Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la adquisición de competencias y obtención del diploma acreditativo en el uso de la Ecocardiografía básica en Cuidados Intensivos y Urgencias / Diploma on Basic Echocardiography training and competencies for Intensive Care and Emergency medicine: Consensus document of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES)

El uso de la ecocardiografía a pie de cama se ha convertido en una herramienta indispensable en la monitorización hemodinámica y diagnóstico en el paciente crítico. Su conocimiento, manejo e indicaciones requieren por parte de las sociedades científicas una implicación para una formación reglada que capacite al profesional. El grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y el grupo de trabajo de Ecografía Clínica de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) han desarrollado un documento de consenso en el que se definen los objetivos de aprendizaje y los requisitos necesarios para adquirir las competencias recomendadas en relación con el uso de la Ecocardiografía básica en Cuidados Intensivos y Urgencias, y así poder obtener un diploma acreditativo en Ecocardiografía básica en Cuidados Intensivos y Urgencias. En este documento se definen las competencias y el programa de formación para alcanzar el nivel básico en Ecocardiografía en Cuidados Intensivos y Urgencias, como parte del Diploma Completo en Ecografía en Cuidados Intensivos y Urgencias de la SEDAR y SEMES. La Sociedad Española de Anestesiología y Reanimación (SEDAR), junto con la Sociedad Española de Medicina Interna (SEMI) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), ha desarrollado un documento de consenso determinando las competencias y un programa formativo para la adquisición de un diploma en ecografía (pulmonar, vascular y abdominal) en Cuidados Intensivos y Urgencias. Solo cuando se obtenga el Diploma en Ecocardiografía básica y el Diploma en Ecografía pulmonar, vascular, abdominal de la SEDAR, SEMI y SEMES se podrá adquirir el Diploma Completo de Ecografía en Cuidados Intensivos y Urgencias de la SEDAR y SEMES.(AU)

Cardiac ultrasound has become an essential tool for diagnosis and hemodynamic monitoring in critically ill patients. Scientific societies need to work toward developing a training program that will allow clinicians to acquire competence in performing cardiac ultrasound and understanding its indications. The Clinical Ultrasound for Intensive Care task force of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES) have drawn up this position statement defining the learning objectives and training required to acquire the competencies recommended for basic ultrasound management in the intensive care and emergency setting in order to obtain a diploma in Basic Ultrasound in Intensive Care and Emergency Medicine. This document defines the training program and the competencies needed for basic skills in ultrasound in Intensive Care and Emergency Medicine - part of the Diploma in Ultrasound for Intensive Care and Emergency Medicine awarded by SEDAR/SEMES. The Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES) have drawn up a position statement determining the competencies and training program for a diploma in ultrasound (lung, abdominal and vascular) in Intensive Care and Emergency Medicine. To obtain the SEDAR/SEMES Diploma in Ultrasound in Intensive Care and Emergency Medicine, clinicians must have completed the SEDAR, SEMI and SEMES Diploma in basic ultrasound and the Diploma in lung, abdominal, and vascular ultrasound.(AU)

Diploma on Basic Echocardiography training and competencies for Intensive Care and Emergency medicine: Consensus document of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES).

Cardiac ultrasound has become an essential tool for diagnosis and hemodynamic monitoring in critically ill patients. Scientific societies need to work toward developing a training program that will allow clinicians to acquire competence in performing cardiac ultrasound and understanding its indications. The Clinical Ultrasound for Intensive Care task force of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES) have drawn up this position statement defining the learning objectives and training required to acquire the competencies recommended for basic ultrasound management in the intensive care and emergency setting in order to obtain a diploma in Basic Ultrasound in Intensive Care and Emergency Medicine. This document defines the training program and the competencies needed for basic skills in ultrasound in Intensive Care and Emergency Medicine-part of the Diploma in Ultrasound for Intensive Care and Emergency Medicine awarded by SEDAR/SEMES. The Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES) have drawn up a position statement determining the competencies and training program for a diploma in ultrasound (lung, abdominal and vascular) in Intensive Care and Emergency Medicine. To obtain the SEDAR/SEMES Diploma in Ultrasound in Intensive Care and Emergency Medicine, clinicians must have completed the SEDAR, SEMI and SEMES Diploma in basic ultrasound and the Diploma in lung, abdominal, and vascular ultrasound.

Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo / Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES)

El uso de la ecografía como herramienta de diagnóstico clínico y guía de procedimientos a pie de cama se ha convertido en un examen indispensable en los cuidados del paciente agudo. La capacitación de los profesionales en unas competencias mínimas de conocimiento, manejo e indicaciones de uso requieren de una formación reglada definida por las Sociedades Científicas. El grupo de trabajo de Ecografía en Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), de la Sociedad Española de Medicina Interna (SEMI) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) ha desarrollado este documento de consenso en el que se define el programa de formación y las competencias mínimas recomendadas a adquirir con relación al uso de la Ecografía en Cuidados Intensivos, Anestesia, Urgencias y Emergencias. En este documento se definen el programa de formación y las competencias a adquirir para alcanzar el diploma acreditativo en ecografía toraco-pulmonar, ecografía abdominal y ecografía vascular. Este documento puede servir de guía para definir las competencias a adquirir en los programas de formación de médicos internos residentes (MIR) de los especialistas que trabajen en cuidados intensivos, anestesia, urgencias y emergencias.(AU)

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.(AU)

Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES). / Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo.

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.

[Metformin-associated lactic acidosis: incidence, diagnosis, prognostic factors and treatment]. / Acidosis láctica asociada a metformina: incidencia, diagnóstico, factores pronóstico y tratamiento.

We describe the case of a patient with severe lactic acidosis, as well as presenting some data on its incidence, diagnosis, prognostic factors, and the most appropriate treatment. A 76 year-old male patient with diabetes on treatment with metformin, hypertension, dyslipaemia, and with mild cognitive impairment, was admitted to the Intensive Care Unit in a state of circulatory shock, requiring aggressive treatment with vasopressors and volume. The patient had acute kidney injury with an anuria of 3 days, probably secondary to dehydration to vomiting and to NSAIDs. As a result of the acute renal damage, the patient suffered a severe metformin-associated lactic acidosis. The rest of the causes of metabolic acidosis with an increased anion gap were ruled out, as well as a possible sepsis or rhabdomyolysis. Metformin-associated lactic acidosis is an uncommon metabolic condition, but with a high mortality. To reduce the mortality of these patients, it is important to make an early diagnosis using the clinical records, physical examination, and laboratory tests, with an early resuscitation with volume, vasopressors, bicarbonate, and renal replacement therapy.

Acidosis láctica asociada a metformina: incidencia, diagnóstico, factores pronóstico y tratamiento / Metformin-associated lactic acidosis: incidence, diagnosis, prognostic factors and treatment

Describimos el caso de un paciente con acidosis láctica grave y presentamos algunos datos acerca de su incidencia, diagnóstico, factores pronósticos y tratamiento más adecuado. Un paciente varón de 76 años diabético en tratamiento con metformina, hipertenso, dislipémico y con ligero deterioro cognitivo, ingresó en la Unidad de Cuidados Intensivos en estado de shock circulatorio requiriendo tratamiento agresivo con vasopresores y volumen. El paciente presentaba un daño renal agudo con anuria de 3 días probablemente secundario a la deshidratación por vómitos y a la toma de AINES. A consecuencia del daño renal agudo el paciente padeció una acidosis láctica grave asociada a metformina. Se descartó el resto de causas de acidosis metabólica con anion gap aumentado, así como una posible sepsis o rabdomiolisis. La acidosis láctica asociada a metformina es una condición metabólica poco frecuente pero de alta mortalidad. Para disminuir la mortalidad de estos pacientes, es importante hacer un diagnóstico precoz mediante la historia clínica, la exploración física y la analítica con una rápida reanimación mediante volumen, vasopresores, bicarbonato y técnica de depuración extra-renal(AU)

We describe the case of a patient with severe lactic acidosis, as well as presenting some data on its incidence, diagnosis, prognostic factors, and the most appropriate treatment. A 76 year-old male patient with diabetes on treatment with metformin, hypertension, dyslipaemia, and with mild cognitive impairment, was admitted to the Intensive Care Unit in a state of circulatory shock, requiring aggressive treatment with vasopressors and volume. The patient had acute kidney injury with an anuria of 3 days, probably secondary to dehydration to vomiting and to NSAIDs. As a result of the acute renal damage, the patient suffered a severe metformin-associated lactic acidosis. The rest of the causes of metabolic acidosis with an increased anion gap were ruled out, as well as a possible sepsis or rhabdomyolysis. Metformin-associated lactic acidosis is an uncommon metabolic condition, but with a high mortality. To reduce the mortality of these patients, it is important to make an early diagnosis using the clinical records, physical examination, and laboratory tests, with an early resuscitation with volume, vasopressors, bicarbonate, and renal replacement therapy(AU)

Development and validation of a method for densitometric analysis of berberine in herbal extract and polyherbal formulation.

OBJECTIVE: To develop a new high-performance thin-layer chromatography (HPTLC) method for the quantification of berberine in herbal extract and pharmaceutical dosage form. MATERIALS AND METHODS: The HPTLC was performed on aluminium foil plates coated with 200 µm silica gel 60F(254). Linear ascending development with toluene:ethyl acetate:formic acid:methanol 9:9:3:1 (v/v/v/v) was performed at room temperature (25 ± 2°C) in a twin-trough glass chamber saturated with mobile-phase vapour. Compact bands (R(F) 0.58 ± 0.02) were obtained for berberine. Spectrodensitometric scanning was performed in fluorescence mode at 350 nm. The method was validated for precision, recovery, robustness, specificity, and detection and quantification limits, in accordance with International Conference on Harmonization guidelines. RESULTS: Linear regression analysis of the calibration plots showed a good linear relationship (r(2) = 0.9996 ± 0.0001) between peak area and concentration in the range 10-100 ng/band, respectively. The limits of detection and quantification were 2.8 and 9.3 ng/band. The recovery of the method was 98.5-100.6%. CONCLUSION: The above method was a rapid and cost-effective quality-control tool for routine analysis of berberine in herbal extracts and in pharmaceutical dosage form.

Endometrial fluid is a specific and non-invasive biological sample for protein biomarker identification in endometriosis.

BACKGROUND: The development of non-invasive diagnostic methods for endometriosis requires sensitive and disease specific biomarkers. Here, we describe the use of aspirated endometrial fluid from women with and without endometriosis as a novel biological sample for biomarker discovery. METHODS: Differential protein expression profiling of aspirates from women with early endometriosis (n = 14), advanced endometriosis (n = 32) and without evidence of the disease (n = 32) was assessed by two-dimensional gel electrophoresis (2-DE). A biomarker validation study was performed in an independent cohort (early endometriosis n = 6 and advanced endometriosis n = 14, controls n = 15). RESULTS: The analysis resulted in the identification of 31 proteins showing statistically significant differences in expression. The proteins identified are related to cell signalling, cell death and cell movement, processes that may be involved in the onset and/or progression of endometriosis. The differences in expression observed for 14-3-3 (signal transduction) and moesin (cytoskeletal structure) were confirmed in an independent group of endometriosis patients. CONCLUSIONS: Endometrial fluid represents a novel sample for proteomic analysis offering reliable, disease specific information on protein expression, facilitating the discovery of biomarkers for endometriosis. The results described here complement previous proteomic studies, providing new endometriosis-related proteins to be validated as diagnostic markers.

The risks of translocating wildlife. Pathogenic infection with Theileria sp. and Elaeophora elaphi in an imported red deer.

It is well known that the translocation of wild animals poses risks of the introduction of pathogens into populations, and regulations and recommendations regarding quarantine and screening protocols for wild animals do exist. Less is known about the infection of imported animals with local endemic pathogens. A red deer stag that had been imported from Germany was found recumbent and died from hemolytic anaemia and a process of exertional myopathy. Infection with Theileria sp. was detected in thin blood smears and confirmed by PCR and sequencing. In addition, massive parasitation by Elaeophora elaphi, a parasite endemic to Iberian red deer, was detected. Sequence comparison between the 18S rRNA gene sequence determined that the Theileria strain involved in this case had a 99.7% identity with a Theileria sp. strain obtained from sika-deer, and 95.3% identity with T. cervi. Using sequence distance analysis, the strain from red deer grouped with isolates from Cervus spp. as opposed to isolates from Odocoileus spp. and bovines. Both detected parasites are of little pathogenicity to local red deer, but were pathogenic for the imported red deer from Northern Europe. This case demonstrates that local endemic pathogens may pose naive translocated animals at risk, and illustrates the need for thorough examination and planification of translocation protocols.

PrP polymorphisms in Basque sheep breeds determined by PCR-restriction fragment length polymorphism and real-time PCR.

Two new PCR-based methods were developed to decode prion protein (PrP) gene polymorphisms at codons 136, 154 and 171: a PCR-restriction fragment length polymorphism (RFLP) analysis consisting of two PCR reactions followed by three enzymatic digestions, and a real-time PCR consisting of four reactions with seven fluorogenic probes. Both methods were used to study the distribution of PrP gene polymorphisms in a representative sample (1297 animals) of the populations of the two native breeds of sheep of the Spanish Basque Country, Latxa and Carranzana. Fourteen genotypes were found in the Latxa breed, in which ARQ/ARQ was the genotype most frequently observed (49.3 per cent), followed by ARR/ARQ (32.6 per cent) and ARQ/ARH (5.8 per cent). The genotype associated with the highest resistance to scrapie (ARR/ARR) was present in 5 per cent of the animals analysed. Similar results were observed in the Carranzana sheep.