Bispectral index monitoring for sedation in scheduled adult colonoscopy: A randomized controlled trial.

BACKGROUND: Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy. METHODS: We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and time during colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction. RESULTS: Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; p = 0.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI, 1.013-1.091; p = 0.0087) and in men (95% CI, 1.129-7.668; p = 0.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups. CONCLUSIONS: Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.

Evaluation of succulent plants Echeveria elegans as a biomonitor of heavy metals and radionuclides.

This work evaluates the use of Echeveria elegans as a biomonitor of metals and radionuclides, using semi-urban soils as a study area. The study area is exposed to various trace elements of concern for various social groups in nearby localities. The quantification of metals and radionuclides was performed by X-ray fluorescence spectrometry and gamma spectrometry, respectively. Cumulative frequency distribution curves, descriptive statistics, and multivariate analysis were used to estimate the local geochemical baseline and identify geochemical and anthropogenic patterns of metals and radionuclides from topsoil and E. elegans. The evaluation of contaminants and the contribution of possible exposure routes (topsoil and atmospheric deposition) was performed with the enrichment factor (EF) and the relative concentration factor (CFR). The results suggest that the plant does not present significant physical stress due to the environmental conditions to which it was exposed. Likewise, it can bioaccumulate heavy metals from natural and anthropogenic sources. The quantification of radionuclides in the plant is below the detection limits, indicating a low bioavailability and transfer factor. The CFR and EF results showed that the plant accumulates metals from the topsoil and atmospheric deposition. The bioaccumulation mechanism would be related to the functioning of Crassulaceae Acid Metabolism (CAM). In topsoil, the organic acids of the plant would modify the solubility of the metals present in an insoluble form in the soil, acting as ligands and, subsequently, following the transport route of these metabolites. In atmospheric deposition, the metals deposited in the leaves would be incorporated into the plant through the opening of the stomata because of the capture of CO2 (at night, day, or during environmental stress) by the CAM. Overall, the evidence showed that the succulent can be used as a biomonitor of heavy metals. However, additional studies are required to determine its usefulness as a radionuclide biomonitor.

Inhaled Litsea glaucescens K. (Lauraceae) leaves' essential oil has anxiolytic and antidepressant-like activity in mice by BDNF pathway activation.

ETHNOPHARMACOLOGICAL RELEVANCE: Litsea glaucescens K. (Lauraceae) is a small tree from the Mexican and Central American temperate forests, named as "Laurel". Its aromatic leaves are ordinarily consumed as condiments, but also are important in Mexican Traditional Medicine, and among the most important non wood forest products in this area. The leaves are currently used in a decoction for the relief of sadness by the Mazahua ethnic group. Interestingly, "Laurel" has a long history. It was named as "Ehecapahtli" (wind medicine) in pre-Columbian times and applied to heal maladies correlated to the Central Nervous System, among them depression, according to botanical texts written in the American Continent almost five centuries ago. AIM OF THE STUDY: Depression is the first cause of incapacity in the world, and society demands alternative treatments, including aromatherapy. We have previously demonstrated the antidepressant-like activity of L. glaucescens leaves' essential oil (LEO), as well as their monoterpenes linalool, and beta-pinene by intraperitoneal route in a mice behavioral model. Here we now examined if LEO and linalool exhibit this property and anxiolytic activity when administered to mice by inhalation. We also investigated if these effects occur by BDNF pathway activation in the brain. MATERIALS AND METHODS: The LEO was prepared by distillation with water steam and analyzed by gas chromatography-mass spectrometry (GC-MS). The monoterpenes linalool, eucalyptol and ß-pinene were identified and quantified. Antidepressant type properties were determined with the Forced Swim Test (FST) on mice previously exposed to LEO or linalool in an inhalation chamber. The spontaneous locomotor activity and the sedative effect were assessed with the Open Field Test (OFT), and the Exploratory Cylinder (EC), respectively. The anxiolytic properties were investigated with the Elevated Plus Maze Apparatus (EPM) and the Hole Board Test (HBT). All experiments were video documented. The mice were subjected to euthanasia, and the brain hippocampus and prefrontal cortex were dissected. RESULTS: The L. glaucescens essential oil (LEO) contains 31 compounds according to GC/MS, including eucalyptol, linalool and beta-pinene. The LEO has anxiolytic effect by inhalation in mice, as well as linalool, and ß-pinene, as indicated by OFT and EC tests. The LEO and imipramine have antidepressant like activity in mice as revealed by the FST; however, linalool and ketamine treatments didn't modify the time of immobility. The BDNF was increased in FST in mice treated with LEO in both areas of the brain as revealed by Western blot; but did not decrease the level of corticosterone in plasma. The OFT indicated that LEO and imipramine didn't reduce the spontaneous motor activity, while linalool and ketamine caused a significant decrease. CONCLUSION: Here we report by the first time that L. glaucescens leaves essential oil has anxiolytic effect by inhalation in mice, as well as linalool, and ß-pinene. This oil also maintains its antidepressant-like activity by this administration way, similarly to the previously determined intraperitoneally. Since inhalation is a common administration route for humans, our results suggest L. glaucescens essential oil deserve future investigation due to its potential application in aromatherapy.

¿Cómo diagnosticamos la diverticulitis aguda? Resultados de una encuesta nacional sobre el papel de las técnicas de imagen / How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques

Introducción: La elección de las técnicas de imagen en el diagnóstico de la diverticulitis aguda (DA) es un motivo de controversia. Los objetivos del estudio fueron conocer las preferencias de los radiólogos y el grado de utilización de las distintas técnicas en su manejo radiológico. Métodos: Se difundió una encuesta por Internet a través de la Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA) y Twitter, con preguntas sobre ámbito de trabajo, protocolización, preferencias personales y la realidad asistencial en el manejo radiológico de la DA. Resultados: Se obtuvieron 186 respuestas. El 72% de los radiólogos encuestados trabaja en servicios organizados por «órgano y sistema» (S-OS). Existe protocolo de manejo de DA en un el 48% de los servicios, siendo en el 47,5% la ecografía la técnica de inicio. El 73% de los encuestados cree que la ecografía debería ser la primera opción diagnóstica, pero en realidad esto solo se efectúa en un 24% de los servicios, realizándose tomografía computarizada en el 32,8%, con diferencias significativas en horario de guardia. La clasificación más utilizada es la de Hinchey (75%). El 96% de los encuestados desearía un consenso de especialidad para utilizar la misma clasificación. Existe mayor tasa de protocolización, utilización de clasificaciones y mayor creencia en la ecografía como técnica inicial en S-OS y en hospitales con más de 500 camas. Conclusiones: Hay una gran variabilidad en el manejo radiológico de la DA, con divergencias en los protocolos utilizados y entre las opiniones de los radiólogos y la práctica clínica real.(AU)

Introduction: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists’ preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. Methods: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents’ working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. Results: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with>500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. Conclusions: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists’ opinions, and actual clinical practice.(AU)

Correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por OCT en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular / Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors

Objetivo Determinar la correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por tomografía de coherencia óptica en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular (anti-VEGF). Diseño Se trata de un estudio ambispectivo (prospectivo+retrospectivo) observacional y analítico. Participantes Todos los pacientes de 55 años o más con degeneración macular relacionada con la edad que acudieron al departamento de Retina del servicio de Oftalmología y cumplieron con los criterios de inclusión entre marzo-mayo de 2022. Métodos Se recolectaron los datos por medio de la revisión de expedientes. Se analizaron los estudios de tomografía de coherencia óptica previa a la aplicación de inyecciones intravítreas de los pacientes que se encontraban en el mes posterior a la última dosis. Se incluyeron un total de 33 sujetos y un total de 30 continuaron seguimiento. Se realizaron pruebas de normalidad (Shapiro y Bartlett) entre los grupos de estudio, dando como resultado grupos no normales no homocedásticos. Los sujetos fueron sometidos a una nueva evaluación oftalmológica y nueva toma de mediciones retinianas. Resultados Se realizó un análisis de regresión lineal comparando los valores logarítmicos de la agudeza visual y la sensibilidad al contraste, obteniendo una relación significativa entre ambos valores posterior a la aplicación del tratamiento (p<0,0001). Asimismo, se demostró una correlación entre la disminución de los valores de la sensibilidad al contraste y todas las características evaluadas en el tomografía de coherencia óptica. Conclusiones Las estrategias de antiangiogénesis pueden conducir a mejores resultados en la función visual global, impactando positivamente en la sensibilidad al contraste (AU)

Objective To determine the correlation between contrast sensitivity and morphological characteristics obtained by optical coherence tomography in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). Design This is an ambispective (prospective+retrospective) observational, cross-sectional, and analytical study. Participants All patients over 55 years of age with age-related macular degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. Methods Data collection was carried out by reviewing the records of patients.Optical coherence tomography studies prior to the application of intravitreal injections of patients who were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. Normality tests (Shapiro and Bartlett) were performed where a nonparametric data distribution was demonstrated. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Results A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P<.0001). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients’ optical coherence tomography. Conclusions Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity (AU)

Central nervous system activity of a Tabernaemontana arborea alkaloid extract involves serotonergic and opioidergic neurotransmission in murine models.

Tabernaemontana arborea (Apocynaceae) is a Mexican tree species known to contain ibogan type alkaloids. This study aimed at determining central nervous system-related activities of an alkaloid extract obtained from the root bark of T. arborea. A gas chromatography-mass spectrometry (GC-MS) analysis was performed to describe the alkaloid profile of the extract. A wide dosing range (0.1 to 56.2 mg/kg) of this extract was evaluated in different murine models. Electrical brain activity was examined by electroencephalography (EEG). The extract's effects on motor coordination, ambulatory activity, and memory were analyzed based on the rotarod, open field (OFT), and object recognition tests (ORT), respectively. Antidepressant and antinociceptive activities were determined using the forced swimming test (FST) and the formalin assay, respectively. In order to elucidate the underlying mechanisms of action, the 5-HT1A receptor antagonist WAY100635 (1 mg/kg) or the opioid receptor antagonist naloxone (1 mg/kg) was included in the latter experiments. GC-MS analysis (µg/mg extract) confirmed the presence of the monoterpenoid indole alkaloids (MIAs) voacangine (207.00), ibogaine (106.33), vobasine (72.81), coronaridine (30.72), and ibogamine (24.2) as principal constituents of the extract, which exhibited dose- and receptor-dependent antidepressant (0.1 to 1 mg/kg; 5-HT1A) and antinociceptive (30 and 56.2 mg/kg; opioid) effects, without altering motor coordination, ambulatory activity, and memory. EEG indicated CNS depressant activity at high doses (30 and 56.2 mg/kg). The root bark of T. arborea contains a mixture of alkaloids that may hold therapeutic value in pain relief and the treatment of psychiatric diseases without causing neurotoxic activity at effective doses.

How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques.

INTRODUCTION: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists' preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. METHODS: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents' working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. RESULTS: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with >500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. CONCLUSIONS: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists' opinions, and actual clinical practice.

El valor añadido de los servicios profesionales farmacéuticos asistenciales. Un caso de SFT / The added value of Professional Pharmaceutical Assistance Services. A case of pharmaceutical care

Presentación del caso: paciente de 62 años, dependiente, con buena adherencia terapéutica y presencia de enfermedades psiquiátricas que limitan su calidad de vida. Su hijo, cuidador desde que le diagnosticaron el trastorno de la personalidad, acude a la farmacia solicitando ayuda para abordar la situación. Estudio y evaluación del caso: se evaluó el estado de salud de la paciente y se detectaron posibles resultados negativos asociados a la medicación (RNM) que limitaban su calidad de vida. Intervención: se derivó a su médico de atención primaria con un informe de interconsulta multidisciplinar indicado los posibles RNM y las posibles modificaciones. Resultados: el médico de atención primaria aceptó la intervención y comenzó con una deprescripción progresiva de benzodiacepinas, con respecto a la sintomatología extrapiramidal se confirmó el RNM y se derivó a su especialista en psiquiatría. Tras mejorar significativamente su calidad de vida, se abordaron sus enfermedades cardiovasculares. Para ello se indicaron medidas higiénico- sanitarias que disminuyeran su riesgo cardiovascular. Conclusiones: la coordinación de los diferentes profesionales sanitarios permite un aumento de la autonomía del paciente, una deprescripción de medicamentos y una optimización de recursos sanitarios, traduciéndose como una mejora en su calidad de vida (AU)

Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors.

OBJECTIVE: To determine the correlation between contrast sensitivity and morphological characteristics obtained by Optical Coherence Tomography (OCT) in patients with Age-Related Macular Degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). DESIGN: This is an ambispective (prospective + retrospective) observational, cross-sectional, and analytical study. PARTICIPANTS: All patients over 55 years of age with Age-Related Macular Degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. METHODS: Data collection was carried out by reviewing the records of patients diagnosed with Age-Related Macular Degeneration of the neovascular variety treated with the loading dose of anti-VEGF. OCT studies obtained by Optovue® iVue80 prior to the application of intravitreal injections of patients who met the inclusion criteria and were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Normality tests (Shapiro‒Wilk) were performed where a nonparametric data distribution was demonstrated. RESULTS: A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P = <.0001***). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients' OCT. CONCLUSIONS: Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity.

Categorización de la diverticulitis aguda de colon izquierdo mediante ecografía y tomografía computarizada. Valor de las clasificaciones de gravedad disponibles / Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: value of current severity classification schemes

Antecedentes y objetivoEl manejo actual de la diverticulitis aguda de colon izquierdo requiere pruebas con alto valor pronóstico. Los objetivos del estudio son analizar la utilidad de la ecografía como método diagnóstico inicial y evaluar la validez de las clasificaciones actuales de gravedad de dicha enfermedad.PacientesEstudio observacional retrospectivo de pacientes con diverticulitis aguda de colon izquierdo. Se solicitó ecografía o tomografía computarizada (TC) siguiendo un algoritmo clínico. Tras los hallazgos de imagen, se clasificó la enfermedad como leve, localmente complicada y complicada. Se evaluaron la eficacia de la ecografía como herramienta diagnóstica inicial y las razones por las que se realizó una TC como técnica inicial. Se compararon los hallazgos con las clasificaciones de diverticulitis publicadas.ResultadosDe 311 pacientes con diverticulitis aguda, se seleccionaron 183 con diverticulitis aguda de colon izquierdo, que fueron clasificadas por imagen como leves (104), localmente complicadas (60) y complicadas (19). En 98 pacientes, el diagnóstico se realizó por ecografía, en 77 por TC y en 8 mediante ambas. Las principales razones de utilización inicial de TC fueron falta de experiencia del radiólogo en ecografía abdominal y falta de disponibilidad de un radiólogo de guardia. A 6 pacientes diagnosticados por ecografía se les realizó una nueva evaluación por TC, pero solo en 3 cambió la clasificación. Ninguna de las clasificaciones publicadas recoge todos los hallazgos en imagen.ConclusionesLa ecografía debería ser la primera técnica a utilizar para el diagnóstico de diverticulitis aguda de colon izquierdo. Para establecer el pronóstico de la enfermedad, son útiles diversos parámetros analíticos y hallazgos de imagen. Para una apropiada toma de decisión terapéutica se necesitarían nuevas clasificaciones de gravedad. (AU)

Background and aimsThe current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC.PatientsThis retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC.ResultsA total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings.ConclusionsUS should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making. (AU)