Consulta de preanestesia en cirugía mayor ambulatoria / No disponible

La consulta de preanestesia en la unidad de cirugía mayor ambulatoria, es un elemento muy importante desde el punto de vista organizativo, ya que gracias a un buen planteamiento de la misma podemos obtener un mayor rendimiento así como mejorar la seguridad del paciente. En este trabajo se presenta de manera descriptiva el modo en el que estamos organizados, que se divide fundamentalmente en tres aspectos: a) el cuestionario de salud, que es rellenado por el paciente, consiguiendo así que participen en su salud; b) los algoritmos o flujo gramas que en base a la edad, estado físico, comorbilidades y tipo de cirugía orientan a la hora de pedir pruebas complementarias, consiguiendo así una indicación más precisa de las mismas; y por último c) la clasificación del tipo de cirugía, realizada en base a la experiencia acumulada en nuestro centro y el tipo de cirugía. Este diseño de entre muchos válidos es muy dinámico, permitiendo su adaptación a las necesidades de cada centro, mejorando así el rendimiento y la seguridad del paciente (AU)

Pre-anaesthetic evaluation constitutes an important organizational component in a day surgery unit. A careful set up may lead to major efficiency and improved patient safety. This work presents a description of the organizational model of our unit, which consists of three fundamental elements: a) the health questionnaire, filled in by the patient, thus achieving implication in her/his health related questions; b)the algorithms or flow-charts which, based on patients’ age, ASA, comorbidities, and type of surgery, indicate more precisely the complementary analyses to be done; and c) finally classification of the surgery to be carried out, based on the body of experience accumulated in our centre. This design is, among many other valid ones, very dynamic and permits being adapted to the necessities of varying centres obtaining better efficiency and patient safety (AU)

Olfactory bulbectomy, but not odor conditioned aversion, induces the differentiation of immature neurons in the adult rat piriform cortex.

The piriform cortex layer II of young-adult rats presents a population of prenatally generated cells, which express immature neuronal markers, such as the polysialylated form of the neural cell adhesion molecule (PSA-NCAM) or doublecortin (DCX), and display structural characteristics of immature neurons. The number of PSA-NCAM/DCX expressing cells in this region decreases markedly as age progresses, suggesting that these cells differentiate or die. Since the piriform cortex receives a major input from the olfactory bulb and participates in olfactory information processing, it is possible that the immature neurons in layer II are affected by manipulations of the olfactory bulb or olfactory learning. It is not known whether these cells can be induced to differentiate and, if so, what would be their fate. In order to address these questions, we have performed unilateral olfactory bulbectomy (OBX) and an olfactory learning paradigm (taste-potentiated odor aversion, TPOA), in young-adult rats and have studied the expression of different mature and immature neuronal markers, as well as the presence of cell death. We have found that 14 h after OBX there was a dramatic decrease in the number of both PSA-NCAM and DCX expressing cells in piriform cortex layer II, whereas that of cells expressing NeuN, a mature neuronal marker, increased. By contrast, the number of cells expressing glutamate decarboxylase, isoform 67 (GAD67), a marker for interneurons, decreased slightly. Additionally, we have not found evidence of numbers of dying cells high enough to justify the disappearance of immature neurons. Analysis of animals subjected to TPOA revealed that this paradigm does not affect PSA-NCAM expressing cells. Our results strongly suggest that OBX can induce the maturation of immature neurons in the piriform cortex layer II and that these cells do not become interneurons. By contrast, these cells do not seem to play a crucial role in olfactory memory.

Relationship between Serum Concentration of Uric Acid and Insulin Secretion among Adults with Type 2 Diabetes Mellitus.

To determine the relationship between serum concentrations of uric acid and insulin secretion with hyperglycaemic clamp technique among adults with type 2 diabetes mellitus (DM2) without hyperuricemia, we carried out a cross-sectional study on 45 patients of both gender. We observed correlation between uric acid with male gender r = 0.710 (P = 0.001). Also correlation between uric acid and total insulin secretion was positive r = 0.295 (P = 0.049). As well as a positive correlation adjusted for body mass index was demonstrated for the first, second, and total phases of insulin secretion, respectively, r = 0.438 (P = 0.022), r = 0.433 (P = 0.022), and r = 0.439 (P = 0.024). Serum concentration of uric acid showed a positive relationship with the total phase of insulin secretion; even in states prior to hyperuricemia, uric acid can play an important role in the function of the beta cell in patients with DM2.

Prevalence of metabolic syndrome in adults with excess of adiposity: comparison of the Adult Treatment Panel III criteria with the International Diabetes Federation definition.

The aim was to compare the Adult Treatment Panel (ATP) III criteria with the International Diabetes Federation (IDF) definition of metabolic syndrome (MS) in adults with excess adiposity who were considered a high-risk population. A cross-sectional study was carried out in 274 adults with excess adiposity. MS was assessed in all volunteers considering the ATP III criteria and the new IDF definition. Among all individuals, 130 (47%) were similarly classified under the two definitions. Under the ATP III criteria, but not the IDF definition, 2 (1%) participants had MS, and 29 (11%) subjects had MS under the IDF definition but not the ATP III criteria (p=0.009). The ATP III criteria and the IDF definition were useful for identifying MS in adults with excess of adiposity; however, the IDF proposal identified a greater percentage of patients.