Pregabalina preoperatoria previene las fasciculaciones y mialgias inducidas por succinilcolina: metaanálisis de ensayos aleatorizados / Preoperative pregabalin prevents succinylcholine-induced fasciculations and myalgias: A meta-analysis of randomized trials

La succinilcolina es el bloqueador neuromuscular de referencia para la inducción de secuencia rápida. Sin embargo, su uso se asocia a fasciculaciones y mialgias. Se realizó una revisión sistemática y un metaanálisis. Se incluyeron ensayos clínicos controlados aleatorizados comparando gabapentinoides frente a placebo, para la prevención de fasciculaciones y mialgias inducidas por succinilcolina. Se incluyeron seis estudios clínicos aleatorizados. El número total de pacientes fue de 481, de los cuales 241 se incluyeron en el grupo de intervención y 240 en el grupo de placebo. Los gabapentinoides redujeron la incidencia de mialgia inducida por succinilcolina (RR=0,69; IC95%: 0,56-0,84; p<0,001), que siguió siendo estadísticamente significativa para pregabalina (RR=0,71; IC95%: 0,54-0,93; p=0,013) y gabapentina (RR=0,61; IC95%: 0,45-0,82; p=0,001) por separado. No hubo diferencia entre los grupos en cuanto a fasciculaciones (RR=0,92; IC95%: 0,82-1,03; p=0,148). El uso preoperatorio de gabapentinoides se asocia a una menor incidencia de mialgias inducidas por succinilcolina dentro de las primeras 24horas posteriores al procedimiento. (AU)

Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction, however, its use is associated with fasciculations and myalgias. A systematic review and meta-analysis including randomized controlled clinical trials was performed comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included. The total number of patients was 481, of which 241 were in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR=.69; 95%CI: .56-.84; P<.001), which remained statistically significant for pregabalin (RR=.71; 95%CI: .54-.93; P=.013) and gabapentin (RR=.61; 95%CI: .45-.82; P=.001) separately. There was no difference between the groups in fasciculations (RR=.92; 95%CI: .82-1.03; P=.148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24hours after the procedure. (AU)

Preoperative pregabalin prevents succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials.

Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction; however, its use is associated with fasciculation and myalgia. We performed a systematic review and meta-analysis of randomized controlled clinical trials comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included with a total of 481 patients - 241 in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR = 0.69, 95% CI 0.56-0.84, P < .001), which remained statistically significant for pregabalin (RR = 0.71, 95% CI 0.54-0.93, P = .013) and gabapentin (RR = 0.61, 95% CI 0.45-0.82, P = .001) separately. There was no difference in fasciculations between the groups (RR = 0.92, 95% CI 0.82-1.03, P = .148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24 h of surgery.

Species-level identification of trypanosomes infecting Australian wildlife by High-Resolution Melting - Real Time Quantitative Polymerase Chain Reaction (HRM-qPCR).

Conventional nested PCR and Sanger sequencing methods are currently the gold standards for detecting trypanosomes in wildlife. However, these techniques are time-consuming and can often overlook mixed infections. True trypanosome prevalence can thus be underrepresented. Here, we designed an 18S rDNA-based real-time quantitative PCR (qPCR) assay coupled with High-Resolution Melting Analysis (HRMA) to detect and discriminate three Trypanosoma species (T. copemani, T. noyesi, and T. vegrandis) commonly infecting Australian marsupials. A total of 68 genetically characterised samples from blood and tissue were used to validate the High-Resolution Melting - Real Time Quantitative Polymerase Chain Reaction (HRM-qPCR) assay. A further 87 marsupial samples consisting of blood, tissue and in vitro cultures derived from wildlife blood samples, were screened for the first time using this assay, and species identity confirmed using conventional PCR and Sanger sequencing. All three Trypanosoma species were successfully detected in pure cultures using the HRM-qPCR assay, and in samples containing mixed trypanosome infections. Of the 87 marsupial samples screened using the HRM-qPCR assay, 93.1% were positive for trypanosomes, and 8.0% contained more than one trypanosome species. In addition to the three targeted Trypanosoma species, this assay was also able to detect and identify other native and exotic trypanosomes. The turnaround time for this assay, from sample preparation to obtaining results, was less than 2 h, with a detection limit of 10 copies of the amplicon in a reaction for each of the targeted trypanosome species. This more rapid and sensitive diagnostic tool provides a high throughput platform for the detection, identification and quantification of trypanosome infections. It will also improve understanding of host diversity and parasite relationships and facilitate conservation management decisions.

Fauna silvestre asociada a ganado vacuno doble propósito en sistema de silvopastoreo, Pinto, Magdalena,Colombia / Association between wildlife and bovine dual purpose cattle in a silvopastured system, Pinto, Magdalena, Colombia

Objetivo. Evaluar la biodiversidad faunística asociada a ganadería vacuna de doble propósito en dos potreros estructurados con Botriochloa pertusa (colosoana) como herbácea dominante, uno de ellos plantado con Crescentia cujete (Bignoniaceae) como fuente de alimento adicional y otro con escaso y disperso arbolado. Materiales y métodos. El área de estudio está ubicada en el municipio de Pinto, Magdalena. Cada potrero evaluado fue de 10 ha, se mantuvo en cada uno un lote de quince vacas (½ Cebú, » Pardo y » Costeño con Cuernos), la separación entre las áreas muestreadas fue de 500m. Los registros de fauna se condujeron mediante punto fijo de conteo, en diez sitios de avistamiento, durante 20 días continuos, con cubrimiento visual amplio. Al ganado vacuno adulto presente en las dos áreas de trabajo se le realizó un pesaje individual al inicio del trabajo y al final del mismo, con el fin de determinar posibles diferencias entre ellos. Resultados. Estadísticamente el número de individuos y el número de especies presentaron diferencias significativas, siendo mayor la diversidad biológica para el potrero que poseía la plantación de C. cujete, mientras que el peso corporal de las vacas sometidas a pastoreo en las dos áreas no presentó diferencias significativas. Conclusiones. Se demuestra la importancia de este modelo pecuario como promotor de la conservación faunística local al convertirse en refugio de variadas especies silvestres, al tiempo que mantiene la productividad existente sin alterar el ambiente sustancialmente.

Factores ambientales que afectan la edad al primer parto y primer intervalo de partos en vacas del sistema doble propósito / Environmental factors that affect the age of first calving and calving interval in cows under the double-purpose system

Objetivo. Determinar los factores que influyen en la edad al primer parto (AFC) y primer intervalo de parto (PIDP) en hembras bovinas bajo el sistema de doble propósito, en la finca “El Rodeo”, municipio de Magangué, Bolívar - Colombia. Materiales y métodos. Se analizaron 379 datos provenientes de los registros productivos entre los años 1993 hasta 2002, usando el programa estadístico GLM del Statistical Analysis System, donde se obtuvieron la media y el error estándar de cada fuente de variación. En el análisis se consideraron los efectos de año de parto, época de parto, edad al primer parto (no se consideró para EPP), sexo de la cría, grupo racial y peso a los 24 meses. Resultados. La media para la EPP y PIDP fue de 38.9 ± 3.9 meses y 469.2 ± 9 días, respectivamente, donde el efecto época de parto, fue significativo para la duración del PIDP. Los efectos sexo de la cría, peso a los 24 meses y época, no fueron significativos sobre la EPP. Los efectos año de parto, edad al primer parto, sexo de la cría, peso a los 24 meses no fueron significativos sobre el PIDP. Conclusiones. La EPP y PIDP fueron afectados por el año y la época de parto, respectivamente.

Validez y fiabilidad de la escala de Braden para predecir riesgo de úlceras por presión en ancianos / Validity and reliability of the Braden scale to predict pressure ulcer risk in the elderly

OBJETIVO: Determinar la validez predictiva y la fiabilidad de la escala de Braden para predecir el riesgo de úlceras por presión (UP) en ancianos en una institución de referencia de tercer nivel de atención. DISEÑO: Estudio de cohorte. MATERIAL Y MÉTODOS: Se tomaron los 831 pacientes sin UP al ingreso, mayores de 60 años, hospitalizados al menos durante 72 horas en el Hospital de Caldas durante un año, septiembre 1988-1999. Las variables demográficas y el diagnóstico primario al ingreso a las salas de hospitalización se tomaron de la historia clínica. Se clasificó el tipo de piel, se valoró el estado funcional mediante la escala de Barthel. La versión original en inglés de la escala de Braden se tradujo al español y se aplicó a las 72 horas del ingreso y cada semana hasta tres semanas, evaluando de forma simultánea el desarrollo de UP, las cuales se estadificaron de I a IV. La sensibilidad, la especificidad, el Valor Predictivo Positivo (VPP) y el Valor Predictivo Negativo (VPN) fueron calculados para los diferentes puntajes de laEscala de Braden en las cuatro aplicaciones o hasta la evaluación anterior a la detección de la primera UP. RESULTADOS: El promedio de edad fue 71,9 (DE 8), 57 por ciento eran hombres y 96,9 por ciento procedían del hogar. El puntaje en la escala de Barthel osciló entre 0 y 100 con una media de 46,9. En cuanto a los diagnósticos al ingreso las enfermedades cardiovasculares, osteomusculares, gastrointestinales y neurológicas fueron en su orden las patologías más frecuentes. El 8,04 por ciento de los sujetos estudiados desarrollaron UP durante el estudio, 71,6 por ciento la desarrollaron durante la primera semana, 20,8 por ciento en la segunda y 7,5 por ciento en la tercera semana. Se presentaron principalmente en sacro y en estados I y II. El rango de los puntajes en la Escala de Braden osciló entre 6 y 23. El percentil 25 en todas las evaluaciones estuvo entre 15 y 16 puntos, y el percentil 75 en 21. Las variaciones de los puntajes entre las tres evaluaciones fueron mínimas. Las Curvas Operantes de Receptor (COR) derivadas de los datos muestran que un puntaje de 16 produce un punto de corte óptimo donde simultáneamente se maximiza la sensibilidad a 85,4 por ciento y la especificidad a 63,2 por ciento con un VPP de 12,5 en ese punto y un VPN de 98,6. CONCLUSIONES: Este estudio permite concluir que en ancianos hospitalizados la escala de Braden para predecir riesgo de UP es confiable y válida, con un punto de corte de 16. Además sugiere que se deben tener en cuenta otros factores que afectan su validez como la edad y el estado funcional (AU)

Thioredoxin nuclear translocation and interaction with redox factor-1 activates the activator protein-1 transcription factor in response to ionizing radiation.

Thioredoxin (TRX) is a cytoplasmic, redox-sensitive signaling factor believed to participate in the regulation of nuclear transcription factors mediating cellular responses to environmental stress. Activation of the activator protein (AP)-1 transcription factor is thought to be mediated in part by redox-sensitive interactions between the nuclear signaling protein redox factor-1 (Ref-1) and TRX. In this study, the role of TRX and Ref-1 in the activation of the AP-1 complex was examined in HeLa and Jurkat cell lines exposed to ionizing radiation (IR). After exposure to IR, nuclear levels of immunoreactive TRX increased, accompanied by an increase in AP-1 DNA binding activity. It was shown that a physical interaction between Ref-1 and TRX occurs within the nucleus and is enhanced after exposure to IR. Furthermore, TRX immunoprecipitated from irradiated cells was capable of activating AP-1 DNA binding activity in nonirradiated nuclear extracts. In addition, immunodepletion of Ref-1 from nuclear extracts demonstrated that the increase in AP-1 DNA binding activity after IR was also dependent upon the presence of Ref-1 from irradiated cells. Finally, the ability of both TRX and Ref-1 from irradiated cells to stimulate AP-1 DNA binding in nonirradiated nuclear extracts was abolished by chemical oxidation and restored by chemical reduction. These results indicate that, in response to IR, TRX and Ref-1 undergo changes in redox state that contribute to the activation of AP-1 DNA binding activity. These experiments suggest that a redox-sensitive signaling pathway leading from TRX to Ref-1 to the AP-1 complex participates in the up-regulation of DNA binding activity in response to ionizing radiation.

Heat shock inhibits radiation-induced activation of NF-kappaB via inhibition of I-kappaB kinase.

Radiation stimulates signaling cascades that result in the activation of several transcription factors that are believed to play a central role in protective response(s) to ionizing radiation (IR). It is also well established that heat shock alters the regulation of signaling cascades and transcription factors and is a potent radiosensitizing agent. To explore the hypothesis that heat disrupts or alters the regulation of signaling factors activated by IR, the effect of heat shock on IR-induced activation of NF-kappaB was determined. Irradiated HeLa cells demonstrated transient increases in NF-kappaB DNA binding activity and NF-kappaB protein nuclear localization. In addition, irradiated cells demonstrated increased I-kappaB phosphorylation and decreased I-kappaBalpha cytoplasmic protein levels, corresponding temporally with the increase of NF-kappaB DNA binding. Heat shock prior to IR inhibited the increase in NF-kappaB DNA binding activity, nuclear localization of NF-kappaB, and the phosphorylation and subsequent degradation of I-kappaB. I-kappaB kinase (IKK) immunoprecipitation assays demonstrated an increase in IKK catalytic activity in response to IR that was inhibited by pretreatment with heat. Kinetic experiments determined that heat-induced inhibition of NF-kappaB activation in response to IR decayed within 5 h after heating. Furthermore, pretreatment with cycloheximide, to block de novo protein synthesis, did not alter heat shock inhibition of IR induction of NF-kappaB. These experiments demonstrate that heat shock transiently inhibits IR induction of NF-kappaB DNA binding activity by preventing IKK activation and suggests a mechanism independent of protein synthesis.

Intracellular oxidation/reduction status in the regulation of transcription factors NF-kappaB and AP-1.

The eukaryotic cell contains a multitude of pathways coupling environmental stimuli to the specific regulation of gene expression. Two early response transcriptional complexes, NF-kappaB and AP-1, appear to respond to environmental stressors by inducing the expression of response specific downstream genes. Both are well-characterized transcriptional regulatory factors that are induced by a wide variety of seemingly unrelated exogenous and endogenous agents and serve important roles in cell growth and differentiation, immunity, inflammation, and other preprogrammed cellular genetic processes. The activities of NF-kappaB and AP-1 are also affected following exposure to chemicals, drugs, or other agents that appear to alter the cellular oxidation/reduction (redox) status. From these observations, it has been suggested that changes in cellular oxidation/reduction status, communicated via a series of cellular redox-sensitive signaling circuitry employing metal- and thiol-containing proteins, serve as common mechanisms linking environmental stressors to adaptive cellular responses. As such, these transcription factors are ideal paradigms to study the mechanism and possible physiological significance of early response genes in the cellular response to changes in cellular redox status. In this article we summarize the evidence suggesting that cellular redox regulates these transcription factors.

Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy.

We performed a meta-analysis to determine whether laparoscopic or open appendectomy gives better outcomes for patients with suspected acute appendicitis. Studies were selected from the MEDLINE database, personal files, and meeting abstracts. Eleven of 21 randomized controlled trials were included in the meta-analysis. Pooled effect size estimates were calculated using a random effects model. Laparoscopic appendectomy reduced time to full functioning by 5.48 days (95% confidence interval [CI] 3.70 to 7.26; p < 0.001), improved postoperative pain at 24 hours measured by a visual analog scale from 0 to 10 by 1.19 points (95% CI -2.14 to -0.24 points; p=0.014), and decreased the absolute risk for wound infection by 3.2% (95% CI -5.6% to -0. 8%; p=0.009). Operating time was increased by 17.12 min (95% CI 14.19 to 20.03; p < 0.0001). There was no difference between the two surgeries for length of hospital stay, readmission rate, and intra-abdominal abscess formation. Laparoscopic appendectomy improves patient outcomes.

Division of the left hemiliver in man--segments, sectors, or sections.

A major obstacle to coherent terminology for liver anatomy and resections has been that American and French anatomists have divided the left side of the liver through different planes. Couinaud divided the left hemiliver into "sectors" by a plane through the left hepatic vein. Healey and Schroy divided it into "segments" through the umbilical fissure. One anatomic justification for Couinaud's system of sectors is that the transverse portion of the left portal vein was said to terminate by dividing into the umbilical portion of the left portal vein and the vein to segment II. However, corrosion cast studies fail to consider the position of the ligamentum venosum, the structure defining the end of the transverse portion of the left portal vein. Therefore, it is uncertain whether the branch to segment II is a terminal branch of the transverse portion of the left portal vein or a branch of the first part of the umbilical portion. Ten cadaver livers were dissected to determine the position of the branch to segment II in relation to the ligamentum venosum. In all, the branch to segment II came off downstream to the ligamentum venosum, showing that it is a branch of the umbilical portion of the left portal vein. This study does not support the "sectoral" system of Couinaud on the left side of the liver. Division of the left side of the liver through the umbilical fissure as proposed by Healey is anatomically logical and fits well with common surgical resections.

Evaluation of the technique used by health-care workers for taking blood pressure.

The precise guidelines recommended by the American Heart Association for blood pressure measurement are commonly overlooked by health-care workers, who generally take blood pressure in an arbitrary way. To validate this observation we designed a descriptive and observational study to be carried out in a major hospital. One hundred and seventy-two health-care workers divided into four groups (63 general practitioners, 25 clinical and 25 surgical specialists, and 59 nurses) were evaluated in a two-part test. In the first part (practical), the examinee had to follow all the steps recommended by the American Heart Association to get a passing score. In the second part (theoretical, which came second to avoid influencing the practical), the examinee had to answer correctly 7 of 10 questions based on the American Heart Association's guidelines to obtain a passing score. The highest accepted variation in systolic and diastolic pressures between examinee and observer was +/- 4 mm Hg. None of the examinees followed the American Heart Association's recommendations. Sixty-three percent of systolic and 53% of diastolic readings were out of range. Surgical specialists obtained the best practical results (48% systolic and 64% diastolic within range), and nurses obtained the lowest values (29% and 39%, respectively; P = .03 versus surgical specialists). These two groups showed deficiencies in the theoretical test (nurses, 10% correct answers and surgical specialists, 16%). Clinical specialists obtained the best results on the theoretical test (60% correct; P < .05 versus the other groups) but were deficient in the practical test (32% systolic and 60% diastolic within range).(ABSTRACT TRUNCATED AT 250 WORDS)