423 research outputs found
Discordance between microvascular permeability and leukocyte dynamics in septic inducible nitric oxide synthase deficient mice
Obesity in Prader–Willi syndrome: physiopathological mechanisms, nutritional and pharmacological approaches
Prader–Willi syndrome (PWS) is a genetic disorder caused by the lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region. The three main genetic subtypes are represented by paternal 15q11-q13 deletion, maternal uniparental disomy 15, and imprinting defect. Clinical picture of PWS changes across life stages. The main clinical characteristics are represented by short stature, developmental delay, cognitive disability and behavioral diseases. Hypotonia and poor suck resulting in failure to thrive are typical of infancy. As the subjects with PWS age, clinical manifestations such as hyperphagia, temperature instability, high pain threshold, hypersomnia and multiple endocrine abnormalities including growth hormone and thyroid-stimulating hormone deficiencies, hypogonadism and central adrenal insufficiency due to hypothalamic dysfunction occur. Obesity and its complications are the most common causes of morbidity and mortality in PWS. Several mechanisms for the aetiology of obesity in PWS have been hypothesized, which include aberration in hypothalamic pathways of satiety control resulting in hyperphagia, disruption in hormones regulating appetite and satiety and reduced energy expenditure. However, despite the advancement in the research field of the genetic basis of obesity in PWS, there are contradictory data on the management. Although it is mandatory to adopt obesity strategy prevention from infancy, there is promising evidence regarding the management of obesity in adulthood with current obesity drugs along with lifestyle interventions, although the data are limited. Therefore, the current manuscript provides a review of the current evidence on obesity and PWS, covering physiopathological aspects, obesity-related complications and conservative management
Use of Transversus Abdominis Plane and Intercostal Blocks in Bitches Undergoing Laparoscopic Ovariectomy: A Randomized Controlled Trial
In humans and dogs, loco-regional anesthesia is associated with lower peri-operative opioid consumption and less related side effects. The combination of transversus abdominis plane (TAP) and intercostal blocks can be used to desensitize the entire abdominal wall in dogs. The aim of this study was to evaluate the effectiveness of TAP and intercostal blocks in bitches undergoing laparoscopic ovariectomy. Twenty client-owned bitches were enrolled in this double-blinded randomized controlled trial. After premedication with dexmedetomidine, methadone and ketamine, the animals were randomized into two groups. Dogs in the TAP group received intercostal blocks from T8 to T10 and a TAP block with ropivacaine. Dogs in the FEN group received a fentanyl bolus and a constant rate infusion for the entire duration of the procedure. Intra-operative cardiovascular stability, post-operative pain scores, rescue opioid requirement, dysphoria during recovery, time to attain sternal recumbency and interest in food at 6 h post-extubation were compared. Bitches in the TAP group received a statistically significant lower amount of rescue fentanyl intra-operatively and methadone post-operatively. Pain scores were lower in the TAP group until 6 h post-extubation. No difference was found for dysphoric recoveries, time to attain sternal recumbency and appetite at 6 h post-extubation. No adverse event was recorded for any of the dogs. The combination of TAP and intercostal blocks can be part of an effective multi-modal analgesic strategy in bitches undergoing laparoscopic ovariectomy
Non-invasive determination of transpulmonary gradient and pulmonary vascular resistance in potential heart transplant candidates: Can right heart catheterization be avoided?
Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study
La calidad educativa de los centros de hoy depende del nivel de competencias adquirido por sus educadores (Perrenoud, 2002). En este sentido, debemos apostar por un equipo humano formado por sujetos que sepan superarse permanentemente, aptos para ejercer tareas dinámicas y cambiantes y que compartan alternativas para crecer en todos los sentidos. Más todavía, debemos apostar por profesionales capaces de identificar y dominar los procesos que se deben realizar actuando con decisión y responsabilidad. La adquisición de competencias comporta aptitud y actitud para utilizar conocimientos, más concretamente, habilidades y valores, de manera interdisciplinaria, transversal e interactiva en contextos y situaciones que requieren la intervención de contenidos vinculados a las diferentes áreas del currículum (Lleixà, 2007), sin exclusividad, en este caso, del área de Educación Física. Presentamos una propuesta metodológica, el «Paradigma Estratégico para el desarrollo de habilidades competenciales», cuya ejecución implica comprensión, reflexión y discernimiento, teniendo en cuenta la dimensión social de cada situación. El estudio se ha llevado a cabo en la Universidad de Lleida con 40 alumnos de tercer curso de la asignatura «Educación Física y su didáctica». Se pretende valorar el impacto que provoca la implementación del programa «Paradigma estratégico para la adquisición de habilidades competenciales» sobre sus propias percepciones competenciales intrapersonales, antes y después de la aplicación de dicho programa
Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation
Background: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is
able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if
functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO2AT) could identify these patients.
Methods: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed
CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial
applanation tonometry were performed.
Results: There were 70 participants (age 41.7614.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were
desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced
anaerobic threshold (VO2AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27–0.68; p,0.001) and
in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12–0.59; p = 0.001). The area under the receiveroperating-
characteristic curve was 0.93, based on a risk prediction model that incorporated VO2AT, body mass index and
desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU
admission.
Conclusions: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a
preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO2AT has the
potential to predict perioperative morbidity in kidney transplant recipients
Primeros casos autóctonos de hepatitis E en Uruguay
Con el objetivo de describir los primeros casos autóctonos de Hepatitis E se realizó un estudio descriptivo. La población, 9 enfermos, se identificó en el periodo noviembre 2009 a julio 2010. Se seleccionaron por IgG e IgM específicas para VHE y se realizó búsqueda de ARN viral en suero por RT-PCR. Presentaron una media de 51 años, 8 del sexo masculino, educación terciaria, nivel socioeconómico medio alto, atención en el sector privado y residencia urbana. La clínica fue similar a Hepatitis A, con transaminasas elevadas por encima de 1500 (mU/ml), la glutamicopiruvica con valores máximos de 5270 (mU/ml). Todos presentaron hiperbilirrubinemia a predominio directa, aumento de la gamaglutamil transferasa y de Fosfatasa Alcalina. Se demostró circulación en Uruguay del VHE con manifestaciones clínicas, lo que traduce la presencia de una enfermedad emergente.
Se plantea introducir el diagnostico del VHE en forma protocolizada en pacientes sin diagnostico etiológico de hepatitis
Bactericidal/permeability-increasing protein inhibits endotoxin-induced vascular nitric oxide synthesis
Lipopolysaccharides of brucella abortus and brucella melitensis induce nitric oxide synthesis in rat peritoneal macrophages
Producción CientíficaSmooth lipopolysaccharide (S-LPS) and lipid A of Brucella abortus and Brucella melitensis induced the
production of nitric oxide (NO) by rat adherent peritoneal cells, but they induced lower levels of production
of NO than Escherichia coli LPS. The participation of the inducible isoform of NO synthase (iNOS) was
confirmed by the finding of an increased expression of both iNOS mRNA and iNOS protein. These observations
might help to explain (i) the acute outcome of Brucella infection in rodents, (ii) the low frequency of septic
shock in human brucellosis, and (iii) the prolonged intracellular survival of Brucella in humans.This work was supported by (grants FIS 96/1017, SAF96-0144, and SAF98-0176
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