Tromboprofilaxis en pacientes médicos y quirúrgicos: resultados de un estudio multicéntrico realizado en hospitales de la Ciudad de México / Thromboprophylaxis in medical and surgical patients: results of a multicenter study in hospitals of Mexico City

Resumen: ANTECEDENTES: la enfermedad tromboembólica venosa es una complicación que puede manifestarse durante o después de la hospitalización. Existen pocos antecedentes en nuestro país que evalúan el comportamiento médico en este tema. OBJETIVO: conocer la prescripción relacionada con el tipo, duración y posibles causas de la omisión de tromboprofilaxis en pacientes hospitalizados. MATERIAL Y MÉTODO: estudio descriptivo, transversal y no probabilístico en el que de septiembre a noviembre de 2016 se evaluaron médicos de Medicina Interna, Cirugía General, Terapia Intensiva y Urgencias. Se recolectaron datos por cuestionario y presentación de resultados a través de estadística descriptiva. También se evaluó la duración de la prescripción y la dosis administrada. RESULTADOS: se encuestaron 556 médicos adscritos, 14 jefes de servicio y 234 residentes total: 804 de siete hospitales de la Ciudad de México pertenecientes al sistema de salud. El 30% refirió que su hospital cuenta con un programa de tromboprofilaxis; 97.7% la considera segura y 1.2%, riesgosa. El 96% respondió que prescribe tromboprofilaxis en sus pacientes; 592 74% utilizan alguna escala de previsión clínica de enfermedad tromboembólica venosa. El 71% recomienda heparina de bajo peso molecular para tromboprofilaxis y 0.74% administra anticoagulantes orales de nueva generación. CONCLUSIONES: la enfermedad tromboembólica venosa es potencialmente prevenible; sin embargo, la prescripción muestra oportunidades de mejoría en aspectos de farmacología.

Abstract: BACKGROUND: Venous thromboembolic disease VTE is a complication that may occur during or after hospitalization. There are few antecedents in our country that evaluate the medical behavior in this subject. OBJECTIVE: To know the prescription related to type, duration and possible causes for omission of thromboprophylaxis in hospitalized patients. MATERIAL AND METHOD: A descriptive, transversal and non-probabilistic study was done, in which from September to November 2016 physicians of Internal Medicine, General Surgery, Intensive Care and Urgency were evaluated through a data collection by questionnaire and presentation of results through descriptive statistics. We also evaluated duration of prescription and dose administered. RESULTS: A total of 556 seconded physicians, 14 service heads, and 234 residents 804 in total were surveyed in seven hospitals in Mexico City belonging to the health system. Thirty percent reported that their hospital has a thromboprophylaxis program; 97.7% consider it safe and 1.2% risky; 96% responded that they prescribe thromboprophylaxis in their patients; 592 73.6% used some clinical prediction scale for VTE; 71% recommended low molecular weight heparin for thrombo prophylaxis and 0.74% administered new generation oral anticoagulants. CONCLUSIONS: Venous thromboembolic disease is potentially preventable; however, prescription shows opportunities for improvement in aspects of pharmacology.

In situ histochemical localisation of alkaloids and acetogenins in the endosperm and embryonic axis of Annona macroprophyllata Donn. Sm. seeds during germination.

Currently, the Annonaceae family is characterised by the production of acetogenins (ACGs), and also by the biosynthesis of alkaloids, primarily benzylisoquinolines derived from tyrosine. The objective of this study was to confirm the presence of alkaloids and acetogenins in the idioblasts of the endosperm and the embryonic axis of A. macroprophyllata seeds in germination. The Dragendorff, Dittmar, Ellram, and Lugol reagents were used to test for alkaloids, and Kedde's reagent was used to determine the presence of acetogenins in fresh sections of the endosperm and embryonic axis of seeds after twelve days of germination. A positive reaction was observed for all the reagents, and the presence of alkaloids and acetogenins was confirmed in the idioblasts of the endosperm and those involved in the differentiation of the embryonic axis of the developing seedling. We concluded that the idioblasts store both metabolites, acetogenins and alkaloids. Beginning at differentiation, the idioblasts of the embryonic axis simultaneously biosynthesise acetogenins and alkaloids that are characteristic of the species during the development of the seedling. The method used here can be applied to histochemically confirm the presence of acetogenins and alkaloids in tissues and structures of the plant in different stages of its life cycle.

Histochemical detection of acetogenins and storage molecules in the endosperm of Annona macroprophyllata Donn Sm. seeds.

Acetogenins (ACGs) are bioactive compounds with cytotoxic properties in different cell lines. They are antitumoural, antiparasitic, antimalarial, insecticidal, antimicrobial, antifungal and antibacterial. These secondary metabolites function in plant defence and are found in specific organelles and specific cells, thereby preventing toxicity to the plant itself and permitting site-specific defence. The aim of this work was to histochemically determine the in situ localisation of ACGs in the endosperm of Annona macroprophyllata seeds using Kedde's reagent. Additionally, the colocalisation of ACGs with other storage molecules was analysed. The seeds were analysed after 6 and 10 days of imbibition, when 1 or 2 cm of the radicle had emerged and metabolism was fully established. The seeds were then transversally cut in half at the midline and processed using different histological and histochemical techniques. Positive reactions with Kedde's reagent were only observed in fresh, unfixed sections that were preserved in water, and staining was found only in the large cells (the idioblasts) at the periphery of the endosperm. The ACGs' positive reaction with Sudan III corroborated their lipid nature. Paraffin sections stained with Naphthol Blue Black showed reactions in the endosperm parenchyma cells and stained the proteoplasts blue, indicating that they might correspond to storage sites for albumin-like proteins. Lugol's iodine, which is similar in chemical composition to Wagner's reagent, caused a golden brown reaction product in the cytoplasm of the idioblasts, which may indicate the presence of alkaloids. Based on these results, we propose that Kedde's reagent is an appropriate histochemical stain for detecting ACGs in situ in idioblasts and that idioblasts store ACGs and probably alkaloids. ACGs that are located in idioblasts found in restricted, peripheral areas of the endosperm could serve as a barrier that protects the seeds against insects and pathogen attack.