Perforación oral: Una moda arriesgada.
Oral piercing: A risky fashion.
Pramod R C, Suresh K V, Kadashetti V, Shivakumar K M, Ingaleshwar PS, Shetty SJ.
J Educ Ethics Dent 2012;2:56-60
Abstract
Piercing is a more prevalent ancient form of body art all over the world, recently popularity attained in Western society. For centuries, piercing was part of many cultures and religious rites. Ancient Egyptians pierced their navels to signify royalty, Roman centurions wore nipple rings as a sign of virility and courage and Mayans pierced their tongues for spiritual purposes, The Eskimos and Aleuts pierced the lips of female infants as part of a purification ritual and the lower lip of the boys as part of passage into puberty. It is that apparent that oral piercings are becoming much more prevalent in today's society. Popular sites for body piercing include the ears, eyebrows, lips, nose, nipples, navel, penis, scrotum, labia, clitoris and tongue. Oral body art, as it is referred to, usually involves piercing of the tongue, cheeks, lips or uvula. The lip is the most commonly pierced site, but tongue piercing is becoming more prevalent. Due to increase in oral piercing, it is important for dental and medical professionals to have knowledge about piercings to educate their patients concerning risk factors, complications and optimal homecare for piercings.
Keywords: Complications, lip, oral piercing, piercing, tongue
http://www.jeed.in/text.asp?2012/2/2/56/121257
Complicaciones de las perforaciones orales y periorales
Oral and perioral piercing complications.
Escudero-Castaño N, Perea-García MA, Campo-Trapero J, Cano-Sánchez, Bascones-Martínez A.
School of Dentistry, Complutense University of Madrid. 28040 madrid-Spain.
Open Dent J. 2008 Dec 4;2:133-6. doi: 10.2174/1874210600802010133.
Abstract
BACKGROUND.: The oral an perioral piercing has a long history as part of religious, tribal,cultural or sexual symbolism and nowdays there is a high incidence of oral and perioral piercing in the adolescent population. This practice has a long history as part of religious, tribal, cultural or sexual symbolism. This article reviews current knowledge on injuries or diseases that might be produced by piercing in the oral cavity. We propose a classification to diagnosed the pathologies related to oral an perioral piercing METHODS.: A search was conducted of articles in PubMed, Scielo published between 1997 and 2007, using the key words ;;oral and perioral, piercing , ;;oral, piercing and disease", ;;recessions and oral piercing . It has reviewed about twentythree articles 17 were narrative reviews and 6 case series RESULTS.: A review was carried out on the origins of oral and perioral body piercing and its local implications, classifying the different alterations like recessions, systemic implications that it can produce in theoral and perioral cavity. CONCLUSION.: Patients with oral and perioral piercing should be regularly followed up because of the possible development of different types of adverse effects. CLINICAL IMPLICATIONS.: Adverse effects of oral and perioral piercing can be systemic, with transmission of infectious diseases such as hepatitis B or C, or can be local, with alteration of oral mucosae or even of dental structures.
KEYWORDS: Oral, perioral piercing and perioral diseases.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606659/pdf/TODENTJ-2-133.pdf
Consideraciones anestesiológicas en un paciente con perforación de la lengua y una solución segura
Anesthetic considerations of a patient with a tongue piercing, and a safe solution.
Brown DC.
Anesthesiology. 2000 Jul;93(1):307-8.
http://journals.lww.com/anesthesiology/Citation/2000/07000/Anesthetic_Considerations_of_a_Patient_with_a.64.aspx
Perforación lingual
Tongue piercing.
Thomas DI.
Anaesthesia. 2000 Jul;55(7):729-30.
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01557-59.x/pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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Murcia.com
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El Universal
Las diez bibliotecas más grandes del mundo | Pulso Diario de San ... marisol
MÉXICO, D.F., noviembre 27 (EL UNIVERSAL).- Las bibliotecas son esos recintos que se encargan de albergar obras literarias para su consulta y disfrute: sus ...
Pulso Online | Pulso Diario de San Luis
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Qué podría decir de Pablo? Pues que a mucha gente le gustaría ser como él, me lo encontré de casualidad por la nube y hasta día de hoy no hay día que no ...
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la silla de parar las prisas
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PACO SALUD
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See on Scoop.it - Recursos TIC para educaciónSee on www.enlanubetic.com.es.
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See on Scoop.it - Recursos TIC para educaciónSee on tiscar.com.
Bibliotecas escolares y recursos educativos
DocuManía : ¿Que hay al otro lado?....La Herencia Digital: DPA/Raimar Heber ¿Que pasa con toda la información que tienes en la nube cuando mueres? Esta pregunta, al igual que me la hago yo, es ...
LUNES, 2 DE DICIEMBRE DE 2013
¿Que hay al otro lado?....La Herencia Digital
DPA/Raimar Heber
¿Que pasa con toda la información que tienes en la nube cuando mueres? Esta pregunta, al igual que me la hago yo, es probable que os la halláis formulado vosotros en alguna ocasión, no os preocupéis, no sois raros, ni siniestros, ni pertenecientes a ninguna secta satánica, ni nada de eso, lamuerte es algo natural e inevitable, y es por eso que nos preguntemos que sucederá con toda nuestra información una vez hayamos pasado a mejor vida, es la denominada herencia digital, muy en boca últimamente, aunque no lo es tanto en otros países de nuestro entorno.
Nos guste o no, la muerte es el final de la carrera de nuestro cuerpo y de sus funciones. Es el fin como ciudadano y también el fin de nuestra identidad legal. Con la muerte dejan de tener validez nuestros carnet de identidad y de conducir, nuestros ahorros, nuestros bienes muebles e inmuebles, etc. ¿qué pasa con todo aquello que constituye nuestra identidad digital como cuentas de correo, perfiles en redes sociales, vídeos en Vimeo o Youtube, blogs, etc?
La identidad digital es parte integrante de nuestro día a día, utilizamos aplicaciones con naturalidad, enviamos correos, nos "relacionamos" en las redes sociales y pensamos que toda esa información es nuestra y que la controlamos...¿seguro? No es fácil dar una respuesta contundente a esto, pues en multitud de ocasiones la información que subimos a la nube, es en definitiva, propiedad del que las aloja. Pero esto es otro asunto.
Canales de sodio dependientes de voltaje: la biofísica, la farmacología, y canalopatías relacionadas.
Voltage-gated sodium channels: biophysics, pharmacology, and related channelopathies.
Savio-Galimberti E, Gollob MH, Darbar D.
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Nashville, TN, USA.
Front Pharmacol. 2012 Jul 11;3:124. doi: 10.3389/fphar.2012.00124. eCollection 2012.
Abstract
Voltage-gated sodium channels (VGSC) are multi-molecular protein complexes expressed in both excitable and non-excitable cells. They are primarily formed by a pore-forming multi-spanning integral membrane glycoprotein (α-subunit) that can be associated with one or more regulatory β-subunits. The latter are single-span integral membrane proteins that modulate the sodium current (I(Na)) and can also function as cell adhesion molecules. In vitro some of the cell-adhesive functions of the β-subunits may play important physiological roles independently of the α-subunits. Other endogenous regulatory proteins named "channel partners" or "channel interacting proteins" (ChiPs) like caveolin-3 and calmodulin/calmodulin kinase II (CaMKII) can also interact and modulate the expression and/or function of VGSC. In addition to their physiological roles in cell excitability and cell adhesion, VGSC are the site of action of toxins (like tetrodotoxin and saxitoxin), and pharmacologic agents (like antiarrhythmic drugs, local anesthetics, antiepileptic drugs, and newly developed analgesics). Mutations in genes that encode α- and/or β-subunits as well as the ChiPs can affect the structure and biophysical properties of VGSC, leading to the development of diseases termed sodium channelopaties.
KEYWORDS: biophysics, channelopathies, electrophysiology, pharmacology, sodium channels, voltage-gated sodium channels
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394224/pdf/fphar-03-00124.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
La anestesia espinal: una técnica de hoja perene
Spinal anesthesia: an evergreen technique.
Di Cianni S, Rossi M, Casati A, Cocco C, Fanelli G.
Department of Anesthesia and Pain Therapy, University Hospital, Parma, Italy.
Acta Biomed. 2008 Apr;79(1):9-17.
Abstract
Spinal anesthesia is a simple technique that provides a deep and fast surgical block through the injection of small doses of local anesthetic solution into the subarachnoid space. The purpose of this review is to provide an overview on recent developments on local anesthetic drugs, side effects, and special techniques of intrathecal anesthesia. Spinal anesthesia can be considered adequately safe, and severe complications are reasonably rare. The cardiovascular effects associated with sympathetic block are more frequent, but successfully treated with volume expansion and administration of vasoactive drugs. It is clear that the total dose of local anesthetic injected into the subarachnoid space is the most important determinant of both therapeutic and unwanted effects of spinal anesthesia. Several studies have also demonstrated the efficacy and safety of using small doses of long acting agents, such as bupivacaine or ropivacaine, to produce an adequately short spinal block in outpatients. Levopivacaine, the pure S(-)-enantiomer of racemic bupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine. In the last years we have assisted important changes in the health care organization, with most of the surgical procedures performed on outpatients or on elderly patients with concomitant diseases. This forced us to change the indications and clinical use of intrathecal anesthesia techniques, which have been modified according to the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but evergreen technique.
http://www.actabiomedica.it/data/2008/1_2008/di_cianni.pdf
Colecistectomía laparóscopica con raquianestesia. Estudio prospectivo, randomizado
Laparoscopic cholecystectomy under spinal anaesthesia: A prospective, randomised study.
Tiwari S, Chauhan A, Chaterjee P, Alam MT.
Department of Surgery, Military Hospital, Agra, Uttar Pradesh, India.
J Minim Access Surg. 2013 Apr;9(2):65-71. doi: 10.4103/0972-9941.110965.
Abstract
CONTEXT: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC). AIMS: Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA) in comparison to general anaesthesia(GA). SETTINGS AND DESIGN: A prospective, randomised study conducted over a two year period at an urban, non teaching hospital. MATERIALS AND METHODS: Patients meeting inclusion criteria e randomised into two groups. Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. STATISTICAL ANALYSIS USED: The Student t test, Pearson's chi-square test and Fisher exact test. RESULTS: Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02) while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours) but same as GA group at time of discharge (24 hours). No late postoperative complication or readmission noted in either group. CONCLUSION: Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor.
KEYWORDS: General anaesthesia, laparoscopic cholecystectomy, spinal anaesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673576/
http://www.journalofmas.com/temp/JMinAccessSurg9265-2373247_063532.pdf
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Una revisión exhaustiva de la hiperalgesia inducida por opioides
A comprehensive review of opioid-induced hyperalgesia.
Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L.
Centers for Pain Management, Tifton, GA 31794, USA. info@centersforpain.com
Pain Physician. 2011 Mar-Apr;14(2):145-61.
Abstract
Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli. The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain. OIH appears to be a distinct, definable, and characteristic phenomenon that could explain loss of opioid efficacy in some patients. Findings of the clinical prevalence of OIH are not available. However, several observational, cross-sectional, and prospective controlled trials have examined the expression and potential clinical significance of OIH in humans. Most studies have been conducted using several distinct cohorts and methodologies utilizing former opioid addicts on methadone maintenance therapy, perioperative exposure to opioids in patients undergoing surgery, and healthy human volunteers after acute opioid exposure using human experimental pain testing. The precise molecular mechanism of OIH, while not yet understood, varies substantially in the basic science literature, as well as clinical medicine. It is generally thought to result from neuroplastic changes in the peripheral and central nervous system (CNS) that lead to sensitization of pronociceptive pathways. While there are many proposed mechanisms for OIH, 5 mechanisms involving the central glutaminergic system, spinal dynorphins, descending facilitation, genetic mechanisms, and decreased reuptake and enhanced nociceptive response have been described as the important mechanisms. Of these, the central glutaminergic system is considered the most common possibility. Another is the hypothesis that N-methyl-D-aspartate (NMDA) receptors in OIH include activation, inhibition of the glutamate transporter system, facilitation of calcium regulated intracellular protein kinase C, and cross talk of neural mechanisms of pain and tolerance. Clinicians should suspect OIH when opioid treatment's effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages. The treatment involves reducing the opioid dosage, tapering them off, or supplementation with NMDA receptor modulators. This comprehensive reviewaddresses terminology and definition, prevalence, the evidence for mechanism and physiology with analysis of various factors leading to OIH, and effective strategies for preventing, reversing, or managing OIH.
http://www.painphysicianjournal.com/2011/march/2011;14;145-161.pdf
http://www.integration.samhsa.gov/pbhci-learning-community/Opioid-Induced_Hyperalgesia_Article.pdf
Hiperalgesia inducida por opioides: implicaciones clínicas para al algólogo.
Opioid induced hyperalgesia: clinical implications for the pain practitioner.
Silverman SM.
Comprehensive Pain Medicine, Pompano Beach, FL 33064, USA. silvpain1@bellsouth.net
Pain Physician. 2009 May-Jun;12(3):679-84.
Abstract
Opioids have been and continue to be used for the treatment of chronic pain. Evidence supports the notion that opioids can be safely administered in patients with chronic pain without the development of addiction or chemical dependency. However, over the past several years, concerns have arisen with respect to administration of opioids for the treatment of chronic pain, particularly non-cancer pain. Many of these involve legal issues with respect to diversion and prescription opioid abuse. Amongst these, opioid induced hyperalgesia (OIH) is becoming more prevalent as the population receiving opioids for chronic pain increases. OIH is a recognized complication of opioid therapy. It is a pro-nocioceptive process which is related to, but different from, tolerance. This focused review will elaborate on the neurobiological mechanisms of OIH as well as summarize the pre-clinical and clinical studies supporting the existence of OIH. In particular, the role of the excitatory neurotransmitter, N-methyl-D-aspartate appears to play a central, but not the only, role in OIH. Other mechanisms of OIH include the role of spinal dynorphins and descending facilitation from the rostral ventromedial medulla. The links between pain, tolerance, and OIH will be discussed with respect to their common neurobiology. Practical considerations for diagnosis and treatment for OIH will be discussed. It is crucial for the pain specialist to differentiate amongst clinically worsening pain, tolerance, and OIH since the treatment of these conditions differ. Tolerance is a necessary condition for OIH but the converse is not necessarily true. Office-based detoxification, reduction of opioid dose, opioid rotation, and the use of specific NMDA receptor antagonists are all viable treatment options for OIH. The role of sublingual buprenorphine appears to be an attractive, simple option for the treatment of OIH and is particularly advantageous for a busy interventional pain practice.
http://www.painphysicianjournal.com/2009/may/2009;12;679-684.pdf
Opioid-induced hyperalgesia
Hiperalgesia inducida por opioides (HIO)
Dr. Guillermo Aréchiga-Ornelas, Dr. José Emilio Mille-Loera, Dr. Alfonso Ramírez-Guerrero
Revista Mexicana de Anestesiología Volumen 33, Suplemento 1, abril-junio 2010
http://www.sld.cu/galerias/pdf/sitios/anestesiologia/hiperalgesia_y_opioides_2010.pdf
Hiperalgesia inducida por opioides (HIO)
Plínio da Cunha Leal, Jefferson Clivatti, João Batista Santos Garcia, Rioko Kimiko Sakata
Rev Bras Anestesiol 2010; 60: 6: 355-359
http://www.scielo.br/pdf/rba/v60n6/es_v60n6a11.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
La mayor biblioteca online brasileña difunde obras de la Miguel de ... Terra Argentina
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La biblioteca popular Alfonsina Storni fue inaugurada en las instalaciones del Colegio San Martín, ubicado en lslas Orcadas del Sur 1570, Florencio Varela, con ...
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La mayor biblioteca online brasileña difunde obras de la Miguel de ... JulianMarquina
La biblioteca "online" brasileña Nuvem de Livros, la de mayor usuarios en Iberoamérica, incluirá en breve el catálogo de los contenidos editoriales de la ...
RecBib - Recursos Bibliotecarios
Las diez bibliotecas más grandes del mundo | Pulso Diario de San ... marisol
MÉXICO, D.F., noviembre 27 (EL UNIVERSAL).- Las bibliotecas son esos recintos que se encargan de albergar obras literarias para su consulta y disfrute: sus ...
Pulso Online | Pulso Diario de San Luis
Palabras de Mujer en la Biblioteca de Ingenio | Triángulo Digital admin
El Ayuntamiento de la Villa de Ingenio está organizando, a través de la Biblioteca Municipal de Ingenio y en colaboración con la Concejalía de Igualdad, una.
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una señora de san diego se pierde yendo a la biblioteca y acaba Francesc Puigcarbó
Anne Terhune, una mujer de 60 años que vive en San Diego (California, Estados Unidos) salió tranquilamente de su casa rumbo a la biblioteca pero lo que se ...
ABSURDIDADES
Pérdida de memoria, enfermedad de Alzheimer y anestesia general. Una preocupación preoperatoria
Memory Loss, Alzheimer's Disease and General Anesthesia: A Preoperative Concern.
Thaler A, Siry R, Cai L, García PS, Chen L, Liu R.
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, USA.
J Anesth Clin Res. 2012 Feb 20;3(2). pii: 1000192.
Abstract
BACKGROUND:The long-term cognitive effects of general anesthesia are under intense scrutiny. Here we present 5 cases from 2 academic institutions to analyze some common features where the patient's or the patient family member has made a request to address their concern on memory loss, Alzheimer's disease and general anesthesia before surgery. METHODS:Records of anesthesia consultation separate from standard preoperative evaluation were retrieved to identify consultations related to memory loss and Alzheimer's disease from the patient and/or patient family members. The identified cases were extensively reviewed for features in common. We used Google® (http://www. google.com/) to identify available online information using "anesthesia memory loss" as a search phrase. RESULTS: Five cases were collected as a specific preoperative consultation related to memory loss, Alzheimer's disease and general anesthesiafrom two institutions. All of the individuals either had perceived memory impairment after a prior surgical procedure with general anesthesia or had a family member with Alzheimer's disease. They all accessed public media sources to find articles related to anesthesia and memory loss. On May 2nd, 2011, searching "anesthesia memory loss" in Google yielded 764,000 hits. Only 3 of the 50 Google top hits were from peer-reviewed journals. Some of the lay media postings made a causal association between general anesthesia and memory loss and/or Alzheimer's disease without conclusive scientific literature support. CONCLUSION: The potential link between memory loss and Alzheimer's disease with general anesthesia is an important preoperative concern from patients and their family members. This concern arises from individuals who have had history of cognitive impairment or have had a family member with Alzheimer disease and have tried to obtain information from public media. Proper preoperative consultation with the awareness of the lay literature can be useful in reducing patient and patient family member's preoperative anxiety related to this concern.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708317/pdf/nihms-387114.pdf
Exposición a la anestesia general y riesgo de enfermedad de Alzheimer. Revisión sistemática y meta-análisis
Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis.
Seitz DP, Shah PS, Herrmann N, Beyene J, Siddiqui N.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. seitzd@providencecare.ca
BMC Geriatr. 2011 Dec 14;11:83. doi: 10.1186/1471-2318-11-83.
Abstract
BACKGROUND:Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. METHODS: We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. RESULTS: A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. CONCLUSIONS: A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258207/pdf/1471-2318-11-83.pdf
Modulación anestésica de la neuroinflamación en la enfermedad de Alzheimer
Anesthetic modulation of neuroinflammation in Alzheimer's disease.
Tang JX, Eckenhoff MF, Eckenhoff RG.
Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Anaesthesiol. 2011 Aug;24(4):389-94. doi: 10.1097/ACO.0b013e32834871c5.
Abstract
PURPOSE OF REVIEW: To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. RECENT FINDINGS: A large and growing body of evidence shows that neuroinflammation participates in the development of neurodegeneration associated with Alzheimer's disease. Modulation may be possible early in the pathogenesis, and less so when cognitive symptoms appear. A dysfunctional hypoinflammatory response may permit accelerated damage due to other mechanisms in late disease. The peripheral inflammatory response elicited by surgery itself appears to provoke a muted neuroinflammatory response, which enhances ongoing neurodegeneration in some models. Anesthetics have both anti-inflammatory and proinflammatory effects depending on the drug and concentration, but in general, appear to play a small role in neuroinflammation. Human studies at the intersection of chronic neurodegeneration, neuroinflammation, and surgery/anesthesia are rare. SUMMARY: The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289136/pdf/nihms348459.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
¿Son los anestésicos tóxicos para el cerebro?
Are anaesthetics toxic to the brain?
Hudson AE, Hemmings HC Jr.
Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065, USA.
Br J Anaesth. 2011 Jul;107(1):30-7. doi: 10.1093/bja/aer122. Epub 2011 May 26.
Abstract
It has been assumed that anaesthetics have minimal or no persistent effects after emergence from anaesthesia. However, general anaesthetics act on multiple ion channels, receptors, and cell signalling systems in the central nervous system to produce anaesthesia, so it should come as no surprise that they also have non-anaesthetic actions that range from beneficial to detrimental. Accumulating evidence is forcing the anaesthesiacommunity to question the safety of general anaesthesia at the extremes of age. Preclinical data suggest that inhaled anaesthetics can have profound and long-lasting effects during key neurodevelopmental periods in neonatal animals by increasing neuronal cell death (apoptosis) and reducing neurogenesis. Clinical data remain conflicting on the significance of these laboratory data to the paediatric population. At the opposite extreme in age, elderly patients are recognized to be at an increased risk of postoperative cognitive dysfunction (POCD) with a well-recognized decline in cognitive function after surgery. The underlying mechanisms and the contribution of anaesthesia in particular to POCD remain unclear. Laboratory models suggest anaesthetic interactions with neurodegenerative mechanisms, such as those linked to the onset and progression ofAlzheimer's disease, but their clinical relevance remains inconclusive. Prospective randomized clinical trials are underway to address the clinical significance of these findings, but there are major challenges in designing, executing, and interpreting such trials. It is unlikely that definitive clinical studies absolving general anaesthetics of neurotoxicity will become available in the near future, requiring clinicians to use careful judgement when using these profound neurodepressants in vulnerable patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159425/pdf/aer122.pdf
Los anestésicos interfieren con la polarización de las neuronas corticales en desarrollo.
Anesthetics interfere with the polarization of developing cortical neurons.
Mintz CD, Smith SC, Barrett KM, Benson DL.
Department of Anesthesiology, Columbia University, New York, NY 10032, USA. cdm2134@columbia.edu
J Neurosurg Anesthesiol. 2012 Oct;24(4):368-75. doi: 10.1097/ANA.0b013e31826a03a6.
Abstract
Numerous studies from the clinical and preclinical literature indicate that general anesthetic agents have toxic effects on the developing brain, but the mechanism of this toxicity is still unknown. Previous studies have focused on the effects of anesthetics on cell survival, dendrite elaboration, and synapse formation, but little attention has been paid to possible effects of anesthetics on the developing axon. Using dissociated mouse cortical neurons in culture, we found that isoflurane delays the acquisition of neuronal polarity by interfering with axon specification. The magnitude of this effect is dependent on isoflurane concentration and exposure time over clinically relevant ranges, and it is neither a precursor to nor the result of neuronal cell death. Propofol also seems to interfere with the acquisition of neuronal polarity, but the mechanism does not require activity at GABAA receptors. Rather, the delay in axon specification likely results from a slowing of the extension of prepolarized neurites. The effect is not unique to isoflurane as propofol also seems to interfere with the acquisition of neuronal polarity. These findings demonstrate that anesthetics may interfere withbrain development through effects on axon growth and specification, thus introducing a new potential target in the search for mechanisms of pediatric anesthetic neurotoxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479440/pdf/nihms401666.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
http://www.ncbi.nlm.nih.gov/pubmed/24167011
PROFESIONALES DE LA SALUD
Burnout en médicos hospitalarios: ¿los de consulta externa registran mayores índices?
Una reciente revisión y meta-análisis compara la incidencia de agotamiento entre los galenos hospitalarios.
A pesar de las preocupaciones de larga data acerca del burnout en la medicina hospitalaria, poca literatura científica se ha publicado sobre las diferencias de este síndrome entre los médicos de hospital. Pero ahora una revisión y meta-análisis, titulada "Burnout in Inpatient-Based Versus Outpatient-Based Physicians: A Systematic Review and Meta-analysis" y difundida en la última edición de Journal of Hospital Medicine, determinó cuáles son los médicos hospitalarios que experimentan más agotamiento: si los de pacientes hospitalizados o los de consulta externa.
Los cuatro investigadores de Medicina Interna Hospitalaria y Ciencias de la Salud de la Clínica de Mayo de los Estados Unidos, autores de esta revisión, incluyeron 54 estudios de todo el mundo sobre comparaciones de burnout entre médicos hospitalarios, publicados entre 1974 y septiembre de 2012. Los resultados son sorprendentes: a pesar de que la creencia generalizada parece ser la contraria, los médicos hospitalarios que atienden pacientes ambulatorios registraron mayor agotamiento emocional que los médicos de pacientes hospitalizados.
De acuerdo estos autores, hay varias razones por las cuales los médicos de consulta externa pueden ser más propensos al agotamiento emocional que sus colegas de hospitalización. Según varias encuestas realizadas, los médicos ambulatorios aducen que el elevado volumen de pacientes para atender, el papeleo, las preocupaciones médico-legales, y la falta de apoyo de la comunidad son importantes desencadenantes de burnout. En el caso de los profesionales de pacientes hospitalizados, habría dos motivos que reducirían el agotamiento emocional: más oportunidades de trabajo en equipo, y mayor disponibilidad de trabajo por turnos que les posibilita un mejor equilibrio entre su vida profesional y personal.
J Hosp Med. 2013 Nov;8(11):653-64. doi: 10.1002/jhm.2093. Epub 2013 Oct 25.
Burnout in inpatient-based versus outpatient-based physicians: A systematic review and meta-analysis.
Roberts DL, Cannon KJ, Wellik KE, Wu Q, Budavari AI.
Source
Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona.
Abstract
BACKGROUND:
Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published.
PURPOSE:
A systematic review of the literature on burnout in inpatient-based and outpatient-based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians.
DATA SOURCES:
Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects.
STUDY SELECTION:
Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians.
DATA EXTRACTION:
Fifty-four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty-eight studies used the same burnout measure and therefore were amenable to statistical analysis.
DATA SYNTHESIS:
Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies.
CONCLUSIONS:
The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed. Journal of Hospital Medicine 2013;8:653-664. © 2013 Society of Hospital Medicine.
© 2013 Society of Hospital Medicine.
Prurito inducido por opioides neuroaxiales: una actualización
Neuraxial opioid-induced pruritus: An update.
Kumar K, Singh SI.
Department of Anesthesia, Schulich School of Medicine, London Health Sciences, Victoria Hospital, London, Ontario, Canada.
J Anaesthesiol Clin Pharmacol. 2013 Jul;29(3):303-307.
Abstract
Pruritus is a troublesome side-effect of neuraxial (epidural and intrathecal) opioids. Sometimes it may be more unpleasant than pain itself. The prevention and treatment still remains a challenge. A variety of medications with different mechanisms of action have been used for the prevention and treatment of opioid-induced pruritus, with mixed results. The aim of this article is to review the current body of literature and summarize the current understanding of the mechanisms and the pharmacological therapies available to manage opioid-induced pruritus. The literature source of this review was obtained via PubMed, Medline and Cochrane Database of Systematic Reviews until 2012. The search results were limited to the randomized controlled trials, systemic reviews and non-systemic reviews.
KEYWORDS: Complications, epidural, itching, neuraxial opioids, post-operative, pruritus, spinal
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2013;volume=29;issue=3;spage=303;epage=307;aulast=Kumar;type=2
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788225/
Efecto profiláctico de los antagonistas del receptor 5-HT3 sobre el prurito inducido por opioides neuroaxiales: una revisión cuantitativa sistemática
Effect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids: a quantitative systematic review.
Bonnet MP, Marret E, Josserand J, Mercier FJ.
Département d'Anesthésie-Réanimation, Groupe Hospitalier Paris Sud, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Clamart, France. marie-pierre.bonnet@abc.aphp.fr
Br J Anaesth. 2008 Sep;101(3):311-9. doi: 10.1093/bja/aen202. Epub 2008 Jul 7.
Abstract
Pruritus is a frequent adverse event observed after neuraxial administration of opioids. Central 5-hydroxytryptamine subtype 3 (5-HT3) receptors may be activated in this process. This systematic review aimed to evaluate the efficacy of prophylactic 5-HT3 receptor antagonists on neuraxial opioid-induced pruritus. We searched Medline, Embase, and Cochrane Collaboration Library databases. Studies were evaluated with the Oxford Validity Scale. Studies with a score of 3 or more and reporting prophylactic administration of 5-HT3 receptor antagonists vs placebo were included. Fifteen randomized double-blind controlled trials (n=1337) were selected. 5-HT3 antagonists (n=775) significantly reduced pruritus [odds ratio (OR) 0.44 (95% confidence interval, 95% CI, 0.29-0.68), P=0.0002, number-needed-to-treat (NNT) 6 (95% CI, 4-14)], the treatment request for pruritus [OR 0.58 (95% CI, 0.43-0.78), P=0.0003, NNT 10 (95% CI, 7-20)], the intensity of pruritus [weighted mean difference (WMD) -0.35 (95% CI, -0.59 to -0.10), P=0.007], the incidence and the intensity of postoperative nausea and vomiting (PONV), and the need of rescue treatment [respectively, Peto odds ratio (Peto OR) 0.43 (95% CI, 0.31-0.58), P<0.00001, NNT 7 (95% CI, 6-10); WMD -0.12 (95% CI, -0.24 to 0.00), P=0.05 and OR 0.42 (95% CI, 0.20-0.86), P=0.02, NNT 8 (95% CI, 5-35)]. However, the funnel plot was asymmetric, suggesting a risk of publication bias. 5-HT3 receptor antagonists may be an effective strategy in preventing neuraxial opioid-induced pruritus and PONV. Further large randomized controlled trials are required to confirm these findings.
http://bja.oxfordjournals.org/content/101/3/311.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Duración prolongada de anestesia local con toxicidad mínima
Prolonged duration local anesthesia with minimal toxicity.
Epstein-Barash H, Shichor I, Kwon AH, Hall S, Lawlor MW, Langer R, Kohane DS.
Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Erratum in Proc Natl Acad Sci U S A. 2011 Mar 8;108(10):4264.
Proc Natl Acad Sci U S A. 2009 Apr 28;106(17):7125-30. doi: 10.1073/pnas.0900598106. Epub 2009 Apr 13.
Abstract
Injectable local anesthetics that would last for many days could have a marked impact on periprocedural care and pain management. Formulations have often been limited in duration of action, or by systemic toxicity, local tissue toxicity from local anesthetics, and inflammation. To address those issues, we developed liposomal formulations of saxitoxin (STX), a compound with ultrapotent local anesthetic properties but little or no cytotoxicity. In vitro, the release of bupivacaine and STX from liposomes depended on the lipid composition and on whether dexamethasone was incorporated. In cell culture, bupivacaine, but not STX, was myotoxic (to C2C12 cells) and neurotoxic (to PC12 cells) in a concentration- and time-dependent manner.Liposomal formulations containing combinations of the above compounds produced sciatic nerve blockade lasting up to 7.5 days (with STX + dexamethasone liposomes) in male Sprague-Dawley rats. Systemic toxicity only occurred where high loadings of dexamethasone increased the release of liposomal STX. Mild myotoxicity was only seen in formulations containing bupivacaine. There was no nerve injury on Epon-embedded sections, and these liposomes did not up-regulate the expression of 4 genes associated with nerve injury in the dorsal root ganglia. These results suggest that controlled release of STX and similar compounds can provide very prolonged nerve blocks with minimal systemic and local toxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678453/pdf/zpq7125.pdf
Una visión general de la neurotoxina marina, saxitoxina: la genética, dianas moleculares, métodos de detección y funciones ecológicas
An overview on the marine neurotoxin, saxitoxin: genetics, molecular targets, methods of detection and ecological functions.
Cusick KD, Sayler GS.
The University of Tennessee Center for Environmental Biotechnology, Knoxville, TN 37996, USA. kdaumer@utk.edu
Mar Drugs. 2013 Mar 27;11(4):991-1018. doi: 10.3390/md11040991.
Abstract
Marine neurotoxins are natural products produced by phytoplankton and select species of invertebrates and fish. These compounds interact with voltage-gated sodium, potassium and calcium channels and modulate the flux of these ions into various cell types. This review provides a summary of marine neurotoxins, including their structures, molecular targets and pharmacologies. Saxitoxin and its derivatives, collectively referred to as paralytic shellfish toxins (PSTs), are unique among neurotoxins in that they are found in both marine and freshwater environments by organisms inhabiting two kingdoms of life. Prokaryotic cyanobacteria are responsible for PST production in freshwater systems, while eukaryotic dinoflagellates are the main producers in marine waters. Bioaccumulation by filter-feeding bivalves and fish and subsequent transfer through the food web results in the potentially fatal human illnesses, paralytic shellfish poisoning and saxitoxin pufferfish poisoning. These illnesses are a result of saxitoxin's ability to bind to the voltage-gated sodium channel, blocking the passage of nerve impulses and leading to death via respiratory paralysis. Recent advances in saxitoxinresearch are discussed, including the molecular biology of toxin synthesis, new protein targets, association with metal-binding motifs and methods of detection. The eco-evolutionary role(s) PSTs may serve for phytoplankton species that produce them are also discussed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705384/pdf/marinedrugs-11-00991.pdf
Bloqueo nervioso prolongado retrasa el inicio de dolor neuropático
Prolonged nerve blockade delays the onset of neuropathic pain.
Shankarappa SA, Tsui JH, Kim KN, Reznor G, Dohlman JC, Langer R, Kohane DS.
Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Erratum in Proc Natl Acad Sci U S A. 2013 May 7;110(19):7958.
Proc Natl Acad Sci U S A. 2012 Oct 23;109(43):17555-60. doi: 10.1073/pnas.1214634109. Epub 2012 Oct 8.
Abstract
Aberrant neuronal activity in injured peripheral nerves is believed to be an important factor in the development of neuropathic pain. Pharmacological blockade of that activity has been shown to mitigate the onset of associated molecular events in the nervous system. However, results in preventing onset of pain behaviors by providing prolonged nerve blockade have been mixed. Furthermore, the experimental techniques used to date to provide that blockade were limited in clinical potential in that they would require surgical implantation. To address these issues, we have used liposomes (SDLs) containing saxitoxin (STX), a site 1 sodium channel blocker, and the glucocorticoid agonist dexamethasone to provide nerve blocks lasting ~1 wk from a single injection. This formulation is easily injected percutaneously. Animals undergoing spared nerve injury (SNI) developed mechanical allodynia in 1 wk; nerve blockade with a single dose of SDLs (duration of block 6.9 ± 1.2 d) delayed the onset of allodynia by 2 d. Treatment with three sequential SDL injections resulting in a nerve block duration of 18.1 ± 3.4 d delayed the onset of allodynia by 1 mo. This very prolonged blockade decreased activation of astrocytes in the lumbar dorsal horn of the spinal cord due to SNI. Changes in expression of injury-related genes due to SNI in the dorsal root ganglia were not affected by SDLs. These findings suggest that formulations of this kind, which could be easy to apply clinically, can mitigate the development of neuropathic pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491532/pdf/pnas.201214634.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
