Efecto de Hidroxitirosol sobre algunos biomarcadores cardiovasculares en la Diabetes Mellitus experimental

Las enfermedades cardiovasculares representan la primera causa de mortalidad en los países desarrollados. Las muertes por enfermedades cardiovasculares relacionadas con la diabetes mellitus, son atribuibles a las complicaciones angiopáticas. La dieta mediterránea es reconocida principalmente por su incidencia positiva en la prevención de los eventos cardiovasculares. La principal fuente de grasa es el aceite de oliva virgen, al cual se han atribuido una serie de propiedades beneficiosas para el perfil lipídico, trombosis, metabolismo de la glucosa mediada por la insulina, la presión arterial, la homeostasis, la función endotelial, inflamación y estrés oxidativo. Cada día son más, los estudios que relacionan el efecto saludable a la ingesta de polifenoles, principalmente a través del aceite de oliva virgen; en particular de su principal polifenol, el hidroixitirosol (3,4-dihidroxifenil etanol), al cual se ha demostrado que presenta propiedades antioxidantes, antiinflamatoria, antiagregante plaquetario, anticancerígeno, antimicrobiano, cardioprotector, previene la osteoporosis y neuroprotector. El objetivo del presente estudio fue valorar la posible modificación de los principales biomarcadores que inciden en la aparición de la enfermedad vascular diabética derivada de la administración oral de hidroxitirosol en ratas estreptozotocin-diabéticas. Material y métodos. El estudio se llevó a cabo en de dos meses de evolución ratas diabéticas inducidas con estreptozotocina. Siete grupos de ratas (n = 10 ratas por grupo) se constituyeron: ratas control no diabéticas (NDR), ratas diabéticas (glucosa en sangre 400 mg/dL) sin tratamiento (DR) y ratas diabéticas tratadas desde el primer día de la diabetes (glucosa en sangre 400-600mg/dL) con diferentes dosis de hidroxitirosol (0,5, 1, 2,5, 5 y 10 mg/kg/día, respectivamente). El hidroxitirosol se administró por vía oral una vez al día. Cuantificamos parámetros plaquetarios, bioquímicos endoteliales, de estrés oxidativo, inflamatorios y morfológicos. Resultados: Se observó que los animales diabéticos presentaban un perfil en relación con el sistema vascular, compatible con el daño bioquímico caracterizado por un estrés oxidativo con signos de déficit endotelial y estado proinflamatorio, con un inicio de daño morfológico vascular, lo cual se acompaña de una hipersensibilidad plaquetaria. Tras la administración de hidroxitirosol (fundamentalmente dosis de 0,5 y 2,5 mg/kg/día) nos encontramos que se reduce el estrés oxidativo, la oxidación de LDL y la activación leucocitaria respecto a los animales diabéticos sin tratamiento. Además se frena el estado bioquímico inflamatorio al igual que los parámetros de funcionalismo del endotelio vascular (prostaciclina y óxido nítrico), acercando a valores de los animales normoglucémicos. Se evita la proliferación y crecimiento global de la capa media de la pared arterial y se disminuye de forma dosis-dependiente la activación plaquetaria. Nos encontramos ante un compuesto capaz de actuar en las diferentes fases del evento vascular, desde el inicio de la patología, incluyendo la hiperagregabilidad plaquetaria. Por lo tanto, las conclusiones del presente estudio se pueden explicar: Reduce el estrés oxidativo, la oxidación de LDL y la activación leucocitaria de los animales diabéticos sin tratamiento. Frena el estado bioquímico inflamatorio y el estrés nitrosativo de estos animales. Modula positivamente la disfunción endotelial, acercando los valores bioquímicos endoteliales al nivel de los animales normoglucémicos. Evita la proliferación y crecimiento global de la capa media de la pared arterial. Disminuye de forma dosisdependiente la activación plaquetaria

Äreas Vaginais: função terapéutica

Introducción: Las esferas vaginales también son conocidas como bolas chinas, bolas vaginales, bolas del amor, bolas de geisha, Rin no tama, bolas Ben Wa. Ayudan a fortalecer el suelo pélvico. Estas producen una microvibración al moverse la bola del interior, favoreciendo la musculatura del suelo pélvico y aumentando el riego sanguíneo a nivel de la pelvis. Hay esferas de diferente peso, par su indicación el suelo pélvico debe estar tónico. Objetivo: Revisar la literatura sobre la efectividad de las esferas vaginales e incrementar los conocimientos de los profesionales sobre este tipo de tratamiento propioceptivo, que resulta eficaz para muchas mujeres por su fácil utilización. Metodología: Búsqueda bibliográfica en las bases de datos: Cochrane Plus, Medline, Gerion, Scielo, Cuiden, Biblioteca de Salud Reproductiva de la OMS y google académico. Resultados: Las esferas vaginales son eficaces en el tratamiento de la incontinencia urinaria y fecal y para el entrenamiento del suelo pélvico. La incontinencia urinaria es un problema frecuente y molesto, que puede llegar a interferir en el trabajo, en la vida social y sexual. Hay necesidad de más ensayos para evaluar los métodos y protocolos de entrenamiento adecuados para la prevención de la incontinencia, del prolapso y de la disfunción sexual. Conclusión: Se ha evidenciado que las esferas vaginales son eficaces en el tratamiento de mujeres con incontinencia urinaria de esfuerzo e igualmente efectivas, en el entrenamiento muscular del suelo pélvico.Introduction: Vaginal spheres are also known as Chinese balls, vaginal balls, love balls, geisha balls, Rin no tama, Ben Wa balls. Help strengthen the pelvic floor. These produce a microvibration to move the ball inside, favoring the pelvic floor muscles and increasing blood flow to the pelvic region. There are different areas of weight, torque indications pelvic floor should be tonic. Objective: To review the literature on the effectiveness of vaginal balls and increase knowledge of the professionals on this kind of proprioceptive therapy, which is effective for many women for its easy use. Methods: Literature search in databases: Cochrane, Medline, Gerion, SciELO, Take care, Reproductive Health Library WHO and Academic Google. Results: The vaginal balls are effective in the treatment of urinary and fecal incontinence and pelvic floor training. Urinary incontinence is a common and distressing problem, which may interfere in the work, social and sexual life. There is need for further trials to evaluate the methods and protocols of adequate training for the prevention of incontinence, prolapse and sexual dysfunction. Conclusion: It has been shown that vaginal are better than no active treatment in women with stress urinary incontinence and can be equally effective than pelvic floor muscle training and electrical stimulation.Introdução: áreas vaginais são também conhecidos como bolas chinesas, bolas vaginais, bolas de amor, bolas de geisha, Rin no tama, bolas Ben Wa. Ajude a fortalecer o assoalho pélvico. Estes produzem um micro-vibrações para mover a bola para dentro, favorecendo os músculos do assoalho pélvico e aumentando o fluxo de sangue para a região pélvica. Existem diferentes áreas do peso, as indicações de torque assoalho pélvico deve ser tônica. Objetivo: Revisar a literatura sobre a eficácia das áreas vaginal e aumentar o conhecimento dos profissionais sobre este tipo de terapia proprioceptiva, que é eficaz para muitas mulheres para a sua fácil utilização. Métodos: Pesquisa bibliográfica em bases de dados: Cochrane, Medline, Gerion, SciELO, tome cuidado, Biblioteca de Saúde Reprodutiva da OMS e acadêmico google. Resultados: As esferas vaginais são eficazes no tratamento da incontinência urinária e fecal e treinamento do assoalho pélvico. A incontinência urinária é um problema comum e angustiante, que pode interferir no trabalho, na vida social e sexual. Há necessidade de novos estudos para avaliar os métodos e protocolos de treinamento adequado para a prevenção de incontinencia urinária, prolapso e disfunção sexual. Conclusão: Tem sido demonstrado que as áreas vaginal são eficazes no tratamento de mulheres igualmente eficaz na formação da musculatura do pavimento pélvico e incontinência urinária

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present