Taurolidina para prevenir infecciones asociadas a catéter venoso central en niños con insuficiencia intestinal: experiencia preliminar en un hospital terciario chileno / Taurolidine for the prevention of catheter-related infections in children with intestinal insufficiency: preliminary experience in a Chilean tertiary hospital

INTRODUCCIÓN: Taurolidina es una molécula con propiedades anti-endotóxicas, antimicrobianas y anti-inflamatorias, que inhibe la adhesión bacteriana, lo que ha permitido usarla como terapia de sellado en catéter venoso central de larga duración (CVC) para prevenir infecciones del torrente sanguíneo asociadas a CVC (ITS-CVC). OBJETIVO: Dar a conocer una experiencia preliminar, la primera en Chile, con taurolidina como terapia de sellado para prevenir ITS-CVC y reportar su eficacia. MÉTODO: Se instiló una solución en base a taurolidina en el CVC de tres niños con insuficiencia intestinal, dependientes de alimentación parenteral, atendidos en un hospital terciario de la Región de Valparaíso, y se comparó la tasa de ITS-CVC antes y después de su uso mediante un análisis retrospectivo. RESULTADOS: en los dos pacientes que iniciaron terapia de sellado inmediatamente después de instalado el CVC, la tasa de ITS-CVC se logró llevar a cero, mientras que, en el tercero, portador de un CVC instalado 9 meses antes, con ITS-CVC recurrentes, un nuevo episodio de ITS-CVC obligó a suspender la profilaxis. CONCLUSIONES: La terapia de sellado con solución en base a taurolidina previno las ITS-CVC cuando ésta se inició al momento de instalarse el CVC, no así en un CVC antiguo con ITS-CVC recurrentes.

BACKGROUND: Taurolidine is a molecule with anti-endotoxic, anti-microbial and anti-inflammatory properties that inhibits bacterial adhesion, allowing for its use as lock therapy for the prevention of catheter-related bloodstream infections (CRBSI) in long-term central venous catheters (CVC). AIM: To report a preliminary experience, the first one in Chile, using lock therapy with taurolidine for the prevention of CRBSI and to report its efficacy. METHOD: A taurolidine-based solution was instilled in the CVC of three children with intestinal insufficiency dependent on parenteral nutrition, attended in a Chilean tertiary hospital, and the rate of CRBSI before and after its use was compared in retrospect. RESULTS: In the two patients who started lock therapy immediately after the installation of their CVC, the rate of CRBSI was brought to zero, whereas in the third patient, who had a 9 months-old CVC with a recurrent CRBSI history, an intercurrent CRBSI forced discontinuation of the prophylaxis. CONCLUSIONS: Lock therapy with a taurolidine-based solution prevented CRBSIs when it was begun immediately after installing the CVC, in contrast with an old CVC with a history of recurrent CRBSIs.

Taurolidina, un antiséptico para la prevención de infecciones asociadas a catéter venoso central / Taurolidine, an antiseptic for the prevention of central venous catheter-related infections

Resumen Taurolidina es un antiséptico de amplio espectro usado como solución de terapia de sellado (lock therapy) en adultos y niños portadores de catéter venoso central de larga duración (CVC) para prevenir las infecciones asociadas a CVC (IACVC). No induce desarrollo de resistencia y tiene efectos adversos leves y fugaces, lo que lo convierte en una alternativa, tanto como terapia de sellado como para la profilaxis de las IACVC, en este grupo de pacientes.

Taurolidine is a broad-spectrum antiseptic used as lock therapy solution in adult and pediatric patients with long term central venous catheters (CVC) for the prevention of catheter related bloodstream infections (CRBSI). Taurolidine doesn't induce the resistant development and has only minor and brief side effects, which makes it an alternative both as a lock therapy and for the prevention of CRBSI in this group of patients.

The Current Situation of Treatment Systems for Alcoholism in Korea

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

Actualización del tratamiento farmacológico de la dependencia alcohólica / Pharmacological review of alcoholic dependence treatment

El objetivo de la presente actualización farmacológica es abordar la problemática de la dependencia alcohólica. Partiendo de las bases biológicas y del impacto del etanol sobre los sistemas neurobiológicos y de neurotransmisión, se hará una revisión de las principales herramientas farmacológicas para el tratamiento de la dependencia alcohólica. El disulfiram, la naltrexona y el acamprosato, todas ellas con aprobación por la FDA (Food and Drug Administration) han mostrado mecanismos de acción, perfiles de eficacia, tolerabilidad y adherencia dispares. También nos referiremos al topiramato, el que está siendo estudiado actualmente con relación a esta indicación.

The aim of the present pharmacological update is to revise the problem of alcohol dependence. Starting from the biological bases and the impact of alcohol on the neurobiological and neurotransmission systems, a revision of the main pharmacological tools for alcohol dependence treatment will be done. Disulfiram, naltrexone, acamprosate, all of them approved by the FDA (Food and Drug Administration), have shown mechanisms of action, efficacy, tolerance and adherence dissimilar. We will also refer to topiramate, which is being studied for this indication.

Tratamiento del tinnitus en hipoacusias neurosensoriales de curvas descendentes por modulación de los neurotransmisores con el uso de acamprosato: experiencia clínica / Tinnitus treatment by neurotransmitter modulation in high frequency sensorineural hearing loss using Acamprosate: a clinical experience

Introducción: El tinnitus neurosensorial está correlacionado con numerosas patologías del oído interno y de su vía central y que pueden originarse en cualquier nivel de ésta; sin embargo todas estas noxas pueden manifestarse igual en corteza auditiva, como una sensación auditiva sin mediar un estímulo acústico externo, de tal manera que este mensajero común deben ser los neurotransmisores. Se han descrito dos en la vía auditiva aferente: el glutamato que es excitatorio y el GABA que es inhibitorio. Numerosos estudios revelan que el tinnitus neurosensorial se produciría por un desbalance de estos dos neurotransmisores con predominio excitatorio. El acamprosato es un fármaco usado en el alcoholismo que actuaría modulando el equilibrio GABA-glutamato. Existe un sólo estudio publicado con el uso del acamprosato en el tinnitus con una mejoría o disminución de su intensidad en 80 por ciento o más de los casos. Objetivos: Conocer la real utilidad del fármaco pues en este estudio, arriba mencionado, la evaluación fue sólo subjetiva y sin seguimiento. Material y Método: Fueron estudiados 20 pacientes tratados por un mes efectuándose tinnitumetría, evaluación psicoemocional (THI) y seguimiento. Resultados: De los 20 pacientes, en dos desapareció el tinnitus, en seis bajaron los niveles de la tinnitumetría en 5 dBo más con mejoría del THI en 50 por ciento o más y en doce pacientes la mejoría fue menor o ninguna. Conclusiones: Sería posible modular los neurotransmisores de la vía auditiva aferente con éxito, en aquellos pacientes con tinnitus severo. Es un estudio original con un respaldo fisiopatológico que abre nuevas perspectivas terapéuticas.

effect of monosodium glutamate [MSG] on rat liver and the ameliorating effect of "guanidino ethane sulfonic acid [GES]" [Histological, Histochemical and Electron Microscopy Studies]

Food additives are chemical substances added intentionally to food stuffs to preserve, color, sweeten and flavor food. Monosodium glutamate [MSG] is used as a flavor enhancer and found in most soups, salad dressing and processed meat. The use of MSG in food is growing. Irrational fear had increased in the last few years due to the adverse reactions and toxicity of MSG. The present study was designed to investigate the effect of MSG on the rat liver and the ameliorating effect of taurine analog "Guanidinoethane sulfonic acid [GES]". Sixty albino rats [2-3 months old] were used in the present study. MSG was given orally at a daily dose of 60 mg/1000 g for one month, two months and was given at a daily dose of 100mg/1000gm for one month. The results revealed that the deleterious effects of MSG were dose related and cumulative. In MSG treated rats, the examined sections showed remarkable alterations varied considerably from moderate structural changes to cytoplasmic lysis and signs of degeneration of cellular organelles. The histological changes showed disturbed liver architecture, hemorrhage in the central veins, areas of necrosis, vacuolation and increased inflammatory cells infiltration. The glycogen granules increased as well as the collagen fibers in the liver cells. Ultrastructural changes showed loss of cytoplasmic differentiation, vacuolation, pyknotic nuclei with irregular nuclear membranes and elongated electron dense mitochondria. Conversely, treatment of rats with taurine analog [GES] significantly attenuated the cellular toxicity of MSG

Pharmacotherapy for Alcohol Dependence: Anticraving Medications for Relapse Prevention

Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors. Relapse prevention for alcohol dependence has traditionally involved psychosocial and psychotherapeutic interventions. Pharmacotherapy, however, in conjunction with behavioral therapy, is generating interest as another modality to prevent relapse and enhance abstinence. Naltrexone and acamprosate are at the forefront of the currently available pharmacological options. Naltrexone is an opioid receptor antagonist and is thought to reduce the rewarding effect of alcohol. Acamprosate normalizes the dysregulation of N-methyl-D-aspartate (NMDA)-mediated glutamatergic excitation that occurs in alcohol withdrawal and early abstinence.These different mechanisms of action and different target neurotransmitter systems may endow the two drugs with efficacy for different aspects of alcohol use behavior. Since not all patients seem to benefit from naltrexone and acamprosate, there are ongoing efforts to improve the treatment outcomes by examining the advantages of combined pharmacotherapy and exploring the variables that might predict the response of the medications. In addition, novel medications are being investigated to assess their efficacy in preventing relapse and increasing abstinence.

Uso do acamprosato no tratamento do zumbido: um estudo duplo-cego / Tinnitus treatment with acamprosate: double-blind study

O tratamento do zumbido é, ainda nos dias de hoje, um grande desafio para os otorrinolaringologistas. Várias lacunas persistem em sua fisiopatologia, tendo como resultado vários tipos de tratamento, com resultados muito irregulares. O acamprosato é uma droga utilizada no tratamento do alcoolismo, devido à sua ação reguladora da transmissão glutamatérgica e GABA-érgica, nunca tendo sido empregado no tratamento do zumbido. OBJETIVO: Avaliar a segurança e eficácia do uso do acamprosato, no tratamento do zumbido de causa neurossensorial. FORMA DE ESTUDO: ensaio clinico randomizado. MATERIAL E MÉTODO: 50 pacientes com zumbido de causa neurossensorial foram divididos em 2 grupos, 25 recebendo acamprosato e 25 placebo por 3 meses, em um estudo prospectivo duplo-cego, sendo analisados os efeitos terapêuticos e efeitos colaterais, de acordo com escala (nota) de 1 a 10, atribuída pelo próprio paciente. RESULTADOS: Foi observado algum grau de melhora sintomatológica em 86,9 por cento dos pacientes, sendo que em 47,8 por cento dos casos observamos melhora superior a 50 por cento, dados estatisticamente significativos em relação ao placebo. A incidência de efeitos colaterais encontrada foi baixa (12 por cento) e de intensidade leve, com boa tolerabilidade geral. CONCLUSÃO: O acamprosato, medicação utilizada no tratamento do alcoolismo, é eficaz e seguro para o tratamento do zumbido de causa neurossensorial, com percentual de melhora superior à maioria das medicações utilizadas para o tratamento do zumbido, constituindo uma excelente alternativa terapêutica.

Tratamento farmacológico da dependência do álcool / The pharmacologic treatment of the alcohol dependence

As intervencões farmacológicas podem ter um papel crucial na reducão do craving, consumo de álcool e manutencão da abstinência. Este artigo revisa a farmacoterapia para a dependência de álcool com ênfase na naltrexona, dissulfiram e acamprosato. O antagonista opióide naltrexona diminui taxas de recaída, reduz dias de consumo e prolonga períodos de abstinência. Acamprosato restaura a atividade normal dos sistemas glutamato e GABA. Dissulfiram tem demonstrado ser mais efetivo para pacientes que acreditam em sua eficácia e permanecam aderentes ao tratamento. Ondansetron tem-se mostrado promissor na dependência de álcool de início precoce, mas necessita estudos mais extensivos. Topiramato (até 300 mg/dia) foi mais eficaz do que placebo no tratamento da dependência de álcool.

Efficacy of acamprosate in the treatment of alcohol-dependent outpatients

OBJECTIVE: To evaluate the efficacy and security of acamprosate in the treatment of 75 men, aged 18 to 59 years, with diagnosis of alcohol dependence according to the ICD-10. METHODS: Double-blind, placebo-controlled study, 24-week long. After a one-week detoxification period, patients were randomly divided in two groups: the first group received acamprosate (six tablets of 333 mg/d for 12 weeks) and the second group received placebo (six tablets for 12 weeks). After the first 12 weeks, patients continued the follow-up for further 12 weeks without medication. RESULTS: Patients who were receiving acamprosate showed significantly higher continuous abstinence time within the 24 weeks of treatment compared with patients who were assigned to placebo treatment (p=.017). Twenty-five percent of patients who were receiving acamprosate and 20 percent of the placebo-treated patients dropped out. Few side-effects were reported in both groups. CONCLUSION: Acamprosate proved to be safe and effective in treating alcohol-dependent patients and to maintain the abstinence during 24 weeks

Rol biológico y nutricional de la taurina y sus derivados en la fisiologia organica y celular / Biological and nutritional role of taurine and its derivatives on cellular and organic physiology

Se describen varios aspectos relacionados con el rol biológico y nutricional de la taurina y sus derivados, en células de mamíferos, con especial referencia a lo que sucede en el humano. Se analizan, además, algunos aspectos relacionados con la estructura y función de la molécula respecto a su capacidad antioxidante y osmoreguladora. Se discuten también las alteraciones que en algunos casos se pueden presentar en la distribución de este aminoácido, las cuales se producen ya sea por cambios en su biosíntesis en algunas etapas del desarrollo, o bien, por cambios a nivel del transporte en algunos tejidos donde las concentraciones están aumentadas varias veces en relación a las concentracicones plasmáticas. Existen algunas evidencias acerca de la posibilidad que la taurina pueda ser considerada como un nutriente condicionalmente esencial, en algunos casos en los que sus concentraciones en el plasma y fluidos biológicos tienen ciertas implicaciones clínicas y nutricionales