen e presence, are associated with increased risk of vertical transmission. The combination of hepatitis B immunoglobulin and vaccination, given before twelve hours after birth, are associated to a reduction of the vertical transmission rate. Tenofovir is the best treatment option as antiviral therapy initiated on gestational weeks 28-32 in pregnant women at high risk of infection transmission. MÉD.UIS. 2018;31(2):49-56.

Effects of Three-Day Serial Sodium Bicarbonate Loading on Performance and Physiological Parameters During a Simulated Basketball Test in Female University Players.

The aim of this study was to investigate the effect of 3-day serial sodium bicarbonate ingestion on repeated sprint and jump performance. Fifteen female university basketball players (23.3 ± 3.4 years; 173.1 ± 5.8 cm; 65.8 ± 6.3 kg; 23.6 ± 4.9% body fat) ingested 0.4 g/kg body mass of sodium bicarbonate or placebo for 3 days (split in three equal daily doses), before completing a simulated basketball exercise. Sprint and circuit times, jump heights, performance decrements, and gastrointestinal side effects were recorded during the test, and blood lactate concentration was measured pre- and posttest. Sodium bicarbonate supplementation led to significant decreases in mean sprint times (1.34 ± 0.23 vs. 1.70 ± 0.41 s, p = .008, 95% confidence intervals [-0.54, -0.10 s]) and mean circuit times (30.6 ± 2.0 vs. 31.3 ± 2.0 s, p = .044) and significantly greater mean jump height (26.8 [range 25.2-34.2] vs. 26.0 [range 25.6-33.6] cm, p = .013) compared with placebo. Performance decrement was significantly less for sprints with sodium bicarbonate compared with placebo (9.9 [range 3.4-37.0]% vs. 24.7 [range 4.1-61.3]%, p = .013), but not different for jumps (13.1 ± 4.5% vs. 12.5 ± 3.1%, p = .321) between conditions. No differences in gastrointestinal side effects were noted between conditions. Significantly greater postexercise blood lactate concentrations were measured in the sodium bicarbonate condition compared with the placebo condition (8.2 ± 2.8 vs. 6.6 ± 2.4 mmol/L, p = .010). This study is the first to show that serial loading of sodium bicarbonate is effective for basketball players to improve repeated sprint and jump performance during competition, or withstand greater training load during practice sessions without any gastrointestinal side effects.

Munc13 proteins control regulated exocytosis in mast cells.

Mast cells (MCs) are involved in host defenses against pathogens and inflammation. Stimulated MCs release substances stored in their granules via regulated exocytosis. In other cell types, Munc13 (mammalian homolog of Caenorhabditis elegans uncoordinated gene 13) proteins play essential roles in regulated exocytosis. Here, we found that MCs express Munc13-2 and -4, and we studied their roles using global and conditional knock-out (KO) mice. In a model of systemic anaphylaxis, we found no difference between WT and Munc13-2 KO mice, but global and MC-specific Munc13-4 KO mice developed less hypothermia. This protection correlated with lower plasma histamine levels and with histological evidence of defective MC degranulation but not with changes in MC development, distribution, numbers, or morphology. In vitro assays revealed that the defective response in Munc13-4-deficient MCs was limited to regulated exocytosis, leaving other MC secretory effector responses intact. Single cell capacitance measurements in MCs from mouse mutants differing in Munc13-4 expression levels in their MCs revealed that as levels of Munc13-4 decrease, the rate of exocytosis declines first, and then the total amount of exocytosis decreases. A requirement for Munc13-2 in MC exocytosis was revealed only in the absence of Munc13-4. Electrophysiology and EM studies uncovered that the number of multigranular compound events (i.e. granule-to-granule homotypic fusion) was severely reduced in the absence of Munc13-4. We conclude that although Munc13-2 plays a minor role, Munc13-4 is essential for regulated exocytosis in MCs, and that this MC effector response is required for a full anaphylactic response.