Daily supplementation with fresh pomegranate juice increases paraoxonase 1 expression and activity in mice fed a high-fat diet.

PURPOSE: Studies have found that pomegranate juice (PJ) consumption increases the binding of high-density lipoproteins (HDL) to paraoxonase 1 (PON1), thus increasing the catalytic activity of this enzyme. PON1 is an antioxidant arylesterase synthesized in the liver and transported in plasma in association with HDL. Decreased levels of PON1 are associated with higher levels of cholesterol. We determined the effects of PJ on body weight, cholesterol, and triacylglycerols through 5 months of supplementation. In addition, the effect of PJ on pon1 gene expression in the liver was also measured by RT-qPCR as well as the activity in serum by a semiautomated method using paraoxon as a substrate. METHODS: CD-1 mice were either fed a control diet or were fed a high-fat diet 1.25% (wt/wt) cholesterol, 0.5% (wt/wt) sodium cholate, and 15% (wt/wt) saturated fat. 300 µL of PJ containing 0.35 mmol total polyphenols was administered by oral gavage to half of the high fat mice daily. The rest of the high fat mice and the control mice were administered with 300 µL of water. RESULTS: PJ-supplemented animals had significantly higher levels of expression of pon1 compared to the unsupplemented group. PJ-supplemented animals had twice the PON1 activity of the unsupplemented group. In addition, PJ-supplemented animals had the lowest body weight and significantly reduced cholesterol and triacylglycerol levels, although the tricylglycerol levels were not consistently decreased. CONCLUSIONS: These results suggest that PJ protects against the effects of a high-fat diet in body weight, and cholesterol levels.

Differentiation of fibrotic liver tissue using laser-induced breakdown spectroscopy.

Hepatic cirrhosis is a major cause of morbidity and mortality worldwide due to hepatitis C, alcoholism and fatty liver disease associated with obesity. Assessment of hepatic fibrosis relies in qualitative histological evaluation of biopsy samples. This method is time-consuming and depends on the histopathologists' interpretation. In the last decades, non-invasive techniques were developed to detect and monitor hepatic fibrosis. Laser-induced breakdown spectroscopy (LIBS) is a good candidate for a real-time, independent and fast technique to diagnose hepatic fibrosis. In this work LIBS was employed to characterize rat liver tissues with different stages of fibrosis. Depth profiling measurements were carried out by using a nanosecond Nd:YAG laser operated at the fundamental wavelength and an echelle spectrometer coupled with an ICCD camera. Due to the soft nature of the samples, plasma conditions largely change between consecutives shots. Thus, a theoretically supported procedure to correct the spectral line intensities was implemented. This procedure allows the reduction of the intensities' dispersion from 67% to 12%. After the correction, the LIBS signal shows an enhancement in calcium intensity by a factor of three as the fibrosis progressed. Calcium is known to increase crosslinking of extracellular matrix proteins in the fibrous septa. Therefore, our result singles it out as a key participant in the hepatic fibrosis.

Extracolonic Cancer in Inflammatory Bowel Disease: Data from the GETECCU Eneida Registry.

OBJECTIVES: The objective of this study was (a) To know the prevalence and distribution of extracolonic cancer (EC) in patients with inflammatory bowel disease (IBD); (b) To estimate the incidence rate of EC; (c) To evaluate the association between EC and treatment with immunosuppressants and anti-tumor necrosis factor (TNF) agents. METHODS: This was an observational cohort study. INCLUSION CRITERIA: IBD and inclusion in the ENEIDA Project (a prospectively maintained registry) from GETECCU. EXCLUSION CRITERIA: Patients with EC before the diagnosis of IBD, lack of relevant data for this study, and previous treatment with immunosuppressants other than corticosteroids, thiopurines, methotrexate, or anti-TNF agents. The Kaplan-Meier method was used to evaluate the impact of several variables on the risk of EC, and any differences between survival curves were evaluated using the log-rank test. Stepwise multivariate Cox regression analysis was used to investigate factors potentially associated with the development of EC, including drugs for the treatment of IBD, during follow-up. RESULTS: A total of 11,011 patients met the inclusion criteria and were followed for a median of 98 months. Forty-eight percent of patients (5,303) had been exposed to immunosuppressants or anti-TNF drugs, 45.8% had been exposed to thiopurines, 4.7% to methotrexate, and 21.6% to anti-TNF drugs. The prevalence of EC was 3.6%. In the multivariate analysis, age (HR=1.05, 95% CI=1.04-1.06) and having smoked (hazards ratio (HR)=1.47, 95% confidence interval (CI)=1.10-1.80) were the only variables associated with a higher risk of EC. CONCLUSIONS: Neither immunosuppressants nor anti-TNF drugs seem to increase the risk of EC. Older age and smoking were associated with a higher prevalence of EC.

Resultados funcionales de la aplicación de toxina botulínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores / Functional results of type a botulinum toxin versus oral antiinflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion

Las enfermedades del mango de los rotadores se caracterizan por signos inespecíficos, síntomas y alteraciones de la anatomía, su etiología es multifactorial y pueden abarcar desde tendinitis hasta rupturas masivas de espesor completo del tendón del manguito de los rotadores, las cuales comprometen la biomecánica normal del hombro afectado. Normalmente suceden en mayores de 40 años; sin embargo, el asociado a trauma depende del mecanismo de lesión y no tiene relación directa con la edad de aparición de los síntomas. Se han descrito factores vasculares en el daño al tendón del manguito de los rotadores, en patologías que afectan a la microcirculación; sin embargo, estudios recientes no han demostrado que el tendón bajo observación directa presente datos de hipovascularidad. La toxina botulínica tipo A realiza su acción mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular; en las articulaciones provoca liberación de la tensión capsular así como la disminución de factores pro inflamatorios tales como la interleucina-1; aunque existen pocos artículos sobre su utilidad intraarticular, en los grupos musculares y tendinosos, además de tener un efecto miorrelajante existen diversas publicaciones que apoyan su utilidad en el manejo del dolor y su utilidad en la rehabilitación de este grupo de pacientes; en dosis bajas, ha sido ampliamente utilizada. Material y métodos: Se trata de un estudio prospectivo, experimental y longitudinal en el cual se realizó seguimiento a 24 pacientes con diagnóstico de síndrome de hombro doloroso demostrado por pruebas clínicas y de gabinete debido a lesiones del mango de los rotadores, sin criterios de reparación quirúrgica inmediata, o ya reparados, a los cuales a 12 pacientes se les aplicará toxina botulínica tipo A en el espacio subacromial de forma peri-tendón del tendón conjunto del manguito de los rotadores, así como en puntos de dolor y contractura muscular en hombro, con una dosis total de 200 UI de toxina botulínica tipo A, mientras que al grupo control, de 12 pacientes, se le administraron antiinflamatorios vía oral por seis semanas, tipo Cox 2, Celecoxib 100 mg cápsulas una cada 12 horas; a los dos grupos se les sometió a un programa de rehabilitación ya establecido, el cual fue supervisado cada dos semanas y hasta las seis semanas de evolución; se realizaron valoraciones subjetivas y objetivas valorando la presencia de dolor, el nivel funcional y la movilidad posible mediante la escala de valoración funcional de hombro de Constant y la escala visual análoga. Resultados: Grupo de Celecoxib Promedio de escala de Constant inicial fue de 60 puntos, el inmediato a la primera dosis se mantuvo en 60 puntos, a las dos semanas de tratamiento con Celecoxib se encontró un puntaje de Constant promedio de 66 puntos y a las seis semanas el promedio fue de 70.33 puntos, siendo el valor de la p > 0.005. Grupo de toxina botulínica 200 UI máximo en hombro afectado, 50 UI subacromial y 150 en puntos de dolor además de asociarlo a programa de ejercicios de rehabilitación supervisados en consultorio. El promedio de la escala de Constant inicial fue de 58 puntos, el inmediato a la primera dosis se elevó a 70.83 puntos, a las dos semanas posteriores a infiltración y seguimiento de ejercicios en consultorio fue de puntaje Constant promedio de 77.16 puntos y a las seis semanas el promedio fue de 78.5 puntos, siendo el valor de la p < 0.005 (p = 0.00045). En cuanto a la escala visual análoga se observó que en el grupo de Celecoxib existió una disminución de dicha escala a las seis semanas con una p < 0.005.

Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). Results: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doctor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

Efectividad de dos medicamentos intrarticulares en pacientes con artrosis de rodilla: colágeno polimerizado versus hylano gf 20 / Effectiveness of two intraarticular drugs in patients with knee arthrosis: polymerized collagen versus hylan GF 20

El tratamiento de la osteoartrosis se enfoca en mejorar el dolor y la calidad de vida de los portadores. Los antiinflamatorios no esteroideos son la primera elección pero su efectividad es cuestionable por el riesgo de gastropatía y falla renal secundarias. Los medicamentos de uso intrarticular, son una alternativa segura y efectiva para mejorar los síntomas y la función; pueden retrasar la cirugía pero desconocemos si son modificadores de la enfermedad. Nuestro objetivo fue comparar la función y dolor de rodilla en pacientes con osteoartrosis al término del tratamiento asignado. Nuestra hipótesis es que no existe diferencia en los resultados entre ambos grupos. Material y métodos: Estudio prospectivo, aleatorio simple, no cegado, estudiamos a dos grupos de pacientes con osteoartrosis de rodilla. El Grupo 1 fue tratado con colágeno PVP y el Grupo 2 recibió hylano GF-20. Se les aplicó el cuestionario subjetivo del Comité Internacional de Rodilla IKDC y el dolor se midió mediante escala visual análoga, al inicio del tratamiento, al mes y tres meses posteriores al término del mismo. Resultados: La disminución en el dolor medido con escala visual análoga resulta estadísticamente significativa en ambos grupos; sin embargo, al comparar ambos grupos no encontramos diferencias. Así mismo se comportan los resultados del IKDC en ambos grupos, no hay diferencia: sólo se encuentra diferencia entre las mediciones basales y el resultado final.

The purpose of osteoarthrosis treatment is to improve patient's pain and quality of life. Non-steroidal anti-inflammatory drugs are the first choice but their effectiveness is questionable due to the risk of secondary gastric disease and renal failure. Intra-articular drugs are a safe and effective alternative to improve symptoms and function; they may delay surgery but we don't know if they are disease modifying. Our objective was to compare knee function and pain in patients with osteoarthrosis until treatment is finished. Our hypothesis is that there is no difference in the results of both groups. Material and methods: A prospective, simple, randomized non blinded trial where we studied two groups of patients with knee osteoarthrosis. Group 1 was treated with Collagen PVP and Group 2 received hylan GF-20. We gave patients a subjective questionnaire of the International Knee Committee IKDC and pain was measured using the visual analog scale at the beginning of treatment, after one month and after three months. Results: Decrease in pain measured with the visual analog scale is statistically significant in both groups, however, when comparing both groups we did not find differences. The results of the IKDC were the same in both groups, there was no difference except in baseline measurements and in the final result.

[Functional results of type A botulinum toxin versus oral anti-inflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion]. / Resultados funcionales de la aplicación de toxina botuínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores.

UNLABELLED: Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). RESULTS: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doc tor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

[Effectiveness of two intraarticular drugs in patients with knee arthrosis. Polymerized collagen versus hylan]. / Efectividad de dos medicamentos intrarticulares en pacientes con artrosis de rodilla: colágeno polimerizado versus hylano gf 20.

UNLABELLED: The purpose of osteoarthrosis treatment is to improve patient's pain and quality of life. Non-steroidal anti-inflammatory drugs are the first choice but their effectiveness is questionable due to the risk of secondary gastric disease and renal failure. Intra-articular drugs are a safe and effective alternative to improve symptoms and function; they may delay surgery but we don't know if they are disease modifying. Our objective was to compare knee function and pain in patients with osteoarthrosis until treatment is finished. Our hypothesis is that there is no difference in the results of both groups. MATERIAL AND METHODS: A prospective, simple, randomized non blinded trial where we studied two groups of patients with knee osteoarthrosis. Group 1 was treated with Collagen PVP and Group 2 received hylan GF-20. We gave patients a subjective questionnaire of the International Knee Committee IKDC and pain was measured using the visual analog scale at the beginning of treatment, after one month and after three months. RESULTS: Decrease in pain measured with the visual analog scale is statistically significant in both groups, however, when comparing both groups we did not find differences. The results of the IKDC were the same in both groups, there was no difference except in baseline measurements and in the final result.

2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla / The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document

La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia(SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias(SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: “La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH)and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: “Does this particular AABT reduce the transfusion rate or not? “All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation(GRADE) methodology (AU)

2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla / The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document

La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia (SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias (SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6 sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: «La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology (AU)

[The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. / 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla.

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?¼ All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.

[The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. / 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla.

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.

Alternativas terapéuticas de la hemorragia masiva / Treatment alternatives in massive hemorrhage

La hemorragia masiva es la principal causa de morbimortalidad en el paciente traumatizado, y una de las más importantes en el paciente sometido a cirugía mayor. El tratamiento convencional se basaba en la reposición inicial de la volemia con la infusión de grandes cantidades de fluidos y en la transfusión de hemoderivados, con objeto de asegurar la perfusión y oxigenación tisular. Hipotermia, acidosis y coagulopatía se considera triada letal. En esta revisión los autores abordan un enfoque terapéutico actualizado del manejo de la hemorragia masiva. Se preconiza infundir cristaloides de forma pautada (no masiva) para lograr una presión arterial sistólica de 85mmHg. La administración de hemoderivados debe ser precoz y con ratio 1:1:1 (cantidades equiparables de concentrados de hematíes, plasma y plaquetas), y si es posible, guiada por tromboelastograma a la cabecera del paciente. La coagulopatía puede ser precoz y tardía. Salvo el ácido tranexámico, se discute la relación coste-beneficio de fármacos prohemostáticos, como fibrinógeno, complejo protrombínico, y FVII recombinante (AU)

Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. This review focuses on the latest therapeutic management of massive hemorrhage. The authors advocate the use of crystalloids as per protocol (controlled volumes) in order to achieve a systolic blood pressure of 85mmHg. The administration of the three blood products (red cells, plasma, and platelets) should be on a 1:1:1 basis. Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion (AU)

[Treatment alternatives in massive hemorrhage]. / Alternativas terapéuticas de la hemorragia masiva.

Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. This review focuses on the latest therapeutic management of massive hemorrhage. The authors advocate the use of crystalloids as per protocol (controlled volumes) in order to achieve a systolic blood pressure of 85mmHg. The administration of the three blood products (red cells, plasma, and platelets) should be on a 1:1:1 basis. Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion.

[Effectiveness of sodium hyaluronate in patients with gonarthrosis: randomized comparative study]. / Efectividad del hialuronato de sodio en pacientes con gonartrosis, estudio comparativo y aleatorizado.

INTRODUCTION: Hyaluronic acid is a major component of synovial fluid and cartilage; it plays an essential role in joint function. This concept is based on the hypothesis that intraarticular sodium hyaluronate injections improve articular function upon restoring synovial fluid viscosupplementation and promoting endogenous synthesis. MATERIAL AND METHODS: Forty randomly selected patients older than 50 years of age, with a diagnosis of gonarthrosis, standard treatment-naïve, were divided into two 20-patient groups. The first group was treated with five 2.5 ml doses of hyaluronic acid, at one dose per week. The second group was treated with a single 2 ml dose of intraarticular methylprednisolone. A survey containing the Womac functional scale and the pain visual analogue scale was applied to both groups before and 3 months after treatment. RESULTS: A statistically significant reduction in pain (visual analogue scale) was observed 3 months after treatment in group H (1.6 +/- 0.88) and group M (2.95 +/- 1.84), as well as a functional post-treatment improvement in the Womac scale. Results for post-treatment pain were 5.43 +/- 1.05 for group H and 7.86 +/- 0.77 for group M; results for post-treatment stiffness were 3.05 +/- 0.82 for group H and 3.7 +/- 0.85 for group M; and finally for post-treatment functional capacity the results were 12.25 +/- 0.82 for group H and 18.95 +/- 0.85 for group M. CONCLUSION: Intraarticular sodium hyaluronate is more effective for pain and function than methylprednisolone. However, it involves higher costs than conservative treatment and fewer costs than surgical treatment, as well as the discomfort resulting from repeated intraarticular injections and the possibility of anaphylactic reaction.

Electrolytic disorders, hyperosmolar states, and lactic acidosis in brain-dead patients.

Despite the use of well-accepted protocols for donor maintenance, the severe electrolytic disorders are not infrequent with deleterious consequences to the organs. The objective of our survey was to determine the incidence of episodes of electrolyte disorders among brain-dead patients (despite of rigid protocols of maintenance) and the rate of anaerobic metabolism in these patients (suggestive of an occult systemic hypoperfusion). The study group of 50 brain-dead patients underwent therapy to maintain normal arterial pressure, urine output, and body temperature. Standard monitoring for brain-dead patients was followed, except for a frequent evaluation of electrolytes, including glucose, sodium, potassium, phosphorus, osmolality, base excess, and lactate plasma levels. Our results demonstrate that with frequent determinations of electrolytes, despite following strict protocols of maintenance, there was a high incidence of hyperglycemia, hypophosphotemia, hypokaemia, and hyperosmolality. Interesting findings were the high incidence of elevated lactate, and the relationship between lactate levels and bases deficit as well as hypernatremia. It can be concluded that, even following rigid protocols, the maintenance of brain-dead patients demands a close evaluation of electrolyte levels. Our results also suggest that the inclusion in the monitoring protocol of anerobic metabolism data including lactate levels can help to avoid occult ischemia of organs, and consequently improve their quality for transplantation.

La leishmaniasis cutánea en la región subtropical del Ecuador: percepciones, conocimientos y tratamientos populares / Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

En una zona endémica de la región subtropical del coroeste del Ecuador se investigaron las creencias y conocimientos populares acerca de la leishmaniasis cutánea y su tratamiento. Aunque la mayoría de las personas adultas entrevistadas estaban familiarizadas con la enfermedad, el vector y los tratamientos tradicionales, muchas no tenían conocimientos sobre la transmisión de la enfermedad, la curación de las úlceras y el tratamiento médico convencional. Se encontro que el riesgo de contraer la enfermedad y las creencias y conocimientos sobre la misma variaban mucho según el género. Entre los varones, el riesgo de sufrir leishmaniasis cutanea fue casi el triple del observado en mujeres. Asimismo, los varones opinaron con más frecuencia que la enfermedad reducía de manera importante, la capacidad de trabajo del paciente. Por otra parte, las mujeres se mostraron más proclives a considerar a la leishmaniasis cutánea un trastorno grave capaz de menoscabar considerablemente la autoestima de quien la padece. Aunque el 80 por ciento de las personas entrevistadas conocían por lo menos uno de los métodos de tratamiento de la enfermedad, las mujeres en general conocían más métodos que los hombres. La mayoría de los 150 regímenes terapéuticos que se mencionaron se basaban en el uso de plantas autóctonas, sustancias químicas, ácidos, antibióticos, tratamientos térmicos o productos derivados del petróleo. Algunos de esos tratamientos podrían tener eficacia clínica. Sin embargo, solo el 7 por ciento de las personas entrevistadas conocían los compuestos antimoniales pentavalentes. Casi 70 por ciento de los que notificaron infección previa o activa fueron tratados únicamente con métodos tradicionales. Solo 12 por ciento recibieron el tratamiento completo con Glucantine, mientras que 7,5 por ciento recibieron un tratamiento incompleto. Los resultados indican que al planificar futuros programas de lucha contra la leishmaniasis cutánea será importante tener en cuenta aquellas áreas en las que se han detectado un deficit de conocimientos y creencias sobre la enfermedad y su tratamiento que varían según el género

La leishmaniasis cutánea en la región subtropical del Ecuador: percepciones, conocimientos y tratamientos populares / Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

En una zona endémica de la región subtropical del coroeste del Ecuador se investigaron las creencias y conocimientos populares acerca de la leishmaniasis cutánea y su tratamiento. Aunque la mayoría de las personas adultas entrevistadas estaban familiarizadas con la enfermedad, el vector y los tratamientos tradicionales, muchas no tenían conocimientos sobre la transmisión de la enfermedad, la curación de las úlceras y el tratamiento médico convencional. Se encontro que el riesgo de contraer la enfermedad y las creencias y conocimientos sobre la misma variaban mucho según el género. Entre los varones, el riesgo de sufrir leishmaniasis cutanea fue casi el triple del observado en mujeres. Asimismo, los varones opinaron con más frecuencia que la enfermedad reducía de manera importante, la capacidad de trabajo del paciente. Por otra parte, las mujeres se mostraron más proclives a considerar a la leishmaniasis cutánea un trastorno grave capaz de menoscabar considerablemente la autoestima de quien la padece. Aunque el 80 por ciento de las personas entrevistadas conocían por lo menos uno de los métodos de tratamiento de la enfermedad, las mujeres en general conocían más métodos que los hombres. La mayoría de los 150 regímenes terapéuticos que se mencionaron se basaban en el uso de plantas autóctonas, sustancias químicas, ácidos, antibióticos, tratamientos térmicos o productos derivados del petróleo. Algunos de esos tratamientos podrían tener eficacia clínica. Sin embargo, solo el 7 por ciento de las personas entrevistadas conocían los compuestos antimoniales pentavalentes. Casi 70 por ciento de los que notificaron infección previa o activa fueron tratados únicamente con métodos tradicionales. Solo 12 por ciento recibieron el tratamiento completo con Glucantine, mientras que 7,5 por ciento recibieron un tratamiento incompleto. Los resultados indican que al planificar futuros programas de lucha contra la leishmaniasis cutánea será importante tener en cuenta aquellas áreas en las que se han detectado un deficit de conocimientos y creencias sobre la enfermedad y su tratamiento que varían según el género

Se publica en inglés en el Bull. PAHO. Vol. 28(2), 1994