Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial / La glutamina oral reduce el daño miocárdico tras revascularización coronaria bajo derivación cardiopulmonar. Un ensayo clínico aleatorizado

Background: Glutamine is the most abundant free amino acid in the body. It modulates immune cell function and is an important energy substrate for cells in critically ill patients. Reduction of injury cardiac markers had been observed in patients receiving intravenous glutamine and in a pilot study with oral glutamine. The aim of this study was to analyze the effect of preoperative oral supplementation of glutamine on postoperative serum levels of cardiac injury markers. Methods: A randomized clinical trial was performed in 28 Mexican patients with ischemic heart disease who underwent cardiopulmonary bypass with extracorporeal circulation. Patients were randomly assigned to receive oral glutamine (0.5 g/kg/day) or maltodextrin 3 days before surgery. Cardiac injury markers as troponin-I, creatine phosphokinase, and creatine phosphokinase-Mb were measured at 1, 12, and 24 hours postoperatively. Results: At 12 and 24 hours serum markers levels were significantly lower in the glutamine group compared with controls (p = 0.01 and p = 0.001, respectively) (p = 0.004 and p < 0.001, respectively). Overall, complications were significantly lower in the glutamine group (p = 0.01, RR = 0.54, 95% CI 0.31-0.93). Mortality was observed with 2 cases of multiple organ failure in control group and 1 case of pulmonary embolism in glutamine group (p = 0.50). Conclusion: Preoperative oral glutamine standardized at a dose of 0.5 g/kg/day in our study group showed a significant reduction in postoperative myocardial damage. Lower cardiac injury markers levels, morbidity and mortality were observed in patients receiving glutamine (AU)

Introducción: la glutamina es el aminoácido libre más abundante en el cuerpo. Modula funciones celulares inmunológicas y es un sustrato importante de energía. Se observó reducción de los marcadores de daño cardiaco en pacientes que recibieron tanto glutamina intravenosa como oral en un estudio piloto. Nuestro objetivo fue analizar el efecto preoperatorio con suplementación de glutamina oral sobre los niveles postoperatorios de los marcadores de lesión cardiaca. Métodos: ensayo clínico aleatorizado con 28 pacientes mexicanos con cardiopatía isquémica y sometidos a bypass cardiopulmonar con circulación extracorpórea. Los pacientes fueron asignados al azar para recibir glutamina oral (0,5 g/kg/día) o maltodextrina 3 días antes de ser operados. La troponina-I, creatinina fosfoquinasa y creatinina fosfoquinasa-Mb fueron medidas a la hora, 12 y 24 horas postoperatorias. Resultados: a las 12 y 24 horas los niveles séricos de marcadores fueron menores en el grupo de glutamina comparado con los controles (p = 0,01 y p = 0,001, respectivamente) (p = 0,004 y p < 0,001, respectivamente). Las complicaciones fueron menores en el grupo de glutamina (p = 0,01, RR = 0,54, 95% IC 0,31-0,93). La mortalidad ocurrió en 2 casos con dos falla orgánica múltiple en el grupo control y 1 caso de tromboembolia pulmonar en el grupo de glutamina (p = 0,50). Conclusión: la administración estandarizada de glutamina oral de manera preoperatoria (0,5 g/kg/día) en nuestro estudio demostró una reducción significativa del daño miocárdico postoperatorio. Los niveles séricos de marcadores cardiacos, la morbilidad y mortalidad fueron menores en los pacientes que recibieron glutamina (AU)

Greater fish, fruit, and vegetable intakes are related to lower incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology.

BACKGROUND: Little is known about the role of dietary intake in the development of deep vein thrombosis or pulmonary embolus (venous thromboembolism [VTE]). Homocysteine, factor VIII, and von Willebrand factor levels, risk factors for VTE, are influenced by dietary intake. We tested the hypothesis that foods rich in B vitamins and omega-3 fatty acids are negatively associated and meat intake is positively associated with incidence of VTE. METHODS AND RESULTS: In a prospective study over 12 years, 14,962 middle-aged adults participating in the Atherosclerosis Risk in Communities study were followed up for incident VTE. All hospitalizations were identified, and 196 VTEs were validated by chart review. A food frequency questionnaire assessed dietary intake at baseline and year 6. In separate proportional hazards regression analyses, risk of developing VTE was computed across quintiles of selected nutrients, major food groups, and the Western diet pattern, with adjustment for demographic and lifestyle factors, body mass index, and diabetes. Hazard ratios and 95% confidence intervals of VTE incidence across quintiles of fruit and vegetable intake were 1.0 (reference), 0.73 (0.48 to 1.11), 0.57 (0.37 to 0.90), 0.47 (0.29 to 0.77), and 0.59 (0.36 to 0.99) (P(trend)=0.03). Eating fish 1 or more times per week was associated with 30% to 45% lower incidence of VTE for quintiles 2 to 5 compared with quintile 1, suggestive of a threshold effect. Hazard ratios of VTE across quintiles of red and processed meat intake were 1.0, 1.24 (0.78 to 1.98), 1.21 (0.74 to 1.98), 1.09 (0.64 to 1.87), and 2.01 (1.15 to 3.53) (P(trend)=0.02). Hazard ratios were attenuated only slightly after adjustment for factors VIIc and VIIIc and von Willebrand factor. CONCLUSIONS: A diet including more plant food and fish and less red and processed meat is associated with a lower incidence of VTE.

Tromboembolismo pulmonar y viajes de larga duración. ¿Se debería realizar tratamiento anticoagulante preventivo en estos pacientes? / No disponible

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