Contenido en Lisina y Arginina en soluciones de aminoácidos comercializadas en España / Comparison of Lysine and Arginine content in amino acid parenteral formulas approved in Spain

Introducción: La terapia basada en péptidos con radionúclidos representa una estrategia terapéutica eficaz frente a tumores neuroendocrinos pero no está exenta de efectos adversos como la nefrotoxicidad. Para prevenir esta nefrotoxicidad se emplean soluciones de aminoácidos de Lisina y Arginina. El objetivo de este artículo es conocer el contenido de L-Lisina, L-Arginina y la osmolaridad en las soluciones de aminoácidos autorizadas en España hasta marzo de 2021 y comparar la composición de éstas con las características de las soluciones nefroprotectoras indicadas en la ficha técnica de Lutecio. Métodos: Revisión de las fichas técnicas de todas aquellas soluciones de aminoácidos comercializadas en España. Las presentaciones comerciales con otros macronutrientes o electrolitos que no tengan una función de estabilidad o conservación de la solución fueron excluidas. Resultados: De las 23.658 presentaciones a marzo de 2021, fueron seleccionadas 90 soluciones. Tras esta primera selección, 18 presentaciones comerciales cumplían los criterios de inclusión. De las soluciones incluidas, al extrapolar el contenido a un volumen máximo de 2000 ml, cumplían con los objetivos de L-Lisina y L-Arginina. El contenido difería entre presentaciones pero contenían más L-Arginina y presentaban una alta osmolaridad. Discusión: Empleando un volumen máximo de 2000 ml, la mayoría de las soluciones incluidas en el estudio cumplían con los requisitos de L-Lisina y L-Arginina indicadas en la ficha técnica, si bien pueden existir problemas de administración por vía periférica por su osmolaridad. El hecho de que incluyan otros aminoácidos podría dar lugar a otro tipo de efectos adversos como toxicidad gastrointestinal. (AU)

Introduction: Peptide Receptor Radionuclide Therapy represents an effective therapeutic strategy against neuroendocrine tumors, but it is not without serious adverse effects such as nephrotoxicity. In order to prevent this nephrotoxicity, Lysine and Arginine amino acid solutions are used. The objectives of this article are to to know the content of L-Lysine, L-Arginine and the osmolarity in commercial amino acid solutions authorized in Spain until march 2021 and to compare their composition with the characteristics of the nephroprotective solutions indicated in the Lutetium technical data sheet. Methods: Review of all the technical sheets of all those amino acid solutions that were marketed in Spain. Commercial presentations with other macronutrients or electrolytes that do not have a stability or solution conservation function were excluded. Results: From the 23,658 commercial presentations as of march 2021, 90 parenteral nutrition solutions were selected. After this first selection, 18 commercial presentations met the inclusion criteria. Of the included solutions, when the content was extrapolated to a maximum volume of 2000 ml, they met the objectives of L-Lysine and L-Arginine. The content varied between solutions and was mostly the highest content in L-Arginine. The solutions studied had a high osmolarity. Discussion: Using a maximum volume of 2000 ml, most of the solutions included in the study fulfilled the requirements of the content of L-Lysine and L-Arginine indicated in the technical data sheet, although there may be problems of administration by peripheral route to the have a high osmolarity. The fact that they include other amino acids could lead to other types of adverse effects such as gastrointestinal toxicity. (AU)

Going Viral: A Systematic Review of Google Trends in Plastic Surgery and a Recommended Framework for Its Use.

As the leading global search engine with billions of daily queries, Google and its open-source Google Trends (Google, Mountain View, CA) represent an emerging and powerful tool for epidemiological and medical research. Within the field of plastic surgery, Google Trends has yielded insights into online interest for facial feminization surgery, gender-affirmation surgery, cosmetic body procedures, and breast reconstruction, among other common procedures. The existing literature of Google Trends in plastic surgery was systematically reviewed following established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google Trends' 4 input variables-keyword, region, period, and category-were assessed. Seventeen plastic surgery studies employing Google Trends were reviewed. There was strong inter-rater reliability (Cohen's kappa = 0.68). Analyzing keyword syntax, only 3 of 17 studies (17.6%) used the "+" function to combine terms, which can significantly improve sensitivity. For the region variable, 12 of 16 studies (75%) conducted worldwide searches; yet, none of the studies used any non-English keywords, introducing significant bias. For the period, 88.2% of studies utilized a timespan of greater than 5 years, resulting in monthly intervals between data points in Google Trends. For the "category" variable, none of the studies appear to have employed the "surgery," "cosmetic surgery" or "health" categories to improve specificity. Google Trends is presented as an emerging methodology in plastic surgery research. The strengths and limitations of Google Trends as a resource for plastic surgeons and medical professionals are discussed, and a recommended step-by-step guide for conducting and interpreting Google Trends research is outlined.

Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19 / Tracing of COVID-19 patients by telemedicine with telemonitoring

OBJETIVO: Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. MÉTODOS: Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril de 2020. Se incluyeron dos grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo contactando con todos los pacientes al menos una vez al día. RESULTADOS: Se incluyeron 313 pacientes (52,4% mujeres) con edad media 60,9 (DS 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio se siguieron ambulatoriamente 224 pacientes y 89 tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (SD 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. CONCLUSIONES: Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least once a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DS 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way

Monitoring of COVID-19 patients by telemedicine with telemonitoring. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

Transfusional optimization in liver transplant using viscoelastic test guided therapy. / Optimización transfusional en el trasplante de hígado usando terapia guiada por pruebas viscoelásticas.

BACKGROUND: Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor. METHODS: We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed. RESULTS: In groupA 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in groupB with a median (IQR) of 2 (0-4) (P<.05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in groupA and 56.5% (median (IQR) of 1 (0-4.5) in B (P<.001) and in the fibrinogen administration, that was 6.5% in groupA and 34.8% in groupB (P<.01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn't find significant differences in the incidence of complication during the early postoperative period between the two groups. CONCLUSIONS: The introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

[Monitoring of COVID-19 patients by telemedicine with telemonitoring]. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11 a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

Spanish guidelines for diagnosis, management, treatment, and prevention of DRESS syndrome

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided

ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS

Hernia diafragmática bilateral, hallazgo casual tras 10 años de un traumatismo / Bilateral diaphragmatic hernia, casual finding 10 years after trauma

Las hernias diafragmáticas traumáticas comúnmente ocurren posteriores a trauma penetrante o cerrado. Debido a las lesiones coexistentes y a la naturaleza silenciosa de las lesiones diafragmáticas, el diagnóstico fácilmente se omite. Presentamos el caso de un paciente con hallazgo casual durante el estudio de un episodio de pancreatitis aguda, de una hernia diafragmática bilateral, contando con el antecedente de accidente de tráfico hace 10 años, no evidenciándose en las pruebas de imagen del pasado defectos diafragmáticos

Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic injuries, the diagnosis is easily missed. We report a patient with incidental finding during the study of an episode of acute pancreatitis, he showed a bilateral diaphragmatic hernia, with a history of traffic accident 10 years ago, not evidenced in imaging tests last diaphragmatic defects

Vólvulo de ciego y colon derecho: una causa infrecuente de obstrucción intestinal / Cecal and right colon volvulus: a infrequent cause of intestinal obstruction

El vólvulo de ciego es infrecuente en Occidente y representa únicamente el 1% de los casos de oclusión intestinal en el adulto. Los pacientes con esta entidad presentan habitualmente un cuadro clínico de dolor abdominal intermitente, vómitos y ausencia de gases y heces por el recto. Presentamos el caso de un paciente intervenido quirúrgicamente por un cuadro oclusivo originado por un vólvulo de ciego y todo colon ascendente con compromiso vascular. El objetivo de presentar este caso clínico es describir las características de esta inusual patología, analizar las causas y exponer las estrategias de tratamiento

The cecal volvulus is common in the West and represents only 1% of cases of intestinal obstruction in adults. Usually patients suffering from this condition present a clinical chart of intermittent abdominal pain, vomits and non-excretion of feces from the rectum. We report the case of a patient who underwent surgery due to an occlusive syndrome is presented, where a volvulus of cecum and right colon with vascular this unusual pathology, analyze the causes and exposing treatment strategies

Metástasis testicular concomitante de cáncer colorrectal avanzado / Concomitant testicular metastasis with advanced colorectal cancer

La metástasis testicular en el cáncer colorrectal se considera un evento inusual. El adenocarcinoma de colon constituye hoy día la segunda causa de muerte en el adulto por neoplasia tras el cáncer de pulmón. Se localiza con mayor frecuencia a nivel del recto y unión rectosigmoidea. Suelen metastatizar en ganglios linfáticos regionales, y a distancia afecta en primer lugar al hígado, siendo el testículo un lugar de raro asentamiento para las metástasis. En otros tumores como el cáncer de próstata, páncreas, melanoma y el adenocarcinoma renal se han comunicado casos de metástasis en cordón espermático y epidídimo. Siendo el cáncer de próstata el que con más frecuencia lo hace a ese nivel. Presentamos el caso de un paciente con adenocarcinoma de sigma y carcinomatosis peritoneal, que presentaba una masa testicular, detectada en el momento diagnóstico de la neoplasia de base. El resultado anatomopatológico de la masa testicular identificó células compatibles con metástasis de adenocarcinoma de colon

Testicular metastasis in colorectal cancer is considered a rare event. Colon adenocarcinoma is today the second cause of death in adults by neoplasia after lung cancer. It is found most often at the rectum and rectosigmoid junction. They tend to metastasize to regional lymph nodes and distant primarily affects the liver, while the testis is a rare site of metastasis .Other tumors including prostate, pancreatic, melanoma and renal cell carcinoma have been reported cases of metastasis in spermatic cord and epididymis. The prostate cancer is the tumor that most often does metastases at that level. We present the case of a patient with adenocarcinoma of the sigmoid colon and peritoneal carcinomatosis, with a testicular mass detected at the time of diagnosis of colon cancer. Pathological result of the testicular mass identified compatible cells with metastatic adenocarcinoma of the colon

Perforación gástrica secundaria a hernia esofágica incarcerada. Causa infrecuente de dolor torácico / Gastric perforation secundary to paraesophageal hernia. Rare cause of chest pain

Las hernias paraesofágicas es una condición muy común. Las complicaciones, incluyendo la hemorragia, la isquemia, y la perforación gástrica, son raras y suelen ocurrir en grandes hernias. Presentamos el caso de una mujer de 82 años diagnosticada de hernia paraesofágica complicada tras acudir al Servicio de Urgencias de nuestro hospital por dolor torácico

The paraesophageal hernia is a very common condition. Complications, including hemorrhage, ischemia, and gastric perforation are rare and usually occur in large hernias. We report the case of a 82 year old woman diagnosed with complicated paraesophageal hernia after going to the emergency department of our hospital because of chest pain

Derrame pleurarl bilateral y pericárdico tras perforación vascular por catéter venoso central / Bilateral pleural and pericardial effusion after vascucular drilling with central venous catheter

La colocación de vías venosas centrales es una medida habitual en cirugía mayor. Más del 15% de los pacientes desarrollan complicaciones tras la colocación de un catéter venoso central. La perforación vascular es una complicación infrecuente (< 5%). Sólo un 10% de las perforaciones tiene lugar en venas centrales, el diagnóstico correcto suele hacerse tarde, contribuyendo a una elevada morbi-mortalidad en estos pacientes. Presentamos el caso de una mujer de 66 años ingresada para cirugía electiva de reconstrucción de tránsito intestinal, que tras instaurar nutrición parenteral total debido a un postoperatorio tórpido ,presenta derrame pleural bilateral y pericárdico tras perforación vascular por catéter venoso central. Con este caso se quiere destacar la particularidad de la presencia de comunicación entre los 3 espacios ,pleurales y pericárdico ya que existen pocos casos descritos en la literatura

lacement of central venous lines, is a standard in major surgery. Over 15% of patients develop complications after placement of central venous catheters. Vascular perforation is a rare complication (<5%).Only 10% of the drilling takes place in central veins, the correct diagnosis is usually made late, contributing to high morbidity and mortality in these patients. We report a 66 year old woman admitted for elective reconstruction of intestinal transit, that after establishing total parenteral nutrition due to a torpid postoperative presents bilateral pleural effusion and pericardial vascular perforation after central venous catheter. This event seeks to highlight the peculiarity of the presence of communication between the 3 spaces, pleural and pericardial effusions as there are few cases reported in the literature

Predicting fluid responsiveness in patients undergoing orthotopic liver transplantation: effects on intraoperative blood transfusion and postoperative complications.

OBJECTIVE: To test the hypothesis that the restrictive volume therapy decreases blood transfusion requirement during liver orthotopic transplantation (OLT) without increasing acute renal complications and hospital length stay. MATERIAL AND METHODS: We conducted a retrospective cohort study (n = 89), randomized into 2 groups: A (liberal fluid strategy) and B (restrictive therapy). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), colloids, crystalloids, perioperative renal function, and hospital length stay. For comparison of proportions, we used the χ(2) test and Student t test to compare means (parametric). A logistic regression model was constructed to evaluate the association of all these variables with probability of PRBCs transfusion. RESULTS: In group A, 88.4% of patients required intraoperative transfusion of PRBCs, with a mean of 8.5 ± 7.02 IU, compared with 82.2% in group B with a mean of 5.02 ± 4.5 IU (P < .001). We also found differences in the following variables: FFP transfusion rate was 95.3% (mean, 15.02 ± 8.2 IU) in group A and 75.6% (mean, 8.7 ± 6.04 IU) in B (P < .001). The amount of colloid was 50% (mean, 692.8 ± 409.6 mL) in group A and 28.9% (mean, 607.6 ± 316.7 mL) in B (P = .032). Platelet concentrates transfusion was 79.1% (mean, 2.05 ± 1.1 IU) in group A and 51.1% (mean, 2.0 ± 1.08 IU) in B (P = .014). As an important effect of restrictive fluid therapy, renal function was assessed; no differences in mean creatinine or acute renal failure in the immediate postoperative period were observed. There was no difference in hospital length stay. Logistic regression modelling identified 3 variables as significant predictors of transfusion: Fluid administration policy, preoperative hemoglobin and FFP units transfused. Furthermore, an increase of preoperative hemoglobin is associated with a lesser probability of transfusion. CONCLUSIONS: These results show that fluid restriction management for OLT decreased blood products requirements, especially FFP. This could suggest that liberal fluid management may aggravate, rather than prevent, bleeding in these patients. We did observed any no difference in failure of renal function.

Membrane surface functionalization via theophylline derivative coating and streptavidin immobilization.

Poly(vinylidene fluoride) (PVDF) and regenerated cellulose (RC) membranes were surface-modified by the adsorption of one adenosine receptor antagonist: the theophylline-oligo(ethylene glycol)-alkene derivative, Theo1. Surface modification was carried out by immersion of the membrane in a dichloromethane solution of Theo1 (PVDF+Theo1 and RC+Theo1 samples). Membrane surfaces with partial coverage by theophylline and/or its inclusion in the membrane structures were studied by X-ray photoelectron spectroscopy (XPS), solid-state nuclear magnetic resonance (SNMR), impedance spectroscopy (IS) and contact angle (CA) measurements. The Theo1 orientation was inferred from the data. Streptavidin (SA) was immobilized onto the membrane/Theo1 hybrid material. The protein-theophylline Theo1 interaction was visualized with bright field microscopy (BFM).

[Electrolytes content in parenteral drugs authorised in Spain]. / Contenido en electrolitos de medicamentos de uso parenteral autorizados por el Ministerio de Sanidad y Consumo.

INTRODUCTION: Fluid therapy is one of the most common daily practices although knowledge is necessary on electrolytes and fluids intake and on all the pathophysiologic states leading to fluid homeostasis impairment in order to properly handle the electrolytes for both fluid therapy and parenteral nutrition. OBJECTIVES: To know the content and electrolyte type in those drugs administered through the parenteral route commercialized and authorized in Spain until February of 2012. METHODS: Review of the technical sheets of all the drugs commercialized in Spain for usage through the parenteral route. Those drugs with content lower than 1 miliequivalent or 1 millimol per commercial presentation were excluded. RESULTS: Of the 1,800 active ingredients studied, only 211 had a commercial presentation for parenteral route. Of these, 52 active ingredients met the study inclusion criteria and most of them (51; 98.07%) had sodium content higher than 1 miliequivalent per commercial presentation, potassium was present in 3 and calcium in only 1. DISCUSSION: Most of the medications studied contained sodium as the main electrolyte; impairments in sodium concentration are one of the most common problems at the hospital setting and in some cases an indicator of quality of health care delivery. Therefore, it would be necessary to take into account the intake received through the medications prescribed to improve electrolyte reposition in both fluid therapy and parenteral nutrition.

Introducción: La fluidoterapia es una de las prácticas más habituales en la práctica clínica diaria pero para un correcto manejo de electrolitos tanto en la sueroterapia como en la Nutrición Parenteral se deben conocer todos los aportes de electrolitos y fluidos y todas aquellas situaciones fisiopatológicos que conllevan alteraciones en la homeostasis de fluidos. Objetivos: Conocer el contenido y tipo de electrolitos de los medicamentos administrados por vía parenteral comercializados y autorizados en España hasta Febrero 2012. Métodos: Revisión de todas las fichas técnicas de todos aquellos medicamentos que estuvieran comercializados en España y con presentación comercial disponible por vía parenteral. Aquellos medicamentos con un contenido menor de 1 miliequivalente o 1 milimol por presentación comercial fueron excluidos. Resultados: De los 1800 principios activos estudiados, sólo 221 formaban parte de alguna presentación comercial por vía parenteral. De estos 221, 52 principios activos cumplían los criterios de inclusión del estudio y la mayoría (51-98,07%) tenían sodio en contenido mayor de un miliequivalente por presentación comercial, luego el potasio estaba presente en 3 y el calcio únicamente en uno. Discusión: La mayoría de medicamentos objeto del estudio contenían como principal electrolito el sodio, siendo la alteración de las concentraciones de este electrolito una de las más frecuentes en el entorno hospitalario y, en algunos casos, indicador de calidad en la atención del paciente. Por ello, para un mejor manejo de la reposición de electrolitos tanto en la sueroterapia como por Nutrición Parenteral es necesario tener en cuenta el aporte recibido por la medicación prescrita en los casos en que sea necesario.

Contenido en electrolitos de medicamentos de uso parenteral autorizados por el Ministerio de Sanidad y Consumo / Electrolytes content in parenteral drugs authorised in Spain

Introducción: La fluidoterapia es una de las prácticas más habituales en la práctica clínica diaria pero para un correcto manejo de electrolitos tanto en la sueroterapia como en la Nutrición Parenteral se deben conocer todos los aportes de electrolitos y fluidos y todas aquellas situaciones fisiopatológicos que conllevan alteraciones en la homeostasis de fluidos. Objetivos: Conocer el contenido y tipo de electrolitos de los medicamentos administrados por vía parenteral comercializados y autorizados en España hasta Febrero 2012. Métodos: Revisión de todas las fichas técnicas de todos aquellos medicamentos que estuvieran comercializados en España y con presentación comercial disponible por vía parenteral. Aquellos medicamentos con un contenido menor de 1 miliequivalente o 1 milimol por presentación comercial fueron excluidos. Resultados: De los 1800 principios activos estudiados, sólo 221 formaban parte de alguna presentación comercial por vía parenteral. De estos 221, 52 principios activos cumplían los criterios de inclusión del estudio y la mayoría (51-98,07%) tenían sodio en contenido mayor de un miliequivalente por presentación comercial, luego el potasio estaba presente en 3 y el calcio únicamente en uno. Discusión: La mayoría de medicamentos objeto del estudio contenían como principal electrolito el sodio, siendo la alteración de las concentraciones de este electrolito una de las más frecuentes en el entorno hospitalario y, en algunos casos, indicador de calidad en la atención del paciente. Por ello, para un mejor manejo de la reposición de electrolitos tanto en la sueroterapia como por Nutrición Parenteral es necesario tener en cuenta el aporte recibido por la medicación prescrita en los casos en que sea necesario (AU)

Introduction: Fluid therapy is one of the most common daily practices although knowledge is necessary on electrolytes and fluids intake and on all the pathophysiologic states leading to fluid homeostasis impairment in order to properly handle the electrolytes for both fluid therapy and parenteral nutrition. Objectives: To know the content and electrolyte type in those drugs administered through the parenteral route commercialized and authorized in Spain until February of 2012. Methods: Review of the technical sheets of all the drugs commercialized in Spain for usage through the parenteral route. Those drugs with content lower than 1 miliequivalent or 1 millimol per commercial presentation were excluded. Results: Of the 1,800 active ingredients studied, only 211 had a commercial presentation for parenteral route. Of these, 52 active ingredients met the study inclusion criteria and most of them (51; 98.07%) had sodium content higher than 1 miliequivalent per commercial presentation, potassium was present in 3 and calcium in only 1. Discussion: Most of the medications studied contained sodium as the main electrolyte; impairments in sodium concentration are one of the most common problems at the hospital setting and in some cases an indicator of quality of health care delivery. Therefore, it would be necessary to take into account the intake received through the medications prescribed to improve electrolyte reposition in both fluid therapy and parenteral nutrition (AU)

Tumor renal inadvertido y shock hipovolémico / Renal Tumor and Hipovolemic Shock

Los autores presentan un caso clínico de shock hipovolémico por hematoma retroperitoneal producido por traumatismo toraco abdominal y debido a rotura de un tumor renal. Se expone el caso y se discute las circunstancias que tuvieron lugar con respecto a la causa que lo originó, el desarrollo y evolución del paciente (AU)

The authors present a case of retroperitoneal hematoma hypovolemic shock caused by abdominal and chest trauma due to rupture of a renal tumor. We describe the case and discusses the circumstances that took place with respect to the cause that led to the development and evolution of the patient (AU)

Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service.

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.