Inicio temprano de la alimentación enteral en pacientes con reconexión intestinal / Early feeding of enteral nutrition in bowel anastomosis

Introducción: En cirugía gastrointestinal en particular posterior a una reconexión intestinal es frecuente no alimentar al paciente hasta cumplir un periodo que puede ser de 3 a 7 días. Algunos estudios han abordado el inicio de la nutrición enteral precoz evidenciando mejoría clínica y metabólica. Objetivos: Identificar la diferencia en la evolución postquirúrgica de los pacientes que inicia nutrición enteral precoz contra quienes no la inician. Métodos: Observacional de cohortes reconstruidas. Pacientes mayores de 18 años admitidos a cirugía de urgencias o cirugía electiva en quienes se realiza anastomosis intestinal. Resultados: 372 pacientes se admitieron en el estudio.229 (61.55%) de cirugía de urgencias y143(38.4%) cirugía electiva. La tolerancia a la alimentación oral fue mayor en grupo entre los 31 y 55 años de edad (X2 40.881 p <0.000). No se mostro diferencia en la tolerancia entre los que se operaron de urgencias y los de cirugía electiva al inicio de la alimentación oral (p=0.945). No se evidenció diferencia en cuanto a sangrado ni en presencia de dehiscencia entre los que iniciaron nutrición enteral precoz y no (X2 0.04).Discusión: Algunas escuelas quirúrgicas continúan difiriendo la nutrición hasta completar un periodo que consideran de seguridad no contando con evidencias de que esto mejore la evolución de los pacientes. Conclusiones: Se debe evaluar el inicio de la nutrición enteral precoz en todo paciente sometido a reconexión intestinal en cuanto presente peristalsis efectiva (AU)

Introduction: It is frequent that in gastrointestinal surgery, in particular when there was an intestinal reconnection to maintain the fasting for tree to sevendays. Some authors has demonstrated that early enteral diet shows clinic and metabolic improvement Objectives: Identify the differences evolution between who’s initiated early enteral feeding and who`s not. Material and Methods: Observational of reconstructed cohorts. Eighteen years old patients admitted to emergency room or elective surgery that made some intestinal anastomosis. Results: Tree hundred seventy-two patients were admitted to the study, 229 (61.55) were from emergency room and 143 (38.4%) by elective surgery. There was no difference in tolerance to early enteral feeding between both groups (p=0.945). No difference was noted in bleeding or anastomotic leak between groups (X2 0.04).Discussion: Some surgical schools still continue delay the early enteral feeding until a period that’s considered from security. There was no evidenced that it is recommended. Conclusion: It’s recommended to evaluate the early enteral feeding in the patients that initiates effective peristalsis as soon as possible (AU)

Hepatitis C virus RNA (HCV-RNA) in blood donors and family members seropositive for anti-HCV antibodies.

BACKGROUND: Non-A, non-B virus is responsible for 75-90% of all cases of blood transfusion-related hepatitis. The aim of this work was to determine hepatitis C virus RNA (HCV-RNA) in a group of blood donors and their household contacts. Serotype and genotype of the isolates were also studied. METHODS: HCV antibodies were investigated in 44,588 blood donors with a commercial immunoassay. Forty-four seropositive donors and 72 household members were further studied. Quantitative analysis of viral RNA was performed with Amplicor HCV 2.0 test, while genotype was determined by INNO-LiPA test and serotype with Murex HCV test. RESULTS: Among the 44,588 donors studied, 333 (0.74%) were positive for anti-HCV. Viral RNA was found in 35 (80%) of the 44 seropositive cases studied. Among the 72 household members, HCV antibodies were detected in six (8.3%) and HCV-RNA in four of these individuals. Serotype 1 and genotype 1 were the most frequent types detected (48 and 64%, respectively). The genotype in the blood donor matched that of his seropositive family member in four of six cases. CONCLUSIONS: Our results suggest that intrafamilial transmission of HCV may occur and we stress the need to study household members of seropositive blood donors, as they have a high risk of infection. In this community, genotype 1 is the most prevalent type in blood donors and family members.