Control de infecciones y anestesia/Infection control and anesthesia

http://www.smo.edu.mx/jornada2013/

Prevención de infecciones durante la ventilación en anestesia utilizando filtros respiratorios.


Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI).
Kramer A, Kranabetter R, Rathgeber J, Züchner K, Assadian O, Daeschlein G, Hübner NO, Dietlein E, Exner M, Gründling M, Lehmann C, Wendt M, Graf BM, Holst D, Jatzwauk L, Puhlmann B, Welte T, Wilkes AR.
Institute for Hygiene and Environmental Medicine, University Greifswald, Germany.
GMS Krankenhhyg Interdiszip. 2010 Sep 21;5(2). pii: Doc13. doi: 10.3205/dgkh000156.
Abstract
An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use.THE BREATHING SYSTEM AND THE MANUAL VENTILATION BAG ARE CHANGED IMMEDIATELY AFTER THE RESPECTIVE ANAESTHESIA IF THE FOLLOWING SITUATION HAS OCCURRED OR IT IS SUSPECTED TO HAVE OCCURRED: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951096/pdf/KHI-05-13.pdf




Control de infecciones en anestesia

Infection control in anaesthesia.
Association of Anaesthetists of Great Britain and Ireland.
Anaesthesia. 2008 Sep;63(9):1027-36. doi: 10.1111/j.1365-2044.2008.05657.x.
1.0. Summary
(1) A named consultant in each department of anaesthesia should liaise with Trust Infection Control Teams and Occupational Health Departments to ensure that relevant specialist standards are established and monitored in all areas of anaesthetic practice. (2) Precautions against the transmission of infection between patient and anaesthetist or between patients should be a routine part of anaesthetic practice. In particular, anaesthetists must ensure that hand hygiene becomes an indispensable part of their clinical culture. (3) Anaesthetists must comply with local theatre infection control policies including the safe use and disposal of sharps. (4) Anaesthetic equipment is a potential vector for transmission of disease. Policies should be documented to ensure that nationally recommended decontamination practices are followed and audited for all reusable anaesthetic equipment. (5) Single use equipment should be utilised where appropriate but a sterile supplies department (SSD) should process reusable items. (6) An effective, new bacterial viral breathing circuit filter should be used for every patient and a local policy developed for the re-use of breathing circuits in line with manufacturer's instructions. The AAGBI recommends that anaesthetic departments should consider changing anaesthetic circuits (7) Appropriate infection control precautions should be established for each anaesthetic procedure, to include maximal barrier precautions for the insertion of central venous catheters, spinal and epidural procedures and any invasive procedures in high risk patients.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773534/pdf/ana0063-1027.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Artritis reumatoide juvenil

http://www.smo.edu.mx/jornada2013/



Eficacia, farmacocinética y seguridad del adalimumab en pacientes pediátricos con artritis idiopática en Japón


Efficacy, pharmacokinetics, and safety of adalimumab in pediatric patients with juvenile idiopathic arthritis in Japan.
Imagawa T, Takei S, Umebayashi H, Yamaguchi K, Itoh Y, Kawai T, Iwata N, Murata T, Okafuji I, Miyoshi M, Onoe Y, Kawano Y, Kinjo N, Mori M, Mozaffarian N, Kupper H, Santra S, Patel G, Kawai S, Yokota S.
Yokohama City University, Japan. timagawa@ca2.so-net.ne.jp
Clin Rheumatol. 2012 Dec;31(12):1713-21. doi: 10.1007/s10067-012-2082-5.
Abstract
The objective of this study was to evaluate the efficacy, pharmacokinetics, and safety of adalimumab in patients with polyarticular juvenile idiopathic arthritis (JIA) in Japan. Patients aged 4 to 17 years were enrolled in a single-arm, open-label, multicentre study of adalimumab. Patients weighing <30 kg received 20 mg every other week (eow), and those ≥30 kg received 40 mg eow. Concomitant methotrexate (MTX) was allowed (≤10 mg/m(2) per week). The primary efficacy outcome was the percent of patients with American College of Rheumatology Pediatric 30 response (ACR Pedi 30) at week 16. JIA core variables, serum adalimumab concentrations, and anti-adalimumab antibodies (AAAs) were analysed. Patients were monitored for adverse events (AEs). Twenty-five patients (20 with concomitant MTX at baseline and 5 without) were enrolled: 24 patients completed 16 weeks of therapy and 22 patients completed 60 weeks. At week 16, 90 % of patients with MTX and 100 % without MTX achieved ACR Pedi 30; response rates were maintained through week 60 in 94 and 80 % of patients, respectively. Each JIA core variable improved over time. Six patients became AAA positive (two each at weeks 8, 16, and 60), some of which were transient. All six AAA-positive patients achieved ACR Pedi 30 at week 16, and four maintained that response at week 60. Six patients (all with MTX) experienced nine serious AEs (JIA, pyrexia, arthralgia, pneumonia, hepatitis B infection, pharyngitis, dehydration, pharyngeal pain, and pneumonia). In pediatric patients with polyarticular JIA in Japan, adalimumab was safe and effective for reducing disease activity for up to 60 weeks.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505492/pdf/10067_2012_

Article_2082.pdf




Artritis juvenil idiopática en dos centros de tercer nivel en Western Cape, África del Sur

Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa.
Weakley K, Scott C, Esser M.
Pediatr Rheumatol Online J. 2012 Oct 10;10(1):35
Abstract
BACKGROUND: Juvenile idiopathic arthritis (JIA) is a disease that shows wide variations between differing populations. Since the recent international consensus on classification criteria, JIA has been widely described in many countries and population groups. There has been almost no data that describes JIA in an African, specifically Sub-Saharan African, setting. Therefore, the aim of this study is to describe disease characteristics, disease course, and functional disability in two tertiary centres in the Western Cape, South Africa and compare the findings to other JIA populations. METHODS: Eighty-six children were recruited during random clinic visits to rheumatology clinics at Tygerberg and Groote Schuur Hospital between April 2010 and April 2011. Children were diagnosed using International League of Associations for Rheumatology (ILAR) 2001 classification criteria. Consent was obtained and medical records examined. The Childhood Health Assessment Questionnaires (CHAQ) and visual analogue scales (VAS) for pain and general well-being were completed and all children were examined by a researcher in conjunction with a paediatric rheumatologist. HIV status as well as tuberculosis disease and treatment were investigated. RESULTS: A total of 86 children were enrolled. Eight children were excluded (2 HIV arthropathy, 1 TB arthritis, 1 SLE, 4 with insufficient data), leaving a total of 78 patients. There was an equal female to male ratio-39 males and 39 females. There were 6 systemic JIA patients (7.69%), 17 persistent oligoarthritis (21.79%), 4 extended oligoarthritis (5.12%), 11 polyarthritis rheumatoid factor (RF) positive (14.10%), 21 polyarthritis RF negative (26.9%), 1 psoriatic arthritis (1.28%), and 18 enthesitis-related arthritis (23%). The median CHAQ for the group was 0.5 (IQR 0.1-1.25), the median VAS for pain was 18 mm (IQR 4--42) and median VAS for general well-being was 25 mm (IQR 3--49). Enthesitis-related arthritis and polyarthritis disease subtypes in this South African population may be more common than seen in JIA populations described in northern Europe, India, United Kingdom, and Turkey. CONCLUSION: This Western Cape South African JIA population appears to have a different profile of JIA than what has been described elsewhere. Enthesitis-related arthritis and polyarthritis disease subtypes appear to be more prevalent. There are also significant challenges in this setting such as later presentation to pediatric rheumatologists, different disease characteristics, and variable disease courses.
http://www.ped-rheum.com/content/pdf/1546-0096-10-35.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Día Clásico del Bacteriólogo y Laboratorista Clínico

La Escuela de Microbiología de la Universidad de Antioquia se une a la celebración del Día Clásico del Bacteriólogo y Laboratorista Clínico y con ocasión de esta festividad expresa su gratitud y reconocimiento a estos profesionales que con gran esmero y dedicación han hecho aportes fundamentales al desarrollo de la microbiología y el bioanálisis en Colombia y en el mundo.
La Escuela de Microbiología de la Universidad de Antioquia se une a la celebración del Día Clásico del Bacteriólogo y Laboratorista Clínico y con ocasión de esta festividad expresa su gratitud y reconocimiento a estos profesionales que con gran esmero y dedicación han hecho aportes fundamentales al desarrollo de la microbiología y el bioanálisis en Colombia y en el mundo.

Ketamina / Ketamine

                        http://www.smo.edu.mx/jornada2013/

Mecanismos de la inmunosupresión inducida por ketamina  Mechanisms of ketamine-induced immunosuppression Feng-Lin Liu, Ta-Liang Chen, Ruei-Ming Chen, Liu F-L, et al. Acta Anaesthesiologica Taiwanica (2012),http://dx.doi.org/10.1016/j.aat.2012.12.001 Abstract Ketamine, a noncompetitive N-methyl-D-aspartate receptor antagonist, is widely used as an intravenous anesthetic agent. It is known to produce increases in blood pressure and stroke volume, which implies its importance in clinical practice. Ketamine has also been shown to possess anti-inflammatory effects. Our previous studies showed that ketamine, at clinically relevant concentrations, can downregulate endotoxin-induced macrophage activation through toll-like receptor-dependent activation of mitogen activated protein kinases and the transcription factors nuclear factor-kappa B and activator protein-1.As to the responsible mechanisms, considerable attention was devoted to ketamine-involved regulation of proinflammatory gene expression. The assessment of how ketamine regulates proinflammatory gene expressions is significant in determining the signal cascades that are influenced by this anesthetic agent and its clinical application in the tactical use of ketamine in preventing sepsis. Herein, we review the literature on the pharmacodynamics, pharmacokinetics, and possible mechanisms involved in ketamine's immunology. http://download.journals.elsevierhealth.com/pdfs/journals/1875-4597/PIIS1875459712000951.pdf   Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Alergia a los anestésicos locales/Local anesthetics alergy

http://www.smo.edu.mx/jornada2013/








Hipersensibilidad a los anestésicos locales. Seis hechos y 7 mitos


HYPERSENSITIVITY TO LOCAL ANAESTHETICS- 6 FACTS AND 7 MYTHS
Joanna Lukawska, MRCP, M Rosario Caballero, PhD,Sophia Tsabouri, MD, PhD, Pierre Dugué, FRCP, MD, APH
Drug Allergy Clinic, Guy's & St
Current Allergy & Clinical Immunology, August 2009 Vol 22, No. 3
ABSTRACT
Local anaesthetics (LAs) are commonly used drugs. In spite of their widespread use, true hypersensitivity appears to be very infrequent. In fact most of the adverse reactions are due to pharmacological, toxic or vasovagal effects of LAs. Our review of the literature has shown that true allergy to LA is in fact exceptional. Skin tests for LA allergy, including skin-prick tests (SPT) and intradermal (ID) tests, have poor sensitivity and specificity. True LA allergy, when appropriate, has to be confirmed by challenge. Provocation challenge is safe and well tolerated.
http://www.allergysa.org/journals/2009/august/hypersensitivity-to-local-anaesthetics.pdf


Pruebas intradérmicas en pacientes con reacciones alérgicas putativas a los anestésicos locales. Análisis de 611 casos

INTRADERMAL TESTING ON PATIENTS WITH PUTATIVE ALLERGIC REACTIONS TO LOCAL ANAESTHETICS - ANALYSIS OF 611 CASES
Petrus J Germishuys, BChD, MSc, MDent
School of Dentistry, Faculty of Health Sciences,
University of Pretoria, Pretoria
Current Allergy & Clinical Immunology, March 2004 Vol 17, No. 1
SUMMARY
Background. Although allergic reactions to local anaesthetics (LAs) of the amide type are relatively rare, many patients and practitioners label any adverse reaction after administration of an LA as 'allergic'. Objective. The aim of this study was to evaluate the reliability of intradermal testing (IDT) of patients with a history of adverse reactions to LA, and to rule out a possible allergy so an alternative LA, unlikely to cause any reaction, could be selected. Methods. IDT was done on 611 patients referred to the author for assessment of LA allergy. Results. Positive skin reactions were found in 15 patients (2.5%). All responded favourably when a different amide LA was prescribed. Conclusion. These results indicate that IDT is safe and can be used to identify an LA that patients with a prior history of adverse reactions can tolerate.
http://www.allergysa.org/journals/march2004/intradermal%20testing.pdf



Reactividad cruzada entre anestésicos locales de tipo amida en un caso de alergia a mepivacaína

Cross-Reactivity Among Amide-Type Local Anesthetics in a Case of Allergy to Mepivacaine
P González-Delgado,1 R Antón,2 V Soriano,1 P Zapater,3 E Niveiro1
J Investig Allergol Clin Immunol 2006; Vol. 16(5): 311-313
Abstract.
Among the various adverse reactions to local anesthetics, IgE-mediated reactions, particularly to the more commonly used amide group, are extremely rare. We report the case of a 39-year-old man who suffered itching and generalized urticaria with facial angioedema 15 minutes after administration of mepivacaine. Skin tests revealed a strong positive reaction to mepivacaine, lidocaine, and ropivacaine, but negative reactions to bupivacaine and levobupivacaine. Furthermore, double-blind placebo-controlled subcutaneous challenge with bupivacaine and levobupivacaine was well tolerated. We conclude that an extensive allergologic study must be carried out in rare cases of true allergic reaction to amide-type local anesthetics in order to rule out cross reactivity.
Key words: Local anesthetics. Amide group. Allergy. Mepivacaine. Lidocaine. Ropivacaine. Bupivacaine. Levobupivacaine.
http://www.jiaci.org/issues/vol16issue05/8.pdf


Anafilaxia secundaria a levobupivacaina

Anaphylaxis secondary to levobupivacaine
Gupta,1 M. Fennelly,2 V. Ramesh3 and K. Agyare
Anaesthesia, 2011, 66, pages 942-944 doi:10.1111/j.1365-2044.2011.06815.x
Summary
We describe the case of a 25-year-old woman presented for elective lumbar decompression and microdiscectomy who, towards the end of her surgery, developed clinical signs of anaphylaxis. Skin testing later confirmed sensitisation to levobupivacaine and possibly MediShield, an anti-adhesion gel used following microdiscectomy. This case is the first confirmed case report of anaphylaxis in response to levobupivacaine. It also highlights the possibility that multiple agents may simultaneously trigger a life-threatening reaction. Anaesthetists should remain alert to the use of potentially allergenic agents employed by surgeons.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06815.x/pdf



Alergia a ropivacaína peridural

Whizar-Lugo VM, Ontiveros-Morales P, Garfias-Flores ME.
Anest Mex 2004;16:180-183.
Resumen
Las reacciones alérgicas a los anestésicos locales del grupo amino amida son muy raras, y no hay casos reportados de alergias secundarios a la ropivacaína peridural. Informamos un paciente mexicano, de 62 años de edad, diabético con dolor torácico intenso secundario a herpes Zoster agudo, al cual se le realizó un bloqueo peridural con 6 mL de ropivacaína simple al 0.25% y 20 minutos después desarrolló una dermatosis pruriginosa localizada en el cuello y el tórax. Esta reacción se repitió con la segunda inyección peridural de 6 mL de ropivacaína simple al 0.125%, por lo que las subsecuentes inyecciones peridurales se hicieron con bupivacaína racémica 0.125%, sin efectos secundarios. El paciente fue seguido durante un año y no tuvo secuelas neurológicas, ni desarrolló neuropatía postherpética. Se ha dicho que los nuevos anestésicos locales levoisoméricos no inducen reacciones alérgicas. Este paciente demuestra que debemos
de estar alertas ante esta remota posibilidad.
Palabras clave: Alergias, anestésicos locales, ropivacaína epidural.
http://www.anestesiaenmexico.org/RAM3/011.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Analgesia postoperatoria/Postoperataive analgesia

http://www.smo.edu.mx/jornada2013/

Analgesia epidural controlada por el paciente con ropivacaína y fentanilo: experiencia con 2276 pacientes quirúrgicos


Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients.
Kim SH, Yoon KB, Yoon DM, Kim CM, Shin YS.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Korean J Pain. 2013 Jan;26(1):39-45. doi: 10.3344/kjp.2013.26.1.39. Epub 2013 Jan 4.
Abstract
BACKGROUND: Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. METHODS: We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. RESULTS: Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. CONCLUSIONS: Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546209/pdf/kjpain-26-39.pdf


Guías para el manejo de dolor postoperatorio después de artroplastia total de rodilla.

Guidelines for the management of postoperative pain after total knee arthroplasty.
Korean Knee Society.
Knee Surg Relat Res. 2012 Dec;24(4):201-7. doi: 10.5792/ksrr.2012.24.4.201. Epub 2012 Nov 29.
Abstract
This clinical practice guideline was approved by Korean Knee Society on February 28, 2012. It is based on a systematic review of published studies on the management of postoperative pain after total knee arthroplasty and was developed to include the overall pain management modalities. The purpose of the guideline is to help improve treatment based on current best evidence. Eleven recommendations have been developed based on a systematic review of research evidence and the consensus opinions of a multidisciplinary working group of experts. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526756/pdf/ksrr-24-201.pdf


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Más sobre AINES/More on NSAIDs

                 http://www.smo.edu.mx/

Todas las causas de mortalidad en ancianos veteranos Australianos que usan AINES COX-2 selectivos o no selectivos: estudio longitudinal  All-cause mortality of elderly Australian veterans using COX-2 selective or non-selective NSAIDs: a longitudinal study. Kerr SJ, Rowett DS, Sayer GP, Whicker SD, Saltman DC, Mant A. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW 2052, Australia. Br J Clin Pharmacol. 2011 Jun;71(6):936-42. doi: 10.1111/j.1365-2125.2010.03702.x. Epub 2010 May 6. Abstract WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Previous studies have found varying impact of exposure to COX-2 selective and non-selective NSAIDs. WHAT THIS STUDY ADDS: * Individuals receiving a COX-2 selective NSAID had an increased risk of all-cause mortality after correction for age, sex and cardiovascular risk as measured by co-prescription. * Despite differences in the pharmacokinetic properties of the COX-2 selective inhibitor drugs, our study lends no support to clinicians preferring any one COX-2 selective inhibitor drug, or substituting one for another on the grounds of mortality risk alone. * The Australian Department of Veterans' Affairs data sets make it possible to conduct timely record linkage studies of all-cause mortality from use of medicines in a large and clinically relevant population. AIM: To determine hazard ratios for all-cause mortality in elderly Australian veterans taking COX-2 selective and non-selective NSAIDs. METHODS: Patient cohorts were constructed from claims databases (1997 to 2007) for veterans and dependants with full treatment entitlement irrespective of military service. Patients were grouped by initial exposure: celecoxib, rofecoxib, meloxicam, diclofenac, non-selective NSAID. A reference group was constructed of patients receiving glaucoma/hypothyroid medications and none of the study medications. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for each exposure group against each of the reference group. The final model was adjusted for age, gender and co-prescription as a surrogate for cardiovascular risk. Patients were censored if the gap in supply of study prescription exceeded 30 days or if another study medication was initiated. The outcome measure in all analyses was death. RESULTS: Hazard ratios and 95% CIs, adjusted for age, gender and cardiovascular risk, for each group relative to the reference group were: celecoxib 1.39 (1.25, 1.55), diclofenac 1.44 (1.28, 1.62), meloxicam 1.49 (1.25, 1.78), rofecoxib 1.58 (1.39, 1.79), non-selective NSAIDs 1.76 (1.59, 1.94). CONCLUSIONS: In this large cohort of Australian veterans exposed to COX-2 selective and non-selective NSAIDs, there was a significant increased mortality risk for those exposed to either COX-2-selective or non-selective NSAIDs relative to those exposed to unrelated (glaucoma/hypothyroid) medications. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099381/pdf/bcp0071-0936.pdf     Uso de AINES que elevan el riesgo cardiovascular: una revisión de las ventas y las listas de medicamentos esenciales en los países de ingreso bajo, mediano y alto.  Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. McGettigan P, Henry D. William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom. PLoS Med. 2013 Feb;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.Abstract BACKGROUND: Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND FINDINGS: Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%. CONCLUSIONS: Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570554/pdf/pmed. 1001388.pdf     Revisión sobre drogas analgésicas, antiinflamatorios no esteroideas  Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Final Update 4 Report November 2010 http://www.ncbi.nlm.nih.gov/books/NBK53955/pdf/TOC.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Booksupdate. NYT

                   http://www.smo.edu.mx/jornada2013/


http://www.nytimes.com/indexes/2013/04/26/books/booksupdate/index.html


April 26, 2013
Books Update

On the Cover of Sunday's Book Review

'The Selected Letters of Willa Cather'
Edited by ANDREW JEWELL and JANIS STOUT
Reviewed by TOM PERROTTA


In her letters, the novelist Willa Cather emerges as a strong and vivid presence, a woman at once surprisingly modern and touchingly - if not always sweetly - old-fashioned.
Up Front: Tom Perrotta
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Reviewed by SYLVIA BROWNRIGG


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Reviewed by MALCOLM JONES


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Reviewed by MOLLY RINGWALD


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Reviewed by FRANCINE PROSE


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Reviewed by CRISTINA GARCÍA


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Reviewed by WESLEY YANG


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By MICHAEL POLLAN
Reviewed by BEE WILSON


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By MARY ROACH
Reviewed by JON RONSON


Mary Roach on what happens after you eat.

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By T. D. ALLMAN
Reviewed by ALEXANDRA STARR


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By MICHAEL SCHUMACHER and DENIS KITCHEN
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Nice Poem; I'll Take It
By SANDRA BEASLEY


How it feels to be the victim of a serial plagiarist.

Inside the List
By GREGORY COWLES


Iris Johansen, whose new novel, "Taking Eve," is at No. 5 on the hardcover fiction list, cites Ayn Rand as one of her favorite authors, but says, "I'm not aware of a Randian influence in my work."

Editors' Choice


Recently reviewed books of particular interest.

Paperback Row
By IHSAN TAYLOR


Paperback books of particular interest.

Book Review Podcast


This week, Tom Perrotta talks about the letters of Willa Cather; Julie Bosman has notes from the field; Alexandra Starr discusses T. D. Allman's "Finding Florida"; and Gregory Cowles has best-seller news. John Williams is the host, filling in for Pamela Paul.




Book Review Podcast: Willa Cather's Letters

Spymaster Makes Cameo in His Book Trailer

Granta Editor Stepping Down

REVIEWS BY THE TIMES'S CRITICS

'The New Digital Age'

'The Way of the Knife' by Mark Mazzetti

'The New Mind of the South' by Tracy Thompson

'Top of the Morning' by Brian Stelter

'Waiting to Be Heard' by Amanda Knox

CHILDREN'S BOOKS

Children's Books: Bouncing Back

ARCHIVE

Crime Columns

Children's Books

The New York Times Book Review: Back Issues

Editor's Note

Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond.

John Williams
Senior Staff Editor
The New York Times on the Web

ebooks. Alerta

El número de lectores de ebooks crece un 280 por ciento en dos años
ecodiario
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, cuando el porcentaje ascendía al 5,86 por ciento. MADRID, 23 (EUROPA PRESS). En concreto, del 5 ...
Ver todos los artículos sobre este tema »

Día del Libro: rosas, e-books y apps
TICbeat (blog)
Con motivo del Día Internacional del Libro, distintos agentes del sector han puesto en marcha iniciativas que promueven el acceso legal a los e-books a través de promociones y descuentos. Durante todo el día, Amazon permitirá a los lectores de Kindle ...
Ver todos los artículos sobre este tema »
TICbeat (blog)

Así ha cambiado el hábito de la lectura con las «tablets» y los «e ...
ABC.es
De acuerdo a sus cifras, la facturación de eBooks o libros digitales (contenidos) en España se ha multiplicado por seis en 2012, frente a los dos millones de euros registrados en 2011. Por otra parte, en lo que va de año el aumento acumulado ha sido ...
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Cómo evitar la piratería de los eBooks
InfoBAE.com
DRM (digital rights management) es un sistema que pretende restringir la copia no autorizada deeBooks y también de otros bienes digitales como películas y música. Digo pretende porque no lo logra. La causa de esto es algo llamado Agujero Analógico: ...
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Cómo conseguir e-books gratis legalmente
androidsis (blog)
Continuando con la celebración del día de libro, hoy día de Sant jordi os queremos recomendar la manera de conseguir e-books gratis, o libros electrónicos de una manera legal y totalmente gratuita. Para ello, nuestro compañeros de Todo e-Readers han ...
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androidsis (blog)

El número de lectores de 'ebooks' se cuadruplica
Diario de Sevilla
El porcentaje de lectores de ebooks se ha multiplicado casi por cuatro en dos años, pero esto apenas ha afectado a lectura de libros tradicionales, lo que implica que están surgiendo lectores mixtos, consumidores de literatura tanto en formato ...
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Gandia celebra la Setmana del Llibre con presentaciones y talleres ...
Las Provincias
A lo largo de la semana, se han programado también una serie de charlas formativas, tituladas Los E-readers y los E-books, para alumnos de a partir de 3º de ESO. Los alumnos podrán manipular y practicar con los dispositivos disponibles en la biblioteca.
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De cines y libros - Diario de Sevilla
Diario de Sevilla
Triunfan los ebooks y desde los años 70 los cines fueron cerrando, sustituidos por los multicines que después fueron reemplazados por las multisalas de los centros comerciales. El disfrute en casa de las películas sin pérdida de calidad es un hecho ...
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Los libros digitales crecerán en un 23 por ciento en el próximo trienio
eldia.es
... de la Asociación Multisectorial de Empresas de la Electrónica, Tecnologías de la Información y Comunicación revela que la edición ha alcanzo el pasado año los 201 millones de euros de facturación, de los cuales 72,6 fueron aportados por los e-books.
Ver todos los artículos sobre este tema »



Blogs 1 resultado nuevo de E-Books


El minidocumental viaja hacia las fronteras del `e-book´ – Literatura ...
según David González | aviondepapel.tv
Joan Planas y Ana Salvá recorren Asia para rodar, fotografiar y relatar los testimonios de personas anónimas en su web documental `Buscando Historias´. Financian con `crowdfunding´ este proyecto web multimedia -híbrido entre el ...
Tecnología Noticias, vídeos...

eBooks - PlanetadeLibros.com
Colecciones. (Fuera de colección) · Novela romántica · Áncora & Delfin · Autores Españoles e Iberoamericanos · Para Dummies. Los eBooks más destacados ...
www.planetadelibros.com/seleccion-editorial-ebooks-5.html
El número de lectores de ebooks crece un 280 por ... - Eldiario.es
El número de lectores de libros digitales o ebooks ha registrado un incremento del 280 por ciento respeto a los niveles que se registraban hace dos años, ...
www.eldiario.es/.../numero-lectores-ebooks-crece-ciento_0_12...
Celebra el día del libro con varios eBooks gratuitos - Todo eReaders
Hoy 23 de abril se celebra el Día del Libro y con motivo de esta celebración muchos periódicos, librerías o editoriales están ofreciendo un gran número.
www.todoereaders.com/celebra-el-dia-del-libro-con-varios-eb...
JOSE MANUEL DA NETA PRIETO MARTINEZ: libros, eBooks ...
Comprar libros y eBooks de JOSE MANUEL DA NETA PRIETO MARTINEZ en tu librería onlinecasadellibro.com.
www.casadellibro.com/libros-ebooks/jose...da.../20088038
Sorteo de ebooks para el día del libro - Todo eReaders
Y queremos organizar un pequeño sorteo para regalar unos ebooks. Para participar tan solo tienes que twittear lo siguiente (acuérdate de cambiar las palabras ...
www.todoereaders.com/sorteo-de-ebooks-para-el-dia-del-libro...

Anestesia regional en neonatos/Regional anesthesia in neonates

http://www.smo.edu.mx/jornada2013/

Anestesia regional en el neonato


Regional anaesthesia and analgesia in the neonate
Per-Arne Lönnqvist, MD, DEAA, FRCA, PhD, Professor of Paediatric
Anaesthesia &; Intensive Care, Senior Consultant
http://web.clas.ufl.edu/users/msscha/PremedCSS/analgesics_infants.pdf

Consideraciones anestésicas en emergencias quirúrgicas neonatales
Anaesthetic consideration for neonatal surgical emergencies.
Pani N, Panda CK.
Indian J Anaesth [serial online] 2012 [cited 2013 Mar 9];56:463-9.
A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.
Keywords: Anaesthesia, emergency surgeries, neonate
http://www.ijaweb.org/text.asp?2012/56/5/463/103962


Manejo anestésico para laparotomía urgente en un neonato con artrogriposis congénita múltiple

Anesthetic management of a neonate with arthrogryposis multiplex congenita for emergency laparotomy.
Chowdhuri R, Samui S, Kundu AK.
Department of Anesthesiology, R.G.Kar Medical College, Kolkata, India.
J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):244-6. doi: 10.4103/0970-9185.81831.
Abstract
Arthrogryposis multiplex congenita is a rare disease, characterized by non-progressive, multiple joint contractures since birth. Anesthetic issues include difficult intravenous access, difficult airway management and regional anesthesia. We report the anesthetic management of a six-day-old neonate presenting to the emergency with features of intestinal obstruction, who was detected for the first time to have arthrogryposis multiplex congenita. General anesthesia along with caudal analgesia for peroperative and postoperative pain relief was used. There was an episode of intraoperative hyperthermia, which was tackled successfully. The child had an uneventful post-anesthesia recovery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127309/




Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Anestésicos, Pre-condicionamiento y Protección Cerebral

                      http://www.smo.edu.mx/jornada2013/

Anestésicos, Pre-condicionamiento y Protección Cerebral Rogean Rodrigues Nunes, Gastao Fernandes Duval Neto, Julio Cesar Garcia de Alencar, Suyane Benevides Franco, Nayanna Quezado de Andrade, Danielle Maia Holanda Dumaresq, Sara Lucia Cavalcante Rev Bras Anestesiol. 2013;63(1):119-138 Justificativa y objetivos: Diversos estudios han demostrado el pre-condicionamiento cerebral como un mecanismo protector frente a una situacion de estres. Estan descritos algunos factores determinantes del PC, como tambien la neuroproteccion proporcionada por los agentes anestésicos y no anestesicos. Contenido: Se hizo la revision con base en los principales articulos de la literatura que engloban la fi siopatologia de la isquemia-reperfusion y la lesion neuronal, y los factores no farmacológicos (infl amacion, glucemia y temperatura), y farmacologicos relacionados con el cambio de la respuesta a la isquemia-reperfusion, ademas de la neuroproteccion inducida por el uso de los anestesicos. Conclusiones: El cerebro tiene la capacidad de protegerse contra la isquemia cuando se le estimula. La elucidación de ese mecanismo posibilita la aplicacion de sustancias inductoras del precondicionamiento cerebral, como algunos anestesicos, otros farmacos y medidas no farmacologicas, como la hipotermia, con el fi n de inducir la tolerancia a las lesiones isquemicas. http://www.scielo.br/pdf/rba/v63n1/es_v63n1a11.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

AINES y corazón/Nonsteroidal Anti-Inflammatory and cardiovascular risk

                                                   http://www.smo.edu.mx/jornada2013/

Diclofenaco prolonga la repolarización del músculo ventricular con daño en la repolarización de reserva  Diclofenac prolongs repolarization in ventricular muscle with impaired repolarization reserve. Kristóf A, Husti Z, Koncz I, Kohajda Z, Szél T, Juhász V, Biliczki P, Jost N, Baczkó I, Papp JG, Varró A, Virág L. Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary. PLoS One. 2012;7(12):e53255. doi: 10.1371/journal.pone.0053255. Epub 2012 Dec 31. Abstract BACKGROUND: The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti-inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. METHODS: Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. RESULTS: Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 µM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl(2) application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 µg/kg) significantly lengthened the QT(c) interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QT(c). Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 µM) decreased the amplitude of rapid (I(Kr)) and slow (I(Ks)) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (I(Ca)) was slightly diminished, but the transient outward (I(to)) and inward rectifier (I(K1)) potassium currents were not influenced. CONCLUSIONS: Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534043/pdf/pone.0053255.pdf     Nuevas acciones de los AINES sobre los canales iónicos vasculares: La contabilización de los efectos secundarios cardiovasculares e identificación de nuevas aplicaciones terapéuticas.  Novel Actions of Nonsteroidal Anti-Inflammatory Drugs on Vascular Ion Channels: Accounting for Cardiovascular Side Effects and Identifying New Therapeutic Applications. Brueggemann LI, Mani BK, Mackie AR, Cribbs LL, Byron KL. Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Maywood, Illinois. Mol Cell Pharmacol. 2010;2(1):15-19. Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for the treatment of both acute and chronic pain. Selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex(®)), rofecoxib (Vioxx(®)), and diclofenac, have been among the most widely prescribed NSAIDs because they prevent the generation of prostaglandins involved in inflammation and pain, but avoid some of the gastrointestinal complications associated with less selective COX-1/COX-2 inhibitors. In 2004, rofecoxib (Vioxx(®)) was voluntarily withdrawn from the market because of adverse cardiovascular side effects. This led to an explosion of research into the cardiovascular effects of the 'coxibs', which revealed differential cardiovascular risk profiles among the members of this drug class. The differential risk profiles may relate to the tendency of some of the drugs to elevate blood pressure (BP). An important component of BP regulation is dependent on the contractile state of vascular smooth muscle cells (VSMCs), which is controlled to a large extent by the activities of KCNQ (Kv7 family) potassium channels and L-type calcium channels. Our recently published data indicate that celecoxib, but not rofecoxib or diclofenac, at therapeutically relevant concentrations, acts as a Kv7 potassium channel activator and a calcium channel blocker, causing relaxation of VSMCs and decreasing vascular tone. These vasorelaxant ion channel effects may account for the differential cardiovascular risk profiles among the different COX-2 inhibitors. We further speculate that these properties may be exploited for therapeutic benefit in the treatment of cardiovascular diseases or other medical conditions. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915785/pdf/nihms-184534.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org