Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion.

INTRODUCTION: Although the prognostic value of persistent hyperlactatemia in septic shock is unequivocal, its physiological determinants are controversial. Particularly, the role of impaired hepatic clearance has been underestimated and is only considered relevant in patients with liver ischemia or cirrhosis. Our objectives were to establish whether endotoxemia impairs whole body net lactate clearance, and to explore a potential role for total liver hypoperfusion during the early phase of septic shock. METHODS: After anesthesia, 12 sheep were subjected to hemodynamic/perfusion monitoring including hepatic and portal catheterization, and a hepatic ultrasound flow probe. After stabilization (point A), sheep were alternatively assigned to lipopolysaccharide (LPS) (5 mcg/kg bolus followed by 4 mcg/kg/h) or sham for a three-hour study period. After 60 minutes of shock, animals were fluid resuscitated to normalize mean arterial pressure. Repeated series of measurements were performed immediately after fluid resuscitation (point B), and one (point C) and two hours later (point D). Monitoring included systemic and regional hemodynamics, blood gases and lactate measurements, and ex-vivo hepatic mitochondrial respiration at point D. Parallel exogenous lactate and sorbitol clearances were performed at points B and D. Both groups included an intravenous bolus followed by serial blood sampling to draw a curve using the least squares method. RESULTS: Significant hyperlactatemia was already present in LPS as compared to sham animals at point B (4.7 (3.1 to 6.7) versus 1.8 (1.5 to 3.7) mmol/L), increasing to 10.2 (7.8 to 12.3) mmol/L at point D. A significant increase in portal and hepatic lactate levels in LPS animals was also observed. No within-group difference in hepatic DO2, VO2 or O2 extraction, total hepatic blood flow (point D: 915 (773 to 1,046) versus 655 (593 to 1,175) ml/min), mitochondrial respiration, liver enzymes or sorbitol clearance was found. However, there was a highly significant decrease in lactate clearance in LPS animals (point B: 46 (30 to 180) versus 1,212 (743 to 2,116) ml/min, P < 0.01; point D: 113 (65 to 322) versus 944 (363 to 1,235) ml/min, P < 0.01). CONCLUSIONS: Endotoxemia induces an early and severe impairment in lactate clearance that is not related to total liver hypoperfusion.

Evaluación de la microcirculación con sidestream dark field (SDF) Microscan® como método de monitorización en microcirugía en modelo porcino / Microcirculation assessment with sidestream dark field (SDF) Microscan® as flap monitoring method in microsurgery in a porcine model

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.

Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.

Evaluación de la salud oral y de las características fenotípicas de individuos con síndrome de Down de diferentes agrupaciones en Monterrey, México / Assessing oral health and phenotypic characteristics of individuals with Down syndrome from a range of associations, in Monterrey, Mexico

Objetivo: El propósito de esta investigación fue identificar las condiciones de la salud oral de los integrantes con síndrome de Down de diferentes agrupaciones en Monterrey, México. Material y métodos: El tamaño de la muestra fue de 97 personas de ambos sexos, con edades entre los 3 y48 años (Me = 9.5). Las condiciones de la salud oral y manifestaciones clínicas propias se evaluaron de acuerdo con los criterios de la Organización Mundial de la Salud, adicionalmente se determinaron los índices de placa dental y gingival de Lõe y Silness. Resultados: El 53.75 por ciento presentó caries, 33.75 por ciento cálculos, se encontró apiñamiento en el 45.75 por ciento, mientras que el 85 por ciento reveló un tipo de alteración en el sector posterior, y se realizó un análisis de las manifestaciones clínicas propias del padecimiento. El índice de placa dental fue de 1.96 y el gingival de 1.91. Conclusiones: Existen condiciones de salud oral defi cientes de los participantes de este estudio, reafi rmándose la urgencia de diseñar y ejecutar programas de atención odontológica integral para pacientes con discapacidad

Objective:The aim of this study was to identify the oral health statusof people with Down syndrome belonging to various associations in Monterrey, Mexico. Material and methods: A sample of 97 individu-als aged from 3 to 48 (MA = 9.5) and of both sexes was selected. The subjects’ oral health status and clinical manifestations were assessed based on World Heart Organization criteria and we also calculated the Lõe-Silness dental plaque and gingival indexes. Results: A total of 53 .75% of the subjects had caries; 33.75% calculus; 45.75% crowding, and 85% presented some form of alteration in the poste-rior sector. The clinical manifestations of the disease in each patient were analyzed. The dental plaque index was 1.96 and the gingival index 1.91. Conclusions: The individuals in the study were found to have poor dental health, which is further evidence of the urgent need to design and implement comprehensive dental care programs for patients with disabilities.

Hábitos orales: succión de dedo, chupón o mamila / Oral habits: thumb sucking, pacifier or bottle

Los hábitos orales de succión, chupón o mamila, pueden modificar el desarrollo orofacial normal, originando deformaciones dentoesqueléticas, además de problemas sicológicos, emocionales, de aprendizaje y de otros aparatos y sistemas (respiratorio, digestivo, entre otros). La incidencia elevada de estos hábitos y de maloclusiones indica la necesidad que el profesional de salud bucal sea competente para detectar malos hábitos y algunos signos de anomalías dentomaxilares en forma temprana, ya que mientras sean detectadas a tiempo, menor será el daño que provoquen.

Suction oral habits can modify the normal development of the orofacial system, leading to facial deformities, besides psychological and emotional problems, learning and along with disturbances in other systems like respiratory, digestive, etc. The high incidences of oral habits show the meaning of the pediatric control in order to prevent malocclusion and oral deformities later.