Efecto de la dieta reducida enfodmaps en el manejo desíntomas gastrointestinales / Effect of a low-fodmaps diet in gastrointestinal symptoms

El enfoque de la dieta reducida en Oligosacáridos, Disacáridos, Monosacáridos y Polialcoholes Fermentables (FODMAPs) con el fin de controlar los Síntomas Gastrointestinales (GI), ha sido estudiado principalmente en pacientes con Síndrome de Intestino Irritable (SII). La absorción deficiente, el efecto osmótico y la fermentación bacteriana de los FODMAPs en el intestino son fenómenos normales, donde la aparición de síntomas (distensión, dolor abdominal y alteración de la motilidad intestinal) ocurrirá si la respuesta subyacente es exagerada o anormal. Discusión: La implementación de la Dieta Reducida en FODMAPs (DRF) requiere de una etapa de restricción de los mismos, seguida por una de reintroducción. La evidencia que se dispone a la fecha resulta prometedora en el control de síntomas GI, tanto del SII, Sensibilidad al Gluten No Celíaca (SGNC) y Enfermedad Inflamatoria Intestinal (EII). Asimismo, se ha vinculado el contenido de FODMAPs de las fórmulas enterales con la diarrea asociada a la nutrición enteral. El impacto a largo plazo de la restricción de FODMAPs sobre la microbiota intestinal es aún desconocido.Conclusión: Se requiere de mayor evidencia para poder recomendar la DRF como tratamiento de primera línea. El asesoramiento dietético por parte de un licenciado en nutrición sobre la misma es indispensable para su eficacia...

Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis.

BACKGROUND: Chronic oral anticoagulation is currently used to avoid thrombosis and the malfunction of tunneled cuffed catheters (TCCs) for hemodialysis (HD). The aim of the study was to assess the efficacy of early warfarin administration, after TCC placement, in comparison to its administration after the first thrombosis or malfunction event of the TCC. PATIENTS AND METHODS: One hundred and forty-four chronic dialysis patients, who underwent TCC placement between June 2001 and June 2005, were randomized into two groups: 81 patients, group A, started oral anticoagulation 12 hr after the TCC placement (target international normalized ratio (INR) 1.8-2.5), in association with ticlopidine 250 mg/die; 63 patients, group B, started warfarin after the first thrombosis/malfunction episode (target INR 1.8-2.5) in association with ticlopidine 250 mg/die. The efficacy of oral anticoagulation therapy in preventing TCC thrombotic complications was evaluated in a 12-month follow-up period, after TCC placement, in terms of: a) the number of patients with thrombotic-malfunction events; b) the number of thrombotic-malfunction events with urokinase infusion (events/patient/year); c) intradialytic blood flow rate (BFR, ml/min); d) negative blood pressure (BP) from the arterial line of the TCC (AP, mmHg); e) positive BP, in the extracorporeal circuit from the venous line (VP, mmHg); and f) bleeding complications. RESULTS: Ten patients (12%) in group A showed TCC thrombosis/malfunction vs. 33 patients (52%) in group B (p < 0.01). In group A, 0.16 events of thrombosis/malfunction per patient/year vs. 1.65 in group B (p < 0.001) were ob-served. BFR was respectively 305 +/- 34 vs. 246 +/- 42 ml/min (p < 0.001). AP was -124 +/- 13 in group A vs. -174 +/- 21 mmHg in group B (p < 0.05). VP was 112 +/- 28 in group A vs. 168 +/- 41 mmHg in group B (p < 0.05). No patient showed any bleeding events. CONCLUSIONS: Early warfarin therapy allows a significant reduction in TCC thrombotic complications and an improvement in both arterial and venous fluxes in comparison with the same therapy administered after the first TCC thrombotic/malfunction event. This therapy did not induce any bleeding complications in the patients included in the study.

Acute hepatitis in childhood: virological, immunological and clinical aspects.

Virological, immunological and clinical findings in 7 previously healthy children, aged 18 months to 11 years, with viral hepatitis are reported. Asymptomatic and fully recovering, although protracted, hepatitis B was diagnosed by chance in a 1 1/2 year-old boy. Anicteric and short-term hepatitis occurred in three children with Epstein-Barr virus infection, concomitantly with typical mononucleosis syndrome. On the contrary, cytomegalovirus (CMV)-associated hepatitis was severe and protracted in two children, and fatal in a 4-year-old girl, whose main autoptic finding was submassive hepatic necrosis. Therefore, our study showed that acute viral hepatitis in non-immunocompromised children is generally self-limited and that CMV hepatitis is more frequent and severe than commonly believed.