Resumen ejecutivo del documento de consenso sobre el manejo de la anemia perioperatoria en España / Executive summary of the consensus document on the management of perioperative anemia in Spain

La anemia perioperatoria constituye un factor independiente de riesgo de morbimortalidad posoperatoria. Sin embargo, persisten barreras conceptuales, logísticas y administrativas que dificultan la implementación generalizada de protocolos para su manejo. El coordinador del proyecto convocó a un grupo multidisciplinar de ocho profesionales para elaborar un documento de consenso sobre el manejo de la anemia perioperatoria, con base a en serie puntos claves (PCs) relativos a su prevalencia, consecuencias, diagnóstico y tratamiento. Estos PCs fueron evaluados utilizando una escala Likert de 5 puntos, desde «totalmente en desacuerdo [1]» a «totalmente de acuerdo [5]». Cada PC se consideró consensuado si recibía una puntuación de 4 o 5 por al menos siete participantes (> 75%). A partir de los 36 PCs consensuados, se construyeron algoritmos diagnóstico-terapéuticos que pueden facilitar la implementación de programas de identificación precoz y manejo adecuado de la anemia perioperatoria, adaptados a las características de las instituciones hospitalarias de nuestro país.(AU)

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 9 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from “strongly disagree [1]” to “strongly agree [5]”. For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.(AU)

Executive summary of the consensus document on the management of perioperative anemia in Spain.

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.

The quinoa variety influences the nutritional and antioxidant profile rather than the geographic factors.

Quinoa (Chenopodium quinoa Willd.) is attracting worldwide attention due to its nutritional and biological properties. Nowadays, this pseudocereal is cultivated worldwide in different environmental conditions. This work evaluates the nutritional profile, polyphenol content and antioxidant capacity of five quinoa cultivars (Negra Collana, Chullpi Real, Salcedo Inia, Pasankalla and Kancolla) from Spain and from the Andean region, looking for the key factor of quinoa composition. Nutritional profile was similar for the same cultivar among the locations but, protein and iron contents were higher (p < 0.05) in Spanish seeds compared to the Andean ones. PCA and Pearson correlation coefficient reveal that the darkest quinoa cultivars, Negra and Pasankalla, had the best bioactive profile because the greater dietary fiber, polyphenol content, and antioxidant capacity (p < 0.05), regardless of origin zone. Concluding, the genetic variability seems to have a higher influence than the geographic factors on the nutritional and antioxidant composition of quinoa.

Accounting for unknown foster dams in the genetic evaluation of embryo transfer progeny.

Animals born by embryo transfer (ET) are usually not included in the genetic evaluation of beef cattle for preweaning growth if the recipient dam is unknown. This is primarily to avoid potential bias in the estimation of the unknown age of dam. We present a method that allows including records of calves with unknown age of dam. Assumptions are as follows: (i) foster cows belong to the same breed being evaluated, (ii) there is no correlation between the breeding value (BV) of the calf and the maternal BV of the recipient cow, and (iii) cows of all ages are used as recipients. We examine the issue of bias for the fixed level of unknown age of dam (AOD) and propose an estimator of the effect based on classical measurement error theory (MEM) and a Bayesian approach. Using stochastic simulation under random mating or selection, the MEM estimating equations were compared with BLUP in two situations as follows: (i) full information (FI); (ii) missing AOD information on some dams. Predictions of breeding value (PBV) from the FI situation had the smallest empirical average bias followed by PBV obtained without taking measurement error into account. In turn, MEM displayed the highest bias, although the differences were small. On the other hand, MEM showed the smallest MSEP, for either random mating or selection, followed by FI, whereas ignoring measurement error produced the largest MSEP. As a consequence from the smallest MSEP with a relatively small bias, empirical accuracies of PBV were larger for MEM than those for full information, which in turn showed larger accuracies than the situation ignoring measurement error. It is concluded that MEM equations are a useful alternative for analysing weaning weight data when recipient cows are unknown, as it mitigates the effects of bias in AOD by decreasing MSEP.

Risk factors for biliary complications after orthotopic liver transplantation with T-tube: a single-center cohort of 743 transplants.

BACKGROUND: Despite recent advances in organ preservation, surgical procedures, and immunosuppression, biliary reconstruction after orthotopic liver transplantation (OLT) remains as a major source of morbidity. The purpose of this study was to identify risk factors for the development of biliary complications (BCs) after end-to-end choledochocholedochostomy (EE-CC) with a T-tube as the standard technique for biliary reconstruction after OLT. METHODS: A total of 833 consecutive liver transplantations that took place from February 1996 to April 2010 were retrospectively reviewed. Patients with concomitant hepatic artery complications were excluded, as were those who underwent urgent retransplantation or died within 1 week after transplantation. Finally, the study group comprised 743 patients. RESULTS: The overall BC rate was 9.8% (73 patients), including stricture in 19 patients (2.6%) and bile leakage in 39 patients (5.2%). After univariate analysis, significant risk factors for BCs were surgery time >5 hours, arterial ischemia time >30 minutes, use of a classic transplant technique, transfusion of red blood cells ≥5 units, anti-cytomegalovirus treatment, and period of transplantation between 1996 and 2002. Stepwise logistic regression study was performed, including those variables with a value of P <.200. Multivariate analysis showed that pretransplant serum creatinine (odds ratio = 1.27; 95% confidence interval [CI], 1.03-1.57; P = .025) and arterial ischemia time >30 minutes (odds ratio = 2.44; 95% CI, 1.45-4.12; P = .001) were the only independent risk factors related to the development of BCs after biliary reconstruction with the T-tube. CONCLUSIONS: The performance of different variables in predicting occurrence of BCs was assessed with the use of receiver operating characteristic analysis. The area under the receiver operating characteristic curve of our model was 0.637 (95% CI, 0.564-0.710), and therefore we must conclude that other variables not included in our model may have influence in the development of BCs after OLT with an EE-CC with a T-tube as the procedure for biliary reconstruction.

External ophthalmomyiasis: a case series.

Oestrus ovis or 'sheep botfly' causes common ophthalmomyiasis in warm climates. It is a self-limited infestation with symptoms such as foreign body sensation and/or tearing. The larvae can be observed in the conjunctiva and should be extracted with forceps. The development of larvae beyond the first stage does not occur in healthy humans, although they may penetrate the ocular globe, causing so-called internal myiasis. External ophthalmomyiasis is typical of rural areas, but it may be observed occasionally in urban environments.

Biliary complications in orthotopic liver transplantation using choledochocholedochostomy with a T-tube.

Despite significant advances in orthotopic liver transplantation (OLT), biliary tract reconstruction is still a major source of complications. Choledochocholedochostomy with a T-tube used to be the standard procedure for biliary reconstruction after OLT. However, many centers currently avoid use of the T-tube because of the high incidence of complications. Our aim was to study the biliary complications occurring at our center when end-to-end choledochocholedochostomy (EE-CC) over a T-tube was used as the standard procedure for biliary reconstruction. A retrospective review was conducted of all patients who underwent liver transplantation from February 1, 1996, to April 30, 2010. Only patients requiring any therapy to treat biliary complications were considered, whereas those with concomitant hepatic artery complications were excluded. The study cohort consisted of 743 patients who had EE-CC with a T-tube. Of these, 73 patients (9.8%) experienced any biliary complication. Anastomotic strictures occurred in 17 patients (2.3%), and non-anastomotic strictures in 2 (0.3%). Fifteen patients with anastomotic strictures were successfully treated by dilatation and stenting. Bile leakage was diagnosed in 39 patients (5.2%). Leakage occurred at the anastomosis in 15 patients (2%), and at the exit site of the T-tube in 24 patients (3.2%). Tube opening was the only treatment used in 30 patients with bile leakage (76.9%). Seven patients experienced leaks after elective T-tube removal (1%). Overall, repeat surgery to manage biliary complications was needed in 9 patients (1.2%). The mortality rate from biliary complications was 0.13%. In conclusion, EE-CC with a T-tube was followed by a low incidence of biliary complications. The complication rate after elective T-tube removal and the repeat surgery rate were extremely low. These results might challenge the current trend to avoid T-tube stenting in OLT.

Bayesian estimation in maternally ancestral animal models for weaning weight of beef cattle.

The Bayesian approach was implemented for fitting several maternally ancestral models for weaning weight data of Angus calves. The goal was to evaluate to what extent genetic evaluation models with additive grand maternal effects (G), or with an ancestrally structured covariance matrix for maternal environmental effects (E), or with a sire × year interaction (ISY), or combinations thereof (GE, GSY, ESY, GESY), redistribute the additive variability and reduce the negative magnitude of the additive correlation between direct and maternal effects (r(AoAm)), when compared with the regular maternal animal model (I). All animals with records had known dams and maternal granddams. The sampling scheme induced low autocorrelations among all variables and tended to converge quickly. The signs of the estimates of r(AoAm) were consistently negative for all models fitted. The magnitudes of the estimates of r(AoAm) from models E, G, GE, ESY, and GESY were almost one-third of those from models I and ISY. Inclusion of the sire × year interaction had some effect in reducing the negative magnitude of r(AoAm), but also reduced the size of the estimates of direct (h(0)(2)) and maternal (h(m)(2)) heritabilities. In comparison, models E or G reduced the negative magnitude of r(AoAm) by 0.50 units and produced more favorable estimates of H(0)(2) and h(m)(2) than models I and ISY. The estimate of h(0)(2) from G was similar to the one from I; however, the estimated h(m)(2) was 0.04 units greater, whereas the estimate of r(AoAm) was much less negative (-0.21 vs. -0.71) than the respective estimates from I. The environmental correlation between the weaning weights of dams and their daughters (λ) was estimated to be -0.28 ± 0.03 in E and ESY, and -0.21 ± 0.03 in GE and GESY. Inclusion of the sire × year interaction effect by itself did not have much of an impact in the reduction of the estimated magnitude of r(AoAm). Rank correlations among EBV for direct effects were larger than 0.94 and did not show any appreciable difference among models, whereas the rank correlation among maternal breeding values displayed differences in the ranking between I and the other models. Models E and ESY recovered the largest amount of total additive variability with maternal effects.

Management of hepatocellular carcinoma recurrence after liver transplantation.

UNLABELLED: Management of patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (OLT) is not well established. We conducted a retrospective analysis of our results in the treatment of HCC recurrence after OLT Patients. The 23 HCC recurrences developed after 182 OLT performed for HCC within Milan criteria, had an average follow-up of 60 months. RESULTS: The median time to recurrence was 23.4 months. Surgical resection of the recurrence was possible in 11 patients, but an R-0 resection was obtained in 8 patients. Four of these 8 patients developed another recurrence, with 3 succumbing due to tumor recurrence and 1 alive at 12 months with recurrence. The other 4 patients without recurrences, include 3 who are alive at 19, 31, and 86 months and 1 who died at 32.6 months due to hepatitis C recurrence. The 3 patients with palliative resections developed recurrences. Twelve patients were rejected for surgery: 8 were treated symptomatically, 2 with systemic chemotherapy, and 2 with everolimus and sorafenib. This last treatment was also prescribed for 2 patients after R-0 surgery who are alive at 19 and 31 months and for 1 patient after R-1 surgery who is alive at 19 months. Of 15 patients who died, 13 succumbed to HCC recurrence. The average survival from transplantation was 61.7 +/- 37.5 and 48 +/- 34.3 months for patients without and with recurrence, respectively (P < .001). The survival from the recurrence was significantly higher among patients with R-0 surgery: 32.3 +/- 21.5 versus 11.9 +/- 6.9 months (P = .006). CONCLUSIONS: HCC recurrence after OLT of patients within Milan criteria was low but had a great impact on survival. Few cases are amenable to R-0 resection, but when possible it was associated with a significantly increased survival, although with an high incidence of a new recurrence. There is a rationale for the use of sorafenib and mammalian target of rapamycin based immunosuppression, which warrants randomized studies.

Prophylactic therapy with valgancyclovir in high-risk (cytomegalovirus D+/R-) liver transplant recipients: a single-center experience.

A retrospective study was performed in liver transplant patients with high risk to develop cytomegalovirus infection (CMV D+/R-) who were treated with valgancyclovir for 3 months as prophylactic therapy. The aim of this study was to determine the safety and efficacy of prophylactic therapy with valgancyclovir. Weekly CMV antigenemia was routinely assessed during the first 3 months posttransplantation, twice a month to month 6, and monthly until the end of the first year, as well as when clinically indicated. The follow-up period was 1 year. From January 2003 to February 2007, 199 liver transplantations were performed at our institution, including 23 (11%) high-risk patients for CMV infection. Median age was 47 +/- 11.6 years. Nineteen patients (70.4%) were men. Five subjects (21.7%) developed CMV infections. Three patients with positive CMV antigenemia at 3, 4, or 6 months posttransplantation were asymptomatic, while 2 (8.7%) showed gastrointestinal CMV disease at 2 months posttransplantation or CMV hepatitis at 1 month after the end of the prophylactic therapy. Treatment with intravenous gancyclovir followed by oral valgancyclovir was successful in both patients. No opportunistic infections were observed and only 1 patient developed leukopenia as an adverse event related to valgancyclovir.

Survival and hepatitis C virus recurrence after liver transplantation in HIV- and hepatitis C virus-coinfected patients: experience in a single center.

INTRODUCTION: Posttransplant hepatitis C virus (HCV) recurrence has been shown to negatively impact graft and patient survivals. It has been suggested that HCV recurrence among HIV- and HCV-coinfected transplant recipients is even more aggressive. OBJECTIVE: To compare the histological severity and survival of posttransplant HCV recurrence between HIV- and HCV-coinfected and HCV-monoinfected patients. PATIENTS AND METHODS: Among 72 adult patients who underwent primary liver transplantation at our institution for HCV-related cirrhosis between October 2001 and April 2007. We excluded one coinfected patient who died on postoperative day 5 leaving 12 HIV- and HCV-coinfected patients for comparison with 59 monoinfected patients. When listed, all coinfected patients fulfilled the criteria of the Spanish Consensus Document for transplantation in HIV patients. Immunosuppression did not differ between the two groups: all were treated with tacrolimus + steroids (slow tapering). Aggressive HCV recurrence was defined as cholestatic hepatitis and/or a fibrosis grade > or =2 during the first posttransplant year. RESULTS: Coinfected patients were younger than monoinfected patients: 45 +/- 6 years vs 55 +/- 9 years (P = .0008). There were no differences in Child score, Model for End-stage Liver Disease score, donor age, graft steatosis, ischemia time, HCV pretransplant viral load or genotype between the groups. Significant rejection episodes were also equally distributed (25% vs 14%; P = .38). Seven coinfected patients and 29 monoinfected patients developed aggressive HCV recurrences (58% vs 49%; P = .75). Median follow-up was 924 days. Global survival at 3 years was 80%. Survivals at 1, 2, and 3 years were 83%, 75%, 62% in the coinfected vs 98%, 89%, 84% in the monoinfected patients, respectively (log-rank test = 0.09). CONCLUSIONS: The severity of histological recurrence was similar among HIV- and HCV-coinfected and monoinfected HCV liver recipients in the first posttransplant year. Mortality attributed to recurrent HCV was similar in the groups. There were no short-term (3-year) differences in survival between the two groups of patients.

Soybean, a promising health source.

Health properties and uses of soybean, as well as the different chemical and botanical characteristics of this legume are shown in this review. Soybean represents an excellent source of high quality protein, it has a low content in saturated fat, it contains a great amount of dietary fibre and its isoflavone content makes it singular among other legumes. Many researches have been carried out into the benefits of legumes: chickpeas, beans, lentils and soy, among others, but characterization and positive health effects of soybeans have been recently studied. The interest in this legume has increased because of its functional components. Most of the studies have been focused on soybean protein as a possible source of prevention against cardiovascular disease. This positive effect may be due to a decrease in serum cholesterol concentrations. In addition, there are many studies on isoflavones, non-nutritive substances, associated with prevention and treatment of different chronic diseases. Moreover, some studies have shown the health properties of soy dietary fibre. Therefore, it would be interesting to consider the replacement of animal based foods for soybean foods in order to obtain some nutritional benefits.

Hostelería hospitalaria del Complejo Hospitalario Universitario de Santiago (CHUS) / The hospital catering service of the Complejo Hospitalario Universitario de Santiago (CHUS)

Los requerimientos de eficiencia en la gestión hospitalaria se basan en las necesidades logísticas en función de las características estructurales del hospital, para concluir con éxito el servicio prestado a los pacientes. Este artículo resume la evaluación desarrollada en el CHUS del servicio prestado en función de la cantidad y calidad ofrecida, así como el grado de fiabilidad y compromiso de la sección de Hostelería Hospitalaria del centro (AU)

The efficiency requirements in hospital management are based on the logistics needs according to the structural characteristics of the hospital, in order to successfully perform the service given to patients. This article summarises the assessment, developed in the CHUS, of the service provided according to the quantity and quality offered, as well as the degree of reliability and commitment in the Hospital Catering section of the centre (AU)

Actitud ante el diagnóstico ecográfico de un hydrops fetal / Management in ultrasound diagnosis of fetal hydrops

El diagnóstico del hydrops fetal obedece generalmente a un hallazgo ecográfico casual. El manejo terapéutico varía en función de la etiología del proceso, por lo que resulta básico filiar su origen. Presentamos un caso de hydrops fetal diagnosticado en el segundo trimestre de gestación; el cariotipo reveló un síndrome de Turner, y el resto de las pruebas solicitadas fueron normales

Diagnosis of hydrops fetalis usually follows an incidental finding on an ultrasound scan. The therapeutic management varies according to the etiology of the process and therefore it is essential to determine its origin. We report a case of hydrops fetalis diagnosed in the second trimester of gestation. The karyotype revealed Turner's syndrome, while the results of remaining tests were normal

Characterization of nonstarch polysaccharides content from different edible organs of some vegetables, determined by GC and HPLC: comparative study.

Content and composition of dietary fiber as nonstarch polysaccharides (NSP) was determined in vegetables belonging to different types of edible organs, using GC and HPLC. Samples analyzed were subterranean organs (radish and leek), leaves (celery, swiss chard, and lettuce), stalks (celery, swiss chard, and asparagus), inflorescence (broccoli), and fruits (tomato, green pepper, and marrow). The results indicate that though the monomeric profile is similar in all these samples quantitative differences were found for neutral sugars and uronic acids among samples of the same type of vegetal organ. The NSP values determined using CG method were in good agreement with HPLC method (R(2) = 0.9005). However, arabinose, mannose, and galactose plus rhamnose are more influenced by the analytical method used than the rest of the monomers in nearly all the samples analyzed. Final values of NSP depend on the method used in celery stalks, broccoli, and green pepper.

Liver transplantation for hepatocellular carcinoma in cirrhotic patients.

A consecutive series of 88 patients underwent transplantation for hepatocellular carcinoma with cirrhosis over a 7-year period. Liver transplantation was indicated because of the tumor in 75 cases (85.2%); tumor was an incidental finding in 13 cases (14.8%). One patient was retransplanted due to primary nonfunction. The perioperative mortality was 4.5%. Tumor recurrence was observed in seven patients (7.95%) with incidental tumor recurrence in one case. As in patients with known primary liver tumors pretransplant, a thorough follow-up is advisable to establish an early diagnosis of recurrence. The actuarial survival for nonincidental hepatocellular carcinoma at 1, 3, and 5 year was 92%, 77%, and 75%, respectively. The differences in actuarial survival between hepatitis C negative and positive hepatocellular carcinoma were not significant (log-rank test P=.27), though there was a clear improvement in results (94%, 85%, and 78% vs 90%, 71%, and 71%), at 1, 3, and 5 years meaning that HCV infection is an important prognostic factor. Although transplantation for HCC has the advantages of removing the tumor and the cirrhotic liver, it remains a controversial topic. In our experience patients showing lesions less than 5 cm or three or fewer lesions experience an equivalent survival to transplanted patients who do not have cancer.

Supporting breastfeeding: current status and future challenges.

Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the 10 Steps to Successful Breastfeeding, are helping to educate society about the benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education are still needed

Secondary structure of prothymosin alpha evidenced for conformational transitions induced by changes in temperature and concentration of n-dodecyltrimethylammonium bromide.

Conformational changes of prothymosin alpha (ProTalpha) induced by changes in temperature and concentration of the denaturant n-dodecyltrimethylammonium bromide (C12TAB) were studied by difference spectroscopy. The conformational transition of ProTalpha by C12TAB was followed as a function of denaturant concentration by absorbance measurements at 230 nm and the data were analyzed to obtain the Gibbs energy of the transition in water (deltaG0(w)) and in a hydrophobic environment (deltaG0(hc)) for saturated protein-surfactant complexes. The value of deltaG0(w) was 6.38 kJ mol(-1) and that for deltaG0(hc), which is not affected by temperature, was -18.62 kJ mol(-1). Changes of absorbance at 230 nm of ProTalpha with temperature can be assumed to resemble a transition in the secondary structure. The parameters characterizing the thermodynamics of unfolding, melting temperature (Tm), enthalpy (deltaHm), entropy (deltaSm) and heat capacity (deltaCp) were determined. The values obtained for Tm, deltaHm, and deltaSm are smaller that those found for other globular proteins; deltaCp was found to be much smaller. These results suggest that ProTalpha exhibits some type of secondary structure under these conditions (10 mM glycine buffer, pH 2.4).

Bacterial translocation of enteric organisms in patients with cirrhosis.

BACKGROUND/AIMS: The aim of the study was to investigate the prevalence and associated risk factors for bacterial translocation in patients with cirrhosis, a mechanism involved in the pathogenesis of bacterial infections in experimental cirrhosis. METHODS: Mesenteric lymph nodes were obtained for microbiological culture from 101 patients with cirrhosis and from 35 non-cirrhotic patients. RESULTS: Enteric organisms were grown from mesenteric lymph nodes in 8.6% of non-cirrhotic patients. In the 79 cirrhotic patients without selective intestinal decontamination, the prevalence of bacterial translocation significantly increased according to the Child-Pugh classification: 3.4% in Child A, 8.1% in Child B and 30.8% in Child C patients (chi2 = 6.106, P < 0.05). However, translocation by Enterobacteriaceae, the organisms commonly responsible for spontaneous bacteremia and peritonitis in cirrhosis, was only observed in 25% of the cases. The prevalence of bacterial translocation in the 22 cirrhotic patients undergoing selective intestinal decontamination, all Child-Pugh class B and C, was 4.5%. The Child-Pugh score was the only independent predictive factor for bacterial translocation (odds ratio 2.22, P = 0.02). CONCLUSIONS: Translocation of enteric organisms to mesenteric lymph nodes is increased in patients with advanced cirrhosis and is reduced to the level found in non-cirrhotic patients by selective intestinal decontamination.