Nanoparticles of Betalain-Gelatin with Antioxidant Properties by Coaxial Electrospraying: Preparation and Characterization.

Betalains are bioactive compounds with attractive antioxidant properties for the food industry, endowing them with potential application in food coatings to maintain quality and extend shelf life. However, they have low stability to factors such as light, temperature, and humidity. An alternative to protect bioactive compounds is nanoencapsulation; one of the most used techniques to produce an encapsulation is coaxial electrospraying. In this research, the preparation and characterization of gelatin-betalain nanoparticles were carried out using the coaxial electrospray technique. Betalains were extracted from pitaya (Stenocereus thurberi) and encapsulated in gelatin. The obtained material was evaluated by SEM, FTIR, TGA, and DSC techniques and for its antioxidant capacity. By SEM, nanoparticles with spherical and monodisperse morphologies were observed, with betalain concentrations of 1 and 3% w/v and average diameters of 864 and 832 µm, respectively. By FTIR, the interaction between betalain and gelatin was observed through amino groups and hydrogen bonds. Likewise, the antioxidant activity of the betalains was maintained at the time of encapsulation, increasing the antioxidant activity as the concentration increased. The results of the DPPH, ABTS, and total phenols methods were 645.4592 µM T/g, 832.8863 ± 0.0110 µM T/g, and 59.8642 ± 0.0279 mg GAE/g for coaxial nanoparticles with 3% betalains, respectively. Therefore, the coaxial electrospray technique was useful for obtaining nanoparticles with good antioxidant properties, and due to the origin of its components and since the use of toxic solvents is not necessary in the technique, the material obtained can be considered food grade with potential application as a coating on functional foods.

Molecular detection of Theileria cervi in equids from México.

Equine piroplasmosis is a parasitic illness caused by various protozoa of the Babesia and Theileria genera, which parasitize within red blood cells. The transmission of these pathogens occurs through certain genus of ticks, including Amblyomma, Haemaphysalis, Hyalomma, and Rhipicephalus. In recent times, an increase in the identification of new Theileria species and genotypes has been observed. This is further complicated by the presence of mixed Theileria infections in both mammals and tick vectors, particularly in regions where wildlife and livestock share habitats and vectors. Therefore, the objective of this study is to document the occurrence of Theileria cervi in a non-typical host. A total of 88 horses (Equus caballus) and 10 donkeys (Equus asinus) were sampled in three municipalities in Veracruz, Mexico. Molecular techniques were employed to identify Babesia/Theileria through the amplification of a segment of the 18S-rDNA and hsp70 genes. The phylogenetic reconstruction grouped the obtained sequences into a monophyletic cluster alongside sequences of T. cervi. This work represents the first documented occurrence of T. cervi in equids. These findings have significant implications from an epidemiological point of view. In addition, further studies are needed to determine the distribution and pathogenicity of this species for domestic animals and to develop effective control strategies.

Efficacy of hydroethanolic extract of Randia aculeata seed against the southern cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae) on naturally infested cattle under field conditions.

The cattle tick Rhipicephalus (Boophilus) microplus is a major problem of concern for cattle industry in tropical and subtropical areas. Control of cattle tick is based mainly on the use of chemical acaricides, which has contributed to the emerging problem of selection of resistant tick lineages. Plants have been used as an alternative to conventional acaricidal drugs. On the other hand, the acaricidal activity of hydroethanolic extract of Randia aculeata seed (EHRA) has been demonstrated against R. microplus under laboratory conditions. However, the utility of EHRA seed as a potential acaricidal needs to be determined under field conditions. For this reason, the aim of this study was to evaluate the efficacy of the EHRA against R. microplus sprayed on naturally infested calves, determine the effect of the EHRA seed on acetylcholinesterase activity in R. microplus larval and identify the chemical composition of EHRA. Forty-five male calves were divided in three groups and treated with: G1 water; G2 EHRA 20% w/v and G3 coumaphos 0.2% v/v. Acetylcholinesterase (AChE) activity in R. microplus larvae was determined by a colorimetric assay. The chemical composition of EHRA was accessed through HPLC/MS. Significantly fewer ticks were observed after 24 h on the treated group compared to control group. EHRA significantly inhibited in vitro AChE activity in R. microplus at all tested concentrations. Chlorogenic acid, vanillinic acid, p-coumaric acid, caffeic acid. rutin, quercetin, (-)-epicatechin, 4-hydroxybenzoic acid, quercetin, vanillin, 2,4-dimethoxy-6-methylbenzoic acid, scopoletin and ferulic acid were identified in the extract. The results provided new data for the elucidation of the mechanisms of EHRA acaricide action and to further evaluate the use as a new alternative control agent against R. microplus under in vivo conditions.

New records, and molecular detection of vector-borne pathogens in Felicola subrostratus from eastern Mexico.

The study of lice associated with domestic cats is a neglected area of veterinary parasitology. In particular, the presence of the cat louse Felicola subrostratus, a small Ischnoceran species found in the fur of the domestic cat, is rarely recognized. In America, this species has been reported across six countries. Although it was also recently reported in Mexico, no studies on the molecular identification of the specimens or the monitoring of potential bacterial, and protozoan pathogens have been carried out. Thus, this work aimed to collect, and identify lice associated with domestic and free ranging cats from the states of Veracruz and Tabasco, using amplification and sequencing of the mitochondrial cytochrome c oxidase subunit I (COI), and the ribosomal 18S rDNA genes, and to monitor selected vector-borne bacterial (Bartonella, Mycoplasma, and Rickettsia) and protozoan (Babesia, and Hepatozoon) agents. Only entire lice were used for molecular host and pathogen identification. Eighty-one lice, identified as F. subrostratus, were recovered from five infested cats, and 30 were selected for molecular identification and pathogen surveillance. Analysis of the COI and 18S rDNA partial sequences showed a similarity of 96.79%-100% with sequences of F. subrostratus from the US. Mycoplasma haemofelis and Hepatozoon canis DNA was detected in three and four samples, respectively. This work provides new collection locations for F. subrostratus, and the first sequences of the COI and 18S rDNA genes from Mexico. It also reports two pathogenic microorganisms found in the lice.

Identification of the G184C, C190A and T2134A mutations in the para-sodium channel gene of the southern cattle tick Rhipicephalus (Boophilus) microplus associated with resistance to cypermethrin in northern Veracruz, Mexico.

The southern cattle tick (Rhipicephalus microplus) represents one of the ectoparasites with the greatest distribution worldwide. Infestations by this arthropod can cause a decrease in the production of meat and milk, as well as anaemia and the transmission of bacterial and parasitic agents. For this reason, several active molecules have been developed to control these arthropods. A widely used group of ixodicides are pyrethroids, especially cypermethrin, which have knockdown effects on ticks. Resistance to cypermethrin has been reported in ticks since the 2000s; it was registered for the first time in Mexico in 2009. Even though multiple studies have evaluated resistance with conventional tests, there are few studies in Mexico that have identified the presence of single nucleotide polymorphisms (SNPs) associated with resistance. Hence, the aim of this work was to monitor three mutations associated with resistance in the sodium/chlorine channel in eight populations of ticks from northern Veracruz. Engorged adult females were collected from which genomic DNA was extracted. Subsequently, three mutations in domains II and III of para­sodium channel gene were detected by conventional PCR and sequencing. Global alignments were done with the reference sequences deposited in GenBank. A total of 116 engorged females were analysed, of which 10 tested positive for G184C and C190A of domain II of the para­sodium channel gene. T2134A was present in domain III in a single production unit. This is the first work where molecular monitoring of cypermethrin resistance has been carried out in the northern zone of the state of Veracruz.

Confirmation of the presence of Rickettsia felis infecting Ornithodoros puertoricensis in Mexico.

Soft ticks are neglected competent vectors of a wide range of pathogenic microorganisms, among which bacteria of the genera Rickettsia and Borrelia stand out. In Mexico, previous studies have shown the presence of a member of the Ornithodoros talaje complex in the Virginia opossum (Didelphis virginiana Didelphimorphia: Didelphidae Kerr) from southeastern Mexico. However, its specific identification has not been achieved. Two D. virginiana were treated in a private clinic during the period of April-May 2022. Tick larvae were manually removed, DNA extraction was performed, and some genes from various bacterial and parasitic pathogens were amplified and sequenced. A total of 96 larvae were recovered, which were morphologically identified as Ornithodoros puertoricensis (Ixodida: Argasidae Fox); the 16 S sequences showed a similarity of 96.79%-99.51% with sequences of O. puertoricensis from Panama and Colombia. The presence of Rickettsia felis (Rickettsiales: Rickettsiaceae Bouyer et al.) was detected in 15 specimens from one host. The soft tick O. puertoricensis is recorded for the first time as an ectoparasite of the Virginia opossum in America and represents the second report for this soft tick in Mexico since 1963. This represents the most northern record of this tick species in its geographic distribution and brings a new soft tick-Rickettsia association.

First report of Babesia bigemina in Lama glama in a zoological garden of Veracruz, Mexico.

Zoological gardens represent specialised centres for the preservation of biological inventories and genetic diversity, allowing the recognition of multiple species in critical conservation categories. However, the close coexistence of multiple species of vertebrates that may be associated with various species of ectoparasites may be the cause of the transmission of multiple infectious agents, among which tick-borne pathogens stand out. In these areas, several animal species usually live in a small space and proximity to other wildlife, visitors and keepers. In Mexico, little is known about the disease agents transmitted by arthropods in zoological gardens. For this reason, the aim of this study was to identify the presence of Babesia/Theileria in animals maintained in captivity. As a part of a project identifying vector-borne pathogens in wildlife, 24 animals were sampled in the Miguel Angel de Quevedo zoo. Molecular identification of Babesia/Theileria was realised through amplification of a fragment of the mitochondrial cytB gene and the ribosomal 18S-rDNA. Two neotropical camelids (Lama glama) tested positive (2/3 = 66.6%) to Babesia bigemina. Our results represent the first record of B. bigemina in animals in captivity in a zoological garden in Mexico and the first finding of this haemoparasite in neotropical camelids in Mexico.

No molecular evidence of SARS-CoV-2 infection in companion animals from Veracruz, Mexico.

Active epidemiological surveillance of infectious agents represents a fundamental tool for understanding the transmission dynamics of pathogens and establishing public policies that can reduce or limit their expansion. Epidemiological surveillance of emerging agents, such as the recently recognized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of COVID-19, is essential to establish the risk of transmission between species. Recent studies reveal that companion animals are organisms susceptible to being infected by this pathogen due to the close contact they have with their owners. For this reason, the aim of the present work was to detect the presence of SARS-CoV-2 in dogs and cats in the state of Veracruz, Mexico, where there is active transmission of this microorganism in human populations. Oral and nasopharyngeal swab samples were collected from dogs and cats with a history of exposure to patients with COVID-19. Total RNA was extracted and detection of viral genes N1 and N2 was performed by reverse transcription polymerase chain reaction (RT-qPCR). All 130 samples of companion animals tested by RT-qPCR for SARS-CoV-2 were negative at the time they were collected. This study represents the second active surveillance of SARS-CoV-2 in populations of domestic dogs and cats in Latin America and the first approach in Mexico. Given that coronaviruses have shown a high capacity to be transmitted between species, it is imperative to establish measures to prevent this agent from entering and establishing in populations of companion animals.

Fear-Avoidance Behavior and Sickness Absence in Patients with Work-Related Musculoskeletal Disorders.

(1) Background and objectives: The purpose of this work is to determine the association of fear-avoidance attitudes with sickness absence status, its duration and disability in a work accident context. (2) Materials and Methods: This is a descriptive observational design, conducting the study in two occupational insurance provider clinics with patients with nonspecific low back and neck pain during the study period. Clinical variables were the Fear Avoidance Questionnaire, Roland Morris Disability Questionnaire, Neck Disability Index, Numerical Pain Scale; sociodemographic variables were sex, age, occupational, educational level, sickness absence status, and duration in days of absence from work. Multiple logistic and linear regressions were used to explore the association between variables. (3) Results: Fear-avoidance behavior is related to sickness absence status (OR = 1.048, p = 0.007), and the physical activity dimension (OR = 1.098, p = 0.013) is more relevant than the work dimension (OR = 1.056, p = 0.028). The duration of sickness absence is related to higher values on the fear-avoidance behavior scale in its global dimension (b = 0.84, p = 0.003, r = 0.327), and the results of the physical activity dimension (B = 1.37, p = 0.035, r = 0.236) were more relevant than the work dimension (B = 1.21, p = 0.003, r = 0.324). Fear-avoidance behavior is related to disability in both dimensions (B = 0.912, p ˂ 0.001, r = 0.505). (4) Conclusions: Fear-avoidance behaviors may influence the typification of sickness absence status, its duration both in its physical activity and work dimension, and its disability reported with higher values than in other healthcare contexts.

Low serum DHEA-S is associated with impaired lung function in women.

BACKGROUND: Emerging evidence suggests that androgens and estrogens have a role in respiratory health, but it is largely unknown whether levels of these hormones can affect lung function in adults from the general population. This study investigated whether serum dehydroepiandrosterone sulfate (DHEA-S), a key precursor of both androgens and estrogens in peripheral tissues, was related to lung function in adult women participating in the European Community Respiratory Health Survey (ECRHS). METHODS: Lung function and serum DHEA-S concentrations were measured in n = 2,045 and n = 1,725 women in 1999-2002 and in 2010-2013, respectively. Cross-sectional associations of DHEA-S levels (expressed as age-adjusted z-score) with spirometric outcomes were investigated, adjusting for smoking habits, body mass index, menopausal status, and use of corticosteroids. Longitudinal associations of DHEA-S levels in 1999-2002 with incidence of restrictive pattern and airflow limitation in 2010-2013 were also assessed. FINDINGS: Women with low DHEA-S (z-score<-1) had lower FEV1 (% of predicted, adjusted difference: -2.2; 95%CI: -3.5 to -0.9) and FVC (-1.7; 95%CI: -2.9 to -0.5) and were at a greater risk of having airflow limitation and restrictive pattern on spirometry than women with higher DHEA-S levels. In longitudinal analyses, low DHEA-S at baseline was associated with a greater incidence of airflow limitation after an 11-years follow-up (incidence rate ratio, 3.43; 95%CI: 1.91 to 6.14). INTERPRETATION: Low DHEA-S levels in women were associated with impaired lung function and a greater risk of developing airflow limitation later in adult life. Our findings provide new evidence supporting a role of DHEA-S in respiratory health. FUNDING: EU H2020, grant agreement no.633212.

Enhancing LoRaWAN Security through a Lightweight and Authenticated Key Management Approach.

Luckily, new communication technologies and protocols are nowadays designed considering security issues. A clear example of this can be found in the Internet of Things (IoT) field, a quite recent area where communication technologies such as ZigBee or IPv6 over Low power Wireless Personal Area Networks (6LoWPAN) already include security features to guarantee authentication, confidentiality and integrity. More recent technologies are Low-Power Wide-Area Networks (LP-WAN), which also consider security, but present initial approaches that can be further improved. An example of this can be found in Long Range (LoRa) and its layer-two supporter LoRa Wide Area Network (LoRaWAN), which include a security scheme based on pre-shared cryptographic material lacking flexibility when a key update is necessary. Because of this, in this work, we evaluate the security vulnerabilities of LoRaWAN in the area of key management and propose different alternative schemes. Concretely, the application of an approach based on the recently specified Ephemeral Diffie⁻Hellman Over COSE (EDHOC) is found as a convenient solution, given its flexibility in the update of session keys, its low computational cost and the limited message exchanges needed. A comparative conceptual analysis considering the overhead of different security schemes for LoRaWAN is carried out in order to evaluate their benefits in the challenging area of LP-WAN.

Risk factors for premenstrual asthma: a systematic review and meta-analysis.

INTRODUCTION: Asthma in women can deteriorate in specific phases during the menstrual cycle. Deterioration in the premenstrual phase (increase in symptoms or deterioration in peak flow measurements) is known as premenstrual asthma. The etiology remains mostly unknown. Areas covered: This paper systematically reviews risk factors for premenstrual asthma. Medline, Embase, CINAHL, Scopus, Web of Science, LILACS and secondary sources were searched. The selection criteria were met by 20 articles. Expert commentary: Women with pre-menstrual asthma are older, have more severe asthma, a higher body-mass index, a longer duration of asthma and a greater likelihood of aspirin sensitive asthma. They more often have dysmenorrhea, premenstrual syndrome, shorter menstrual cycles, and longer menstrual bleeding. The role of hormone levels and systemic inflammation remains unclear.

Preserving Smart Objects Privacy through Anonymous and Accountable Access Control for a M2M-Enabled Internet of Things.

As we get into the Internet of Things era, security and privacy concerns remain as the main obstacles in the development of innovative and valuable services to be exploited by society. Given the Machine-to-Machine (M2M) nature of these emerging scenarios, the application of current privacy-friendly technologies needs to be reconsidered and adapted to be deployed in such global ecosystem. This work proposes different privacy-preserving mechanisms through the application of anonymous credential systems and certificateless public key cryptography. The resulting alternatives are intended to enable an anonymous and accountable access control approach to be deployed on large-scale scenarios, such as Smart Cities. Furthermore, the proposed mechanisms have been deployed on constrained devices, in order to assess their suitability for a secure and privacy-preserving M2M-enabled Internet of Things.

Characteristics of culprit atheromatous plaques obtained in vivo by intravascular ultrasound radiofrequency analysis: results from the CULPLAC study.

OBJECTIVES: We used virtual histology-intravascular ultrasound (VH-IVUS) to investigate the characteristics of culprit lesions in acute coronary syndromes (ACS). BACKGROUND: Autopsy studies of patients who died of ACS have shown that culprit atheromatous plaques almost always contain a large lipid-necrotic core covered by a ruptured thin fibrous cap. There are no studies of sufficient size that have assessed the in vivo characterization of plaques responsible for ACS. METHODS: Patients undergoing angiography for stable ischemic heart disease and ACS (with and without ST-segment elevation) were enrolled in a prospective study. Lesions in patients with stable angina were classified as stable and those in patients with ACS as culprit or nonculprit. RESULTS: The study included 189 patients: VH-IVUS was used to assess 253 lesions (73 stable, 82 nonculprit, and 98 culprit lesions). The thin-cap fibroatheroma phenotype (VH-TCFA) was more frequent among lesions in patients with ACS (55.1% in culprit lesions, 36.6% in nonculprit lesions and 14.4% in stable lesions; P = .007). The arc of the VH-TCFA exposed to the vessel lumen was significantly greater in culprit lesions than in nonculprit lesions (122.28° ± 58 vs 89.46° ± 52; respectively; P = .007). Multivariate analysis showed that VH-TCFA (OR 2.1; P = .033), calcified nodules (OR 2.1; P = .046), positive remodeling (OR 3.5; P < .001) and necrotic core volume (OR 1.02;P = .009) were independently associated with a clinically identified culprit lesion. CONCLUSIONS: Plaque phenotype, rather than the proportion of each tissue, appears to be associated with plaque instability. VH-TCFA, particularly subtype IV, is associated with lesions responsible for ACS.

Safety, tolerability, and efficacy of fixed combination therapy with dorzolamide hydrochloride 2% and timolol maleate 0.5% in glaucoma and ocular hypertension.

Glaucoma is a collection of diseases characterized by multifactorial progressive changes leading to visual field loss and optic neuropathy most frequently due to elevated intraocular pressure (IOP). The goal of treatment is the lowering of the IOP to prevent additional optic nerve damage. Treatment usually begins with topical pharmacological agents as monotherapy, progresses to combination therapy with agents from up to 4 different classes of IOP-lowering medications, and then proceeds to laser or incisional surgical modalities for refractory cases. The fixed combination therapy with the carbonic anhydrase inhibitor dorzolamide hydrochloride 2% and the beta blocker timolol maleate 0.5% is now available in a generic formulation for the treatment of patients who have not responded sufficiently to monotherapy with beta adrenergic blockers. In pre- and postmarketing clinical studies, the fixed combination dorzolamide-timolol has been shown to be safe and efficacious, and well tolerated by patients. The fixed combination dorzolamide-timolol is convenient for patients, reduces their dosing regimen with the goal of increasing their compliance, reduces the effects of "washout" when instilling multiple drops, and reduces the preservative burden by reducing the number of drops administered per day.

Pachymetric mapping with Fourier-domain optical coherence tomography.

PURPOSE: To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) pachymetric mapping and compare central corneal thickness (CCT) measurements by OCT, ultrasound pachymetry, and scanning-slit tomography. SETTING: Doheny Eye Institute, University of Southern California, Los Angeles, California, USA. METHODS: A Fourier-domain OCT system was used to map the corneal thickness in normal eyes with scans centered on the corneal vertex or the pupil. Repeatability of central and pericentral map sectors was assessed by pooled standard deviation. The CCT measurements were compared between the OCT, ultrasound, and scanning-slit devices. RESULTS: Pupil centration (SD: 1.3 microm central, 1.8 to 3.8 microm pericentral) provided better repeatability than vertex centration (SD: 1.7 microm central, 2.4 to 5.7 microm pericentral) in all sectors (P<.035). The mean CCT was 536.9 microm +/- 27.0 (SD) by OCT, 556.6 +/- 30.5 microm by ultrasound, and 537.2 +/- 32.6 microm by scanning-slit tomography (acoustic factor 0.92). The CCT measured by OCT was significantly thinner than by ultrasound pachymetry (P = .007; mean difference -19.7 microm; 95% limits of agreement [LoA], -40.4 to 0.9 microm) but not than by scanning-slit tomography (P = .2637; mean difference -0.3 microm; 95% LoA, -24.0 to 23.5 microm). The CCT by OCT correlated well with ultrasound and scanning-slit CCTs (r = 0.940 and r = 0.934, respectively). CONCLUSION: Pachymetric mapping with Fourier-domain OCT was highly repeatable. Repeatability was better with pupil-centered scans than with corneal vertex-centered scans. Ultrasound pachymetry, Fourier-domain OCT, and scanning-slit tomography should not be used interchangeably for CCT assessment.

[Risk of venous thromboembolic disease in general surgery]. / Riesgo de la enfermedad tromboembólica venosa en cirugía general.

Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventable complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk.

[Prevention of venous thromboembolic disease in general surgery]. / Prevención de la enfermedad tromboembólica venosa en cirugía general.

Postoperative venous thromboembolic disease (VTED) affects approximately one in four general surgery patients who do not receive preventive measures. In addition to the risk of pulmonary embolism, which is often fatal, patients with VTED may develop long-term complications such as post-thrombotic syndrome or chronic pulmonary hypertension. In addition, postoperative VTED is usually asymptomatic or produces clinical manifestations that are attributed to other processes and consequently this complication is often unnoticed by the surgeon who performed the procedure. Thus, the most effective strategy consists of effective prevention of VTED using the most appropriate prophylactic measures against the patient's thromboembolic risk. There is sufficient evidence that VTED can be prevented by pharmacological methods, especially heparin and its derivatives and with mechanical methods such as support tights or intermittent pneumatic compression of the lower extremities. To reduce the incidence of VTED as far as possible, strategies have been proposed that include a combination of drugs and mechanical methods, new antithrombotic drugs, or prolonging the duration of prophylaxis in patients at very high risk, such as those who have undergone surgery for cancer. Another important aspect is the optimal moment to initiate prophylaxis with anticoagulant drugs with the aim of achieving an adequate equilibrium between antithrombotic efficacy and the risk of hemorrhagic complications. The present article reviews the available evidence to attempt to optimize prevention of VTED in general surgery and in some special groups, such as laparoscopic surgery, short-stay surgery and obesity.

Riesgo de la enfermedad tromboembólica venosa en cirugía general / Risk of venous thromboembolic disease in general surgery

A pesar de los esfuerzos preventivos, la enfermedad tromboembólica venosa (ETV) todavía constituye un importante problema para los cirujanos, debido a su frecuencia, morbilidad, mortalidad y al enorme consumo de recursos que ocasiona. Pero lo verdaderamente importante es que potencialmente estamos ante una de las complicaciones y causas de muerte postoperatoria más fácilmente prevenibles. Para tomar correctas decisiones profilácticas (indicación, método, inicio, duración, etc.), es importante conocer la epidemiología de la ETV en la cirugía general y algunas de sus poblaciones más significativas (oncológica, laparoscópica, bariátrica, ambulatoria y de corta estancia), con el objetivo de conocer los diferentes factores de riesgo existentes en las mismas, con la finalidad última de realiza runa estratificación preoperatoria del riesgo. Este artículo hace una puesta al día de todos estos aspectos (AU)

Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventible complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk (AU)

Prevención de la enfermedad tromboembólica venosa en cirugía general / Prevention of venous thromboembolic disease in general surgery

La enfermedad tromboembólica venosa (ETV) postoperatoria constituye una complicación que afecta aproximadamente a 1 de cada 4 pacientes quirúrgicos generales intervenidos y que no reciben medidas para su prevención. Además del riesgo de embolismo pulmonar, fatal en muchos casos, los pacientes que sufren ETV están expuestos a desarrollar complicaciones a largo plazo, tales como síndrome postrombótico o hipertensión pulmonar crónica. Por otra parte, la ETV postoperatoria suele ser asintomática o producir manifestaciones clínicas que se atribuyen a otros procesos, por lo que muchas veces esta complicación pasa desapercibida para el cirujano que intervino al paciente. Así pues, la mejor estrategia consiste en una eficaz prevención de la ETV, utilizando para ello las medidas profilácticas adecuadas al nivel de riesgo tromboembólico del paciente. Existe suficiente evidencia de que la ETV se puede prevenir mediante métodos farmacológicos, entre los que destacan la heparina y sus derivados, y con métodos mecánicos como las medias elásticas o los sistemas de compresión neumática intermitente de los miembros inferiores. Con objeto de reducir en lo posible la incidencia de ETV postoperatoria, se han propuesto estrategias que incluyen la combinación de fármacos y métodos mecánicos, nuevos fármacos antitrombóticos, o prolongar la duración de la profilaxis en los casos de muy alto riesgo, como los operados por cáncer. Otro aspecto importante es el del momento óptimo de inicio de la profilaxis con los fármacos anticoagulantes, con objeto de conseguir un equilibrio adecuado entre la eficacia antitrombótica y el riesgo de presentación de complicaciones hemorrágicas. En este artículo revisamos la evidencia disponible para intentar optimizar en lo posible la prevención de la ETV en cirugía general y en algunos grupos especiales, como la cirugía laparoscópica, de corta estancia y de la obesidad (AU)

Postoperative venous thromboembolic disease (VTED) affects approximately one in four general surgery patients who do not receive preventive measures. In addition to the risk of pulmonary embolism, which is often fatal, patients with VTED may develop long-term complications such as post-thrombotic syndrome or chronic pulmonary hypertension. In addition, postoperative VTED is usually asymptomatic or produces clinical manifestations that are attributed to other processes and consequently this complication is often unnoticed by the surgeon who performed the procedure. Thus, the most effective strategy consists of effective prevention of VTED using the most appropriate prophylactic measures against the patient’s thromboembolic risk. There is sufficient evidence that VTED can be prevented by pharmacological methods, especially heparin and its derivatives and with mechanical methods such as support tights or intermittent pneumatic compression of the lower extremities. To reduce the incidence of VTED as far as possible, strategies have been proposed that include a combination of drugs and mechanical methods, new antithrombotic drugs, or prolonging the duration of prophylaxis in patients at very high risk, such as those who have undergone surgery for cancer. Another important aspect is the optimal moment to initiate prophylaxis with anticoagulant drugs with the aim of achieving an adequate equilibrium between antithrombotic efficacy and the risk of hemorrhagic complications. The present article reviews the available evidence to attempt to optimize prevention of VTED in general surgery and in some special groups, such as laparoscopic surgery, short-stay surgery and obesity (AU)