Libro de Transfusión sanguínea / Book on Blood Transfusion

Enero 4, 2017. No. 2559 Transfusión sanguínea en la práctica clínica Blood Transfusion in Clinical Practice Edited by Puneet Kaur Kochhar, ISBN 978-953-51-0343-1, 284 pages, Publisher: InTech, Chapters published March 16, 2012 under CC BY 3.0 license DOI: 10.5772/1868 Edited Volume Blood Transfusion in Clinical Practice focuses on the application of blood transfusion in different clinical settings. The text has been divided into five sections. The first section includes a chapter describing the basic principles of ABO blood group system in blood transfusion. The second section discusses the use of transfusion in various clinical settings including orthopedics, obstetrics, cardiac surgery, etc. The third section covers transfusion transmitted infections, while section four describes alternative strategies to allogenic blood transfusion. The last section speculates over immunomodulatory effects of blood transfusion. Libro / Book 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Osteoporosis: Paradigmas modernos para los huesos del siglo pasado

Osteoporosis: Paradigmas modernos para los huesos del siglo pasado



http://www.altaespecialidadenortopedia.com.mx/academia/osteoporosis-paradigmas-modernos-para-los-huesos-del-siglo-pasado/

Osteoporosis: Modern Paradigms for Last Century’s Bones

Fuente
Este artículo es originalmente publicado en:



https://www.ncbi.nlm.nih.gov/pubmed/27322315

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924217/

http://www.mdpi.com/2072-6643/8/6/376



De:

Kruger MC¹, Wolber FM².

Nutrients. 2016 Jun 17;8(6). pii: E376. doi: 10.3390/nu8060376.



Todos los derechos  reservados para:

Copyright © 2016 by the authors; licensee MDPI, Basel, Switzerland.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).

Go to:

Abstract

Abstract

The skeleton is a metabolically active organ undergoing continuously remodelling. With ageing and menopause the balance shifts to increased resorption, leading to a reduction in bone mineral density and disruption of bone microarchitecture. Bone mass accretion and bone metabolism are influenced by systemic hormones as well as genetic and lifestyle factors. The classic paradigm has described osteoporosis as being a “brittle bone” disease that occurs in post-menopausal, thin, Caucasian women with low calcium intakes and/or vitamin D insufficiency. However, a study of black women in Africa demonstrated that higher proportions of body fat did not protect bone health. Isoflavone interventions in Asian postmenopausal women have produced inconsistent bone health benefits, due in part to population heterogeneity in enteric bacterial metabolism of daidzein. A comparison of women and men in several Asian countries identified significant differences between countries in the rate of bone health decline, and a high incidence rate of osteoporosis in both sexes. These studies have revealed significant differences in genetic phenotypes, debunking long-held beliefs and leading to new paradigms in study design. Current studies are now being specifically designed to assess genotype differences between Caucasian, Asian, African, and other phenotypes, and exploring alternative methodology to measure bone architecture.

KEYWORDS:

ageing; bone health; bone mineral density; osteoporosis

Resumen

El esqueleto es un órgano metabólicamente activo sometido a remodelación continua. Con el envejecimiento y la menopausia el equilibrio cambia a una mayor resorción, lo que lleva a una reducción de la densidad mineral ósea y la interrupción de la micro-arquitectura ósea. La acumulación de masa ósea y el metabolismo óseo son influenciados por las hormonas sistémicas, así como factores genéticos y de estilo de vida. El paradigma clásico ha descrito la osteoporosis como una enfermedad de “hueso quebradizo” que ocurre en las mujeres posmenopáusicas, delgadas, caucásicas con bajo consumo de calcio y / o insuficiencia de vitamina D. Sin embargo, un estudio de mujeres negras en África demostró que proporciones más altas de grasa corporal no protegen la salud ósea. Las intervenciones de Isoflavona en mujeres posmenopáusicas asiáticas han producido beneficios de salud ósea inconsistentes, debido en parte a la heterogeneidad de la población en el metabolismo bacteriano entérico de la daidzeína. Una comparación de mujeres y hombres en varios países asiáticos identificó diferencias significativas entre países en la tasa de disminución de la salud ósea y una alta tasa de incidencia de osteoporosis en ambos sexos. Estos estudios han revelado diferencias significativas en los fenotipos genéticos, desacreditar las creencias de larga data y conducir a nuevos paradigmas en el diseño del estudio. Actualmente se están diseñando estudios específicos para evaluar las diferencias de genotipo entre los fenotipos de raza caucásica, asiática, africana y otros, y explorar una metodología alternativa para medir la arquitectura ósea.
PALABRAS CLAVE:
envejecimiento; la salud ósea; densidad mineral del hueso; osteoporosis

PMID: 27322315  PMCID: PMC4924217   DOI:  10.3390/nu8060376

Mortalidad postoperatoria / Postoperative mortality

Enero 4, 2017. No. 2560

Nuevo sistema de puntuación quirúrgica para predecir la mortalidad postoperatoria. New surgical scoring system to predict postoperative mortality. Kinoshita M1, Morioka N2, Yabuuchi M1, Ozaki M1. J Anesth. 2016 Dec 19. [Epub ahead of print] Abstract PURPOSE: There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality. METHODS: The study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality. RESULTS: Increased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001). CONCLUSIONS: The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems. KEYWORDS: American Society of Anesthesiologists physical status classification (ASA-PS); Patient safety; Postoperative mortality; Surgical Apgar score (sAs) PDF El puntaje de apgar quirúrgico predice la complicación temprana en amputados transfemorales: Estudio retrospectivo de 170 amputaciones mayores. Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations. Wied C1, Foss NB1, Kristensen MT1, Holm G1, Kallemose T1, Troelsen A1. World J Orthop. 2016 Dec 18;7(12):832-838. doi: 10.5312/wjo.v7.i12.832. eCollection 2016. Abstract AIM: To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS: This was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery. RESULTS: A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0.004] and for the TFA sub-group [OR = 3.82 (1.5-9.42), P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648 (0.562-0.733), P = 0.001], for TFA patients = [0.710 (0.606-0.813), P < 0.001] and for TTA patients = [0.472 (0.383-0.672), P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients. CONCLUSION: SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups. KEYWORDS: Lower extremity amputation; Mortality; Post-operative complication; Surgical apgar score; Transfemoral amputation PDF Estudio observacional para valorar y predecir serios eventos adversos después de cirugía mayor Observational Study to Assess and Predict Serious Adverse Events after Major Surgery. Shiozaki K1, Morimatsu H, Matsusaki T, Iwasaki T. Acta Med Okayama. 2016 Dec;70(6):461-467. Abstract Many patients suffer from postoperative serious adverse events (SAEs). Here we sought to determine the incidence of SAEs, assess the accuracy of currently used scoring systems in predicting postoperative SAEs, and determine whether a combination of scoring systems would better predict postoperative SAEs. We prospectively evaluated patients who underwent major surgery. We calculated 4 scores: American Society of Anesthesiologists physical status (ASA-PS) score, the Charlson Score, the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score, and the Surgical Apgar Score (SAS). We assessed the occurrence of SAEs. We assessed the association between each score and SAEs. We combined these scoring systems to find the best combination to predict the occurrence of SAEs. Among 284 patients, 43 suffered SAEs. All scoring systems could predict SAEs. However, their predictive power was not high (the area under the receiver operating characteristic curves [AUROC] 0.6-0.7). A combination of the ASA-PS score and the SAS was the most predictive of postoperative SAEs (AUROC 0.714). The incidence of postoperative SAEs was 15.1 . The combination of the ASA-PS score and the SAS may be a useful tool for predicting postoperative serious adverse events after major surgery. PDF  5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015