The effects of probiotics, prebiotics and synbiotics on the reduction of IBD complications, a periodic review during 2009-2020.

AIMS: To perform a systematic review on randomized controlled trials to examine the efficacy of probiotics, prebiotics and synbiotics in the treatment of IBD. METHODS AND RESULTS: PubMed, Web of science, Scopus and Google Scholar were systematically searched from January 2009 to January 2020 using the following keywords: 'Inflammatory Bowel Disease', 'Probiotics' and 'Clinical trial'. The statistical analysis was performed using SPSS software version 24.0. A total of 1832 articles were found during the initial search and 21 clinical trials were eligible. Studies comparing the effects of probiotics and placebo among patients with active ulcerative colitis (UC) showed a significant difference in clinical outcomes. Moreover, probiotics improved the overall induction of remission rates among patients with Crohn's disease (CD). Probiotics significantly decreased the IL-1ß, TNF-α and IL-8 levels. Also, the need for systemic steroids, hospitalization, surgery, as well as histological score and disease activity index significantly decreased in patients who used probiotic or pro-/synbiotics. CONCLUSIONS: The use of probiotics, as food supplements, can induce anti-inflammatory reactions, balance the intestinal homeostasis and induce remission in IBD. The efficacy of probiotics on remission induction is more reported in UC rather than CD. Larger well-designed clinical trials are needed to further determine whether probiotics are of clear benefits for remission in IBD.

Medición prehospitalaria del exceso de base arterial y su posible papel en la predicción del desenlace tras una parada cardiaca extrahospitalaria / Prehospital measurement of arterial base excess and its role as a possible predictor

Objetivo: La parada cardiorrespiratoria (PCR) conduce a un estado de acidosis mixtametabólica y respiratoria. Incluso tras una ventilación adecuada y la recuperación del pulso espontáneo (ROSC) la acidosis metabólica se refleja en un exceso de bases (EB).El objetivo del estudio es comprobar que el EB arterial se correlaciona con la mortalidad en el ámbito prehospitalario. Método: Se revisaron de forma retrospectiva las hojas de registro de los pacientes en PCR desde el 1 de enero de 2003 hasta 31 de diciembre de 2010. Se incluyeron 126pacientes con PCR no traumáticas en los que se obtuvo una gasometría en el curso de la reanimación cardiopulmonar (RCP). Se recogieron las siguientes variables: edad, sexo, tiempo hasta el inicio de la reanimación, causa de la PCR, ritmo inicial, duración de la reanimación, uso de trombolítico, adrenalina, bicarbonato, hipotermia terapéutica (..) (AU)

Objective: Cardiac arrest leads to a state of mixed respiratory and metabolic acidosis. Even after adequate ventilation and restoration of spontaneous circulation, metabolic acidosis as reflected by a negative base excess (BE) persists. We hypothesized that arterial BE measured in out-of-hospital cardiac arrest would be significantly associated with prehospital mortality. Methods: We retrospectively reviewed all protocol sheets of emergency medical responses to cardiac arrest in the period from January 1, 2003 to December 31, 2010. One hundred twenty-six adult non traumatic cardiac arrest patients in whom cardiopulmonary resuscitation (CPR) was attempted and an arterial blood gas sample was obtained during ongoing CPR were included for further analysis. The following data were collected: age, sex, delay, bystander or emergency medical technician CPR, cause of cardiac arrest, initial rhythm, CPR duration; use of thrombolytic therapy, epinephrine, sodium bicarbonate, and for a cooling device and blood gas sample parameters. The univariate association (..) (AU)

Role of N-terminal pro B-type natriuretic peptide in identifying patients at high risk for adverse outcome after emergent non-cardiac surgery.

BACKGROUND: Patients undergoing emergency surgery continue to be at very high risk, but accurate risk identification for the individual patient remains difficult. This study tested the usefulness of perioperative N-terminal pro B-type natriuretic peptide (NT-proBNP) for in-hospital and long-term risk stratification. METHODS: We conducted a prospective single-centre observational cohort study in an Austrian university hospital. Two hundred and ninety-seven consecutive patients >50 yr of age undergoing a variety of emergency non-cardiac procedures were included. The primary endpoint was a composite of non-fatal myocardial infarction (MI), acute heart failure, or death between index surgery and 3 yr follow-up. The secondary endpoint was in-hospital major adverse cardiac events (MACE), defined as non-fatal MI, acute heart failure, or cardiac death. RESULTS: During a median follow-up of 34 months (inter-quartile range: 16-39), 31% of subjects reached the primary endpoint. A preoperative NT-proBNP ≥725 pg ml(-1) was associated with a 4.8-fold univariate relative risk [95% confidence interval (CI): 3.1-7.6] and a postoperative NT-proBNP ≥1600 pg ml(-1) was associated with a four-fold univariate relative risk (95% CI: 2.7-6.2) for reaching the primary endpoint. Moreover, preoperative NT-proBNP remained a significant and independent (hazards ratio 1.91, 95% CI 1.08-3.37, P=0.027) predictor in a multivariate Cox proportional hazards model. A preoperative NT-proBNP ≥1740 pg ml(-1) was associated with a 6.9-fold univariate relative risk (95% CI: 3.5-13.4) for MACE during the index hospital stay, but did not remain significant in a multivariate logistic regression model. CONCLUSIONS: Preoperative NT-proBNP can help identify patients at high risk for adverse long-term outcome after emergency surgery.