Fotoféresis extracorpórea y trasplante renal / Extracorporeal photopheresis and renal transplantation

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Pattern of blood concentrations of 47 elements in two populations from the same geographical area but with different geological origin and lifestyles: Canary Islands (Spain) vs. Morocco.

The Canary Islands are one of the outermost regions of the European Union (EU), which are located barely 100 km from the coasts of Morocco. Although these islands are located in Africa, the degree of socioeconomic development and lifestyle in this archipelago is comparable to that of any other region of Europe. It is well established that the main determinants of human exposure to elements have to do both, with their place of residence and with habits related to their lifestyle. For this reason, we wanted to study the pattern of contamination by elements of these two populations so geographically close, but so different both in their lifestyle, and the geological origin of the territory where they live. Thus, we have determined the blood concentrations of 47 elements (including 25 rare earth elements (REE) and other minority elements (ME) widely employed in the hi-tech industry) in a paired sample of Moroccans (n = 124) and Canary Islands inhabitants (n = 120). We found that the levels of iron, selenium, zinc, arsenic, cadmium, strontium, and specially lead, were significantly higher in Moroccans than in Canarians, probably due to the intensive mining activity in this country. We also found significantly higher levels of the sum of REE and ME in Moroccans than in Canarians, possibly related to the inappropriate management of e-waste in this country. On the other hand, in the inhabitants of the Canary Islands we found higher levels of manganese, probably related to a higher degree of exposure to heavy traffic and exposure to Saharan dust of the people living in this region, and niobium and bismuth, probably related to the higher economic development in these islands. Our results indicate that the vicinity of both territories is not a major determinant of each other's contamination.

[Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients]. / Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes.

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparum is related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternative to exchange transfussion, with the same potential benefits but less undesirable side effects. Literature on this technique is scarce, consisting of isolated reports or short series. The objective of this study is to describe the clinical picture and outcome observed in 6 severely ill malaria patients in whom EA was applied as complimentary therapeutic technique. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatients with severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiological and parsitological data were analyzed. RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases, the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarial prophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between 10% and 35%. The number of severity criteria was between one and 4, the more frequent being hyperbilirrubinemia. All patients received conventional intravenous treatment. The total length of admission oscillated between 5 and 37 days, while the length of stay in the Intensive Care Unit varied between one and 17 days. All patients survived. CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lacking many of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of 5% is associated with any additional World Health Organization-2000 criteria of clinical severity, should constitute an indication for AE.

Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes / Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients

FUNDAMENTO Y OBJETIVO: La elevada mortalidad de la malaria grave por Plasmodium falciparum serelaciona con el grado de parasitemia. La eritrocitaféresis automatizada (EA) es una alternativasegura a la exanguinotransfusión, con los mismos beneficios potenciales pero menores efectossecundarios. Sin embargo, son escasas las referencias sobre la eficacia e indicaciones de estatécnica. El objetivo de este trabajo ha sido describir las características clínicas y evolución de6 pacientes con malaria grave en los que se empleó esta técnica terapéutica complementaria.PACIENTES Y MÉTODO: Se ha realizado un estudio observacional, descriptivo y retrospectivo de todoslos pacientes con malaria ingresados en un único hospital entre 1996 y 2006. En cadacaso se recogieron los datos clínicos, epidemiológicos y parasitológicos básicos.RESULTADOS: La serie se compone de 2 mujeres y 4 varones, con una media de edad de 43años. En todos los casos la infección fue adquirida en África subsahariana. Ningún pacientehabía efectuado quimioprofilaxis antipalúdica y la especie causal fue Plasmodium falciparum.El grado de parasitemia osciló entre el 10 y el 35%. De los criterios de gravedad, cuyo númeroosciló entre 1 y 4, el más frecuente fue la hiperbilirrubinemia. Todos los pacientes recibierontratamiento convencional. La duración total del ingreso osciló entre 5 y 37 días, y la estanciaen la unidad de vigilancia intensiva, entre 1 y 17 días. Todos los pacientes sobrevivieron.CONCLUSIONES: En resumen, la EA es una técnica segura, con las mismas ventajas que la exanguinotransfusión,pero sin muchos de sus efectos adversos. De acuerdo con los datos de la bibliografíay estas observaciones, podemos señalar que una parasitemia aislada mayor del 10%o una parasitemia superior al 5% asociada a algún criterio de gravedad son indicación para larealización de EA

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparumis related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternativeto exchange transfussion, with the same potential benefits but less undesirable sideeffects. Literature on this technique is scarce, consisting of isolated reports or short series. Theobjective of this study is to describe the clinical picture and outcome observed in 6 severely illmalaria patients in whom EA was applied as complimentary therapeutic technique.PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatientswith severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiologicaland parsitological data were analyzed.RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases,the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarialprophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between10% and 35%. The number of severity criteria was between one and 4, the more frequentbeing hyperbilirrubinemia. All patients received conventional intravenous treatment. Thetotal length of admission oscillated between 5 and 37 days, while the length of stay in the IntensiveCare Unit varied between one and 17 days. All patients survived.CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lackingmany of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of5% is associated with any additional World Health Organization-2000 criteria of clinical severity,should constitute an indication for AE

Oral surgery in patients undergoing oral anticoagulant therapy.

UNLABELLED: There is an evident need for procedural protocol for oral surgery patients who undergo oral anticoagulant treatment (OAT) because of: 1) the possible severity of complications and 2) the growing demand for OAT, which in some cases may be as much as 8% of the oral surgery patients that are referred to the hospital from primary care centers. In this study, the authors define the parameters for creating a proto- col applicable to this group of patients. The conclusion is that it is not necessary to suspend OAT before surgery; rather, these procedures should be performed under multidisciplinary medical control. OBJECTIVE: The authors demonstrate that it is possible to perform oral surgery on OAT patients, without having to sus- pend treatment beforehand. STUDY DESIGN: A longitudinal study was performed in OAT patients that required some type of oral surgical procedures. After an INR control, the patient underwent surgery and afterwards the patient was given tranexamic acid as a mouth rinse. Postoperative hemorrhage was classified as slight when it lasted less than 5 minutes, moderate when it lasted longer than five minutes, and severe when it required blood transfusion. RESULTS: The study was performed over a 5-year period (1996-2000), by the maxillofacial surgery department. In that time period, 125 patients with OAT were treated; 90 of them were males and 35 were females. Tooth extraction was per- formed in 229 sessions and a total of 367 teeth were extracted, with an average of 1.6% per session. With regards to postoperative hemorrahage, it was slight in 210 cases (91.7%), moderate in 18 (7.9%) and severe only in one case (0.4%). All the variables were compared and no statistically significant differences were found. CONCLUSIONS: We believe that OAT should not be suspended before oral surgery, but it surgery should be performed under multidisciplinary control-especially in the case of the elderly (over 65) or with those patients that have other concomitant illnesses such as renal insufficiency or anemia or other medical treatments.

Cirugía oral en pacientes en tratamiento con anticoagulantes orales. Pauta de actuación / Oral surgery in the patients undergoing oral anticoagulant therapy

Hay una necesidad evidente de protocolizar los procedimientos de cirugía oral en pacientes sometidos a tratamiento anticoagulante por vía oral (TAO), tanto por la gravedad de las complicaciones como por la frecuencia creciente de la demanda, que puede cuantificarse en algunos casos en el 8 por ciento de los pacientes referidos desde atención primaria al hospital para tratamiento quirúrgico oral. En este estudio se definen los parámetros para crear un protocolo aplicable a este grupo de pacientes. Se concluye que los pacientes en TAO no deben suspenderlo previamente a la cirugía oral si bien debería realizarse con control multidisciplinario. especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos, Objetivo: Pretendemos demostrar que es posible la realización de cirugía oral en pacientes anticoagulados, sin necesidad de retirar el tratamiento previamente. Diseño del estudio: Se realizó un estudio longitudinal en aquellos pacientes que precisaron algún procedimiento quirúrgico a nivel oral de los que estaban en TAO. Tras un con trol de INR se procedía a la intervención quirúrgica y posteriormente se suministraba al paciente ácido tranexámico para enjuagues bucales. La hemorragia postoperatoria se catalogó leve cuando el sangrado fue inferior a 5 minutos, moderado mavor de 5 minutos e intenso cuando se precisó transfusión. Resultados: Durante 5 años (1996-2000) se atendieron en nuestro Servicio 125 pacientes con TAO, 90 hombres y 35 mujeres, a los que se les exodonciaron 367 piezas dentarias, en 229 sesiones, con una media de 1,6 exodoncias por sesión. Con respecto a la hemorragia postoperatoria, fue leve en 210 casos (91,7 por ciento), moderada en 18 (7,9 por ciento) y grave en un solo caso (0,4 por ciento).Se compararon todas las variables observándose que no existieron diferencias estadísticamente significativas. Conclusiones: Consideramos que el TAO no debe suspenderse previamente' a la cirugía oral si bien debería realizarse bajo control multidisciplinario, especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos (AU)