Evaluación de la relajación neuromuscular y predictores de vía aérea difícil en pacientes programados para cirugía general Hospital Central Universitario Dr. Antonio María Pineda / Evaluation of muscle relaxation and predictors of difficult airway in patients programmed for general surgery Hospital Central Universitario Dr. Antonio María Pineda

Se realizó una investigación experimental tipo ensayo clínico controlado simple ciego con el fin de evaluar la relajación muscular y los predictores de vía aérea difícil en pacientes programados para cirugía general en el Hospital Central Universitario Dr. Antonio María Pineda. La muestra estuvo conformada por 100 pacientes distribuidos aleatoriamente en cuatro grupos de 25 pacientes cada uno. En los grupos Experimental-1 (E-1) y Control-1 (C-1) se utilizó una dosis del bloqueante neuromuscular Bromuro de Rocuronio de 0,6 mg/kg y en los grupos Experimental-2 (E-2) y Control-2 (C-2) de 1 mg/kg. La edad promedio de los pacientes fue de 34,8 ± 9,8 años; en los grupos E-1 y E-2, los predictores de vía aérea difícil predominantes fueron distancia esternomentoniana (32% y 42%), distancia tiromentoniana (24% y 40%), distancia interincisivos clase I (88% y 92 %), circunferencia de cuello  40 cm (16% y 8 %), Mallampati (88% y 40%), extensión atlanto-occipital (28% y 20%) y protrusión mandibular (28% y 20%). En el 72% y 80% de los pacientes de los grupos experimentales y control no hubo intento adicional de intubación orotraqueal (IOT); el tiempo invertido para alcanzar la IOT fue < 1 minuto en el grupo C-2 (64%) y E-2 (72%). Existen diferencias estadísticamente significativas entre el número de intentos para alcanzar la IOT, la presencia de predictores de vía aérea difícil y la dosis de bloqueante neuromuscular utilizada lo que evidencia de que a medida que se aumenta la dosis del medicamento hay mayor posibilidad de éxitos en la IOT, aun cuando estén presentes predictores de vía aérea difícil(AU)

An experimental simple blind controlled clinical trial was carried out to evaluate muscle relaxation and predictors of difficult airway in patients scheduled for general surgery at the Hospital Central Universitario Dr. Antonio María Pineda. The sample consisted of 100 patients randomly distributed into four groups of 25 patients each. Patients from the Experimental-1 (E-1) and Control-1 (C-1) groups received 0.6 mg/kg of the neuromuscular blocking agent Rocuronium Bromide while Experimetal-2 (E-2) and Control-2 (C-2) patients received a dosage of 1 mg/kg. Average age of participants was 34.8 ± 9.8 years. Predictors of difficult airway in E-1 and E-2 were sternomental distance (32% and 42%, thyromental distance (24% and 40%), interincisive distance class 1 (88% and 92%), neck circumference  40 cm (16% and 8%), Mallampati (88% and 40%), atlanto-occipital extension (28% and 20%) and mandibular protrusion (28% and 20%). In 72% and 80% of patients from the E and C groups there was not an additional attempt of orotracheal intubation (OTI); the time invested to reach the OTI was less than one minute in 64% of patients from the C-2 and 72% of the E-2. There are statistically significant differences between the number of attempts to reach the OTI, presence of predictors of difficult airway and the dose of Rocuronium Bromide which means that as the drug dosage increases, there is a greater possibility of success in the OTI, even when predictors of difficult airway are present(AU)

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.

Background Prophylactic oophorectomy alongside hysterectomy in premenopausal women is a common procedure. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for additional gynaecological surgical interventions,and is weighed against the perceived risk of negative health effects caused by surgically induced menopause. The evidence needed to recommend either prophylactic bilateral oophorectomy or conservation of ovaries at the time of hysterectomy in premenopausal women is limited. This is an update of the original version of this systematic review published in 2008.Objectives To compare hysterectomy alone versus hysterectomy plus bilateral oophorectomy in women with benign gynaecological conditions,with respect to rates of mortality or subsequent gynaecological surgical interventions.Search methods We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to January 2014) and the following electronic databases: CENTRAL (The Cochrane Library 2013, Issue 12), MEDLINE (January 1966 to January 2014),EMBASE (January 1985 to January 2014), and PsycINFO (1806 to January 2014).Selection criteria Randomised controlled trials (RCTs) of hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women with benign gynaecological conditions were eligible. Any surgical approach could be used.Data collection and analysis Three review authors independently assessed trials for inclusion. Study authors were contacted if information was unclear.Main results Only one RCT comparing the benefits and risks of hysterectomy with or without oophorectomy was identified. The results of this pilot RCT have not been published and we have not been able to obtain the results. Therefore, no data could be included in this review. Authors' conclusions The conclusions of this review are limited by a lack of RCTs. Although no evidence is available from RCTs, there is growing evidence from observational studies that surgical menopause may impact negatively on cardiovascular health and all cause mortality.

Mifepristone for uterine fibroids.

BACKGROUND: Uterine fibroids are the most common benign uterine tumours present in women of reproductive age. Mifepristone (RU-486) competitively binds and inhibits progesterone receptors. Studies have suggested that fibroid growth depends on the sexual steroids. Mifepristone has been shown to decrease fibroid size. This review summarises the effects of mifepristone treatment on fibroids and the associated adverse effects as described in randomised controlled trials. OBJECTIVES: To determine the efficacy and safety of mifepristone for the management of uterine fibroids in pre-menopausal women. SEARCH METHODS: We searched the specialised register of the Cochrane Menstrual Disorders and Subfertility (Cochrane Menstrual Disorders and subfertility Review Group), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE, EMBASE, PsycINFO, and CINAHL (to November 2011). We handsearched a number of journals, and searched reference lists, databases of ongoing trials and the Internet. There were no language restrictions. SELECTION CRITERIA: Only truly randomised controlled trials of mifepristone versus other forms of medical therapy or placebo in pre-menopausal women with confirmed uterine fibroids were included. DATA COLLECTION AND ANALYSIS: Four authors independently extracted data and assessed trial quality. Data were analysed using the Peto odds ratios (OR) for dichotomous data and the weighted mean differences for continuous data, with 95% confidence intervals (CI). Meta-analyses were performed using the fixed-effect model. MAIN RESULTS: Three studies involving 112 participants were included. Comparison interventions included different dosages of mifepristone, placebo and vitamin B tablets. There is evidence that treatment with mifepristone relieves heavy menstrual bleeding compared with placebo (Peto OR 17.84; 95% CI 6.72 to 47.38; 2 RCTs, 77 women, I(2) = 0%). Three studies (Bagaria 2009; Engman 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on the fibroid volume (standardised mean difference (SMD) -0.02; 95% CI -0.38 to 0.41; 99 women). Two studies (Bagaria 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on uterine volume (mean difference (MD) -77.24; 95% CI -240.62 to 86.14; 72 women). The pooled data suggest an increased adverse event (abnormal endometrial histology) in the mifepristone group compared to placebo (OR 31.65; 95% CI 4.83 to 207.35; 2 RCTs; 54 women; I(2) = 0%). Only one study (Bagaria 2009) reported endometrial hyperplasia at the end of the therapy (12/19 women in the mifepristone group versus 0/16 in the placebo group; OR 55.0; 95% CI 2.86 to 105.67). Engman 2009 found a significantly higher rate of cystic glandular dilatation in women in the mifepristone group (5/8 women biopsied) compared with the placebo group (1/11 women biopsied) (OR 16.67; 95% CI 1.36 to 204.03). One study (Fiscella 2006) suggested significant improvements (P < 0.001) for specific quality of life outcomes. AUTHORS' CONCLUSIONS: Mifepristone reduced heavy menstrual bleeding and improved fibroid-specific quality of life. However, it was not found to reduce fibroid volume. Further well-designed, adequately powered RCTs are needed before a recommendation can be made on the use of mifepristone for the treatment of uterine fibroids.

Exercise or exercise and diet for preventing type 2 diabetes mellitus.

BACKGROUND: The incidence of type 2 diabetes is associated with the 'Westernised lifestyle', mainly in terms of dietary habits and physical activity. Thus an intensive diet and exercise intervention might prevent or delay the appearance of diabetes in persons at high risk. OBJECTIVES: To assess the effects of exercise or exercise and diet for preventing type 2 diabetes mellitus. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, LILACS, SocioFile, databases of ongoing trials and reference lists of relevant reviews. SELECTION CRITERIA: Studies were included if they were randomised controlled trials of exercise and diet interventions of at least six month duration and reported diabetes incidence in people at risk for type 2 diabetes. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted to obtain missing data. Data on diabetes incidence and secondary outcomes were analysed by means of random-effects meta-analysis. MAIN RESULTS: We included eight trials that had an exercise plus diet (2241 participants) and a standard recommendation arm (2509 participants). Two studies had a diet only (167 participants) and exercise only arm (178 participants). Study duration ranged from one to six years. Overall, exercise plus diet interventions reduced the risk of diabetes compared with standard recommendations (RR 0.63, 95% CI 0.49 to 0.79). This had also favourable effects on weight and body mass index reduction, waist-to-hip ratio and waist circumference. However, statistical heterogeneity was very high for these outcomes. Exercise and diet interventions had a very modest effect on blood lipids. However, this intervention improved systolic and diastolic blood pressure levels (weighted mean difference -4 mmHg, 95% CI -5 to -2 and -2 mmHg, 95% CI -3 to -1, respectively). No statistical significant effects on diabetes incidence were observed when comparing exercise only interventions either with standard recommendations or with diet only interventions. No study reported relevant data on diabetes and cardiovascular related morbidity, mortality and quality of life. AUTHORS' CONCLUSIONS: Interventions aimed at increasing exercise combined with diet are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome). There is a need for studies exploring exercise only interventions and studies exploring the effect of exercise and diet on quality of life, morbidity and mortality, with special focus on cardiovascular outcomes.

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.

BACKGROUND: Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown. OBJECTIVES: To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched. SELECTION CRITERIA: Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear. MAIN RESULTS: Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found. Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality. AUTHORS' CONCLUSIONS: The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.