Influencia del manguito de isquemia en la profilaxis antibiótica en prótesis total de rodilla / Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement

Objetivo. Existe evidencia científica grado iv de la importancia que el antibiótico administrado preoperatoriamente tiene en la prevención de la infección protésica. Hay controversia en si la isquemia aplicada en la cirugía de estos pacientes puede afectar a la concentración mínima inhibitoria del antibiótico en los tejidos periprotésicos. Para estudiar este fenómeno hemos diseñado un estudio basado en la determinación de la concentración de antibiótico en el tejido sinovial. Material y método. Estudio clínico prospectivo observacional de 32 pacientes intervenidos de prótesis total de rodilla. Se administró 2 g de cefonicid como profilaxis y se utilizó el manguito de isquemia en todos los pacientes, cuantificándose la concentración antibiótica mediante la cromatografía líquida de alta resolución en muestras de tejido sinovial del inicio y del final de la intervención. Resultados. La concentración media de antibiótico fue de 23,16 μg/g (IC del 95%, 19,19-27,13) en las muestras del inicio de la intervención y de 15,45 μg/g (IC del 95%, 13,20-17,69) en las muestras del final, mostrándose superiores a la concentración mínima inhibitoria del cefonicid, establecida en 8 μg/g, siendo estos resultados estadísticamente significativos para ambas concentraciones (p < 0,00001). Discusión. La concentración de antibiótico a lo largo de una intervención estándar de prótesis total de rodilla realizada con isquemia preventiva varía a lo largo de la intervención sufriendo un descenso paulatino. Aun así, la concentración determinada al final de la intervención no fue inferior a la concentración mínima inhibitoria del antibiótico estudiado. Como conclusión, la utilización del manguito de isquemia no aumenta el riesgo de infección (AU)

Objective. There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. Material and method. A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2 g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. Results. The mean concentration of antibiotic was 23.16 μg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 μg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 μg/g. These results were statistically significant for both concentrations (P<.00001). Discussion. The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection (AU)

Púrpura trombocitopénica trombótica puerperal / Postpartum thrombotic thrombocytopenic purpura

La púrpura trombocitopénica trombótica es una enfermedad multisistémica de etiología desconocida. Se han observado diversas circunstancias que pueden actuar como factores predisponentes: la gestación, un proceso infeccioso, los anticonceptivos orales y la cirugía. Las mujeres embarazadas o en el período posparto representan un 10% de los casos de púrpura trombocitopénica trombótica, con una incidencia aproximada de un caso de cada 25.000 partos. Presentamos un caso clínico de una mujer que desarrolló púrpura trombocitopénica trombótica a los 6 días de habérsele realizado una cesárea, sin otros hallazgos significativos, enfatizando la importancia de reconocer esta afección en vista de la similitud con otras enfermedades durante el embarazo (AU)

Thrombotic thrombocytopenic purpura is a multisystem disease of unknown etiology. There are various predisposing factors, such as pregnancy, an infectious process, oral contraceptives, and surgery. Pregnant or postpartum women represent 10% of cases of thrombotic thrombocytopenic purpura, with an approximate incidence of one in 25,000 births. We report the case of a woman who developed thrombotic thrombocytopenic purpura 6 days after undergoing a caesarean section without other significant findings, emphasizing the importance of distinguishing this disease from other, highly similar illnesses during pregnancy (AU)

Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement.

OBJECTIVE: There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. MATERIAL AND METHOD: A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. RESULTS: The mean concentration of antibiotic was 23.16 µg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 µg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 µg/g. These results were statistically significant for both concentrations (P<.00001). DISCUSSION: The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection.

[Neurotrophic factors and their importance in attention deficit hyperactivity disorde]. / Factores neurotróficos y su trascendencia en el trastorno por déficit de atención/hiperactividad.

The existing literature that reports findings linked with the involvement of neurotrophic factors in attention deficit hyperactivity disorder (ADHD) is reviewed. Neurotrophins, a family of neurotrophic factors, are a kind of proteins that are specific to the nervous system and play an essential role in neuron survival, differentiation and proliferation during the development of the central and peripheral nervous system. These molecules stimulate axonal growth and exert an influence on the connections with the target tissue in order to establish the synaptic connections. The study of neurotrophins in ADHD, a neurodevelopmental disorder, is of interest mainly due to the functions that these proteins perform in the central nervous system. Studies on animal, pharmacological and molecular genetic models yield evidence that relates neurotrophins with the disorder. This work reviews the results from the studies conducted to date on ADHD and neurotrophic factors, especially brain-derived neurotrophic factor (BDNF). Thus, although pharmacological studies suggest that the response to atomoxetine in adults with ADHD is not directly mediated by the effect on the BDNF, reductions in BDNF levels in the plasma of adult patients with ADHD have been reported. Further studies with broader samples and greater control of environmental factors that can regulate neurotrophin expression, such as diet, physical exercise and situations of social risk, are needed to be able to determine the role they play in the aetiology of ADHD.

TITLE: Factores neurotroficos y su trascendencia en el trastorno por deficit de atencion/hiperactividad.Se revisa la bibliografia existente sobre los hallazgos de la implicacion de los factores neurotroficos en el trastorno por deficit de atencion/hiperactividad (TDAH). Las neurotrofinas, una familia de factores neurotroficos, son un tipo de proteinas especificas del sistema nervioso con un papel esencial en la supervivencia, diferenciacion y proliferacion neuronal durante el desarrollo del sistema nervioso central y periferico. Estas moleculas estimulan el crecimiento axonal e influyen en las conexiones con el tejido diana para el establecimiento de las conexiones sinapticas. El interes por el estudio de las neurotrofinas en el TDAH, un trastorno del neurodesarrollo, deriva principalmente de las funciones que estas proteinas ejercen en el sistema nervioso central. Existen evidencias derivadas de estudios en modelos animales, farmacologicos y de genetica molecular que relacionan a las neurotrofinas con el trastorno. En el presente trabajo se revisan los resultados de los estudios realizados hasta el momento sobre TDAH y factores neurotroficos, principalmente factor neurotrofico derivado de cerebro (BDNF). Asi, aunque estudios farmacologicos sugieren que la respuesta a la atomoxetina en adultos con TDAH no esta directamente mediada por el efecto sobre el BDNF, se han descrito disminuciones en los niveles plasmaticos de BDNF en pacientes adultos con TDAH. Se requieren estudios con muestras mas amplias y mayor control de factores ambientales que pueden regular la expresion de la neurotrofinas, como la dieta, el ejercicio fisico y situaciones de riesgo social, con el fin de determinar el papel de estas en la etiologia del TDAH.

Factores neurotróficos y su trascendencia en el trastorno por déficit de atención/hiperactividad / Neurotrophic factors and their importance in attention deficit hyperactivity disorder

Se revisa la bibliografía existente sobre los hallazgos de la implicación de los factores neurotróficos en el trastorno por déficit de atención/hiperactividad (TDAH). Las neurotrofinas, una familia de factores neurotróficos, son un tipo de proteínas específicas del sistema nervioso con un papel esencial en la supervivencia, diferenciación y proliferación neuronal durante el desarrollo del sistema nervioso central y periférico. Estas moléculas estimulan el crecimiento axonal e influyen en las conexiones con el tejido diana para el establecimiento de las conexiones sinápticas. El interés por el estudio de las neurotrofinas en el TDAH, un trastorno del neurodesarrollo, deriva principalmente de las funciones que estas proteínas ejercen en el sistema nervioso central. Existen evidencias derivadas de estudios en modelos animales, farmacológicos y de genética molecular que relacionan a las neurotrofinas con el trastorno. En el presente trabajo se revisan los resultados de los estudios realizados hasta el momento sobre TDAH y factores neurotróficos, principalmente factor neurotrófico derivado de cerebro (BDNF). Así, aunque estudios farmacológicos sugieren que la respuesta a la atomoxetina en adultos con TDAH no está directamente mediada por el efecto sobre el BDNF, se han descrito disminuciones en los niveles plasmáticos de BDNF en pacientes adultos con TDAH. Se requieren estudios con muestras más amplias y mayor control de factores ambientales que pueden regular la expresión de la neurotrofinas, como la dieta, el ejercicio físico y situaciones de riesgo social, con el fin de determinar el papel de éstas en la etiología del TDAH (AU)

The existing literature that reports findings linked with the involvement of neurotrophic factors in attention deficit hyperactivity disorder (ADHD) is reviewed. Neurotrophins, a family of neurotrophic factors, are a kind of proteins that are specific to the nervous system and play an essential role in neuron survival, differentiation and proliferation during the development of the central and peripheral nervous system. These molecules stimulate axonal growth and exert an influence on the connections with the target tissue in order to establish the synaptic connections. The study of neurotrophins in ADHD, a neurodevelopmental disorder, is of interest mainly due to the functions that these proteins perform in the central nervous system. Studies on animal, pharmacological and molecular genetic models yield evidence that relates neurotrophins with the disorder. This work reviews the results from the studies conducted to date on ADHD and neurotrophic factors, especially brain-derived neurotrophic factor (BDNF). Thus, although pharmacological studies suggest that the response to atomoxetine in adults with ADHD is not directly mediated by the effect on the BDNF, reductions in BDNF levels in the plasma of adult patients with ADHD have been reported. Further studies with broader samples and greater control of environmental factors that can regulate neurotrophin expression, such as diet, physical exercise and situations of social risk, are needed to be able to determine the role they play in the aetiology of ADHD (AU)

[Diagnosis and treatment of attention deficit hyperactivity disorder in adults]. / Diagnostico y tratamiento del trastorno por deficit de atencion/hiperactividad en adultos.

AIM: To review the latest data available concerning the diagnosis and treatment of adults with attention deficit hyper-activity disorder (ADHD). DEVELOPMENT AND CONCLUSIONS: A number of different instruments for evaluating ADHD have been adapted to the adult patient and allow a reliable diagnosis of the disorder to be reached. Semi-structured interviews, like the Diagnostisch Interview Voor ADHD 2.0 (DIVA), simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD. Quick screening instruments that allow better detection of ADHD in adults, such as the Adult Self-Report Scale 1.1 (ASRS), have been validated. In recent years, there has been a notable increase in the number of studies focused on ADHD in adults and that research has provided solid data regarding the safety and effectiveness of different treatments. According to the recommendations of the European Consensus statement by the European Network Adult ADHD, the treatment ought to be multimodal, which means combining pharmacological interventions with psychological and psychosocial ones. Methylphenidate displays a high degree of effectiveness and safety in the treatment of adults at doses of around 1 mg/kg/day. Amphetamines, such as lisdexamphetamine, have also proved to be effective in the treatment of adults with ADHD. Among non-stimulant treatments, atomoxetine has proved to be effective and safe in adults in doses of about 80-100 mg/day. Excellent studies have been conducted on the cognitive-behavioural treatment of adults with ADHD, the results of which highlight its effectiveness in both the short and the long term.

Diagnóstico y tratamiento del trastorno por déficit de atención/hiperactividad en adultos / Diagnosis and treatment of attention deficit hyperactivity disorder in adults

Objetivo. Revisar los últimos datos existentes sobre el diagnóstico y el tratamiento de los adultos con trastorno por déficit de atención/hiperactividad (TDAH). Desarrollo y conclusiones. Existen diferentes instrumentos de evaluación del TDAH adaptados a la edad adulta que permiten un diagnóstico fiable del trastorno. Las entrevistas semiestructuradas, como la Diagnostisch Interview Voor ADHD 2.0 (DIVA), facilitan una evaluación rigurosa de los síntomas del trastorno en la edad adulta, así como de las disfuncionesgeneradas por el TDAH. Se han validado instrumentos de cribado rápido, como la escala Adult Self-Report Scale 1.1 (ASRS), que permiten una mejor detección del TDAH en adultos. Durante los últimos años se ha incrementado de forma notable la investigación centrada en el TDAH en adultos, y se han aportado datos sólidos respecto la seguridad y eficacia de diferentes tratamientos. Según las recomendaciones del Consenso Europeo de la European Network Adult ADHD, se considera que el tratamiento debe ser multimodal, de modo que se combinen las intervenciones farmacológicas con las psicológicas y las psicosociales. El metilfenidato evidencia una elevada eficacia y seguridad en el tratamiento de adultos en dosis en torno a 1 mg/kg/día. Las anfetaminas, como la lisdexanfetamina, también han mostrado ser fármacos eficaces en el tratamiento de los adultos con TDAH. Dentro de los tratamientos no estimulantes, la atomoxetina ha demostrado ser eficaz y segura en adultos en dosis de unos 80-100 mg/día. Se han realizado excelentes estudios sobre el tratamiento cognitivo-conductual en adultos con TDAH, que ponen de manifiesto su eficacia a corto y largo plazo (AU)

Aim. To review the latest data available concerning the diagnosis and treatment of adults with attention deficit hyperactivity disorder (ADHD). Development and conclusions. A number of different instruments for evaluating ADHD have been adapted to the adult patient and allow a reliable diagnosis of the disorder to be reached. Semi-structured interviews, like the Diagnostisch Interview Voor ADHD 2.0 (DIVA), simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD. Quick screening instruments that allow better detection of ADHD in adults, such as the Adult Self-Report Scale 1.1 (ASRS), have been validated. In recent years, there has been a notable increase in the number of studies focused on ADHD in adults and that research has provided solid data regarding the safety and effectiveness of different treatments. According to the recommendations of the European Consensus statement by the European Network Adult ADHD, the treatment ought to be multimodal, which means combining pharmacological interventions with psychological and psychosocial ones. Methylphenidate displays a high degree of effectiveness and safety in the treatment of adults at doses of around 1 mg/kg/day. Amphetamines, such as lisdexamphetamine, have also proved to be effective in the treatment of adults with ADHD. Among non-stimulant treatments, atomoxetine has proved to be effective and safe in adults in doses of about 80-100 mg/day. Excellent studies have been conducted on the cognitive-behavioural treatment of adults with ADHD, the results of which highlight its effectiveness in both the short and the long term (AU)