Toxicidad hepática por fármacos / Drug hepatotoxicity

Diciembre 10, 2017. No. 2928

Daño hepático inducido por drogas. ¿Conocemos todo? Drug-induced liver injury: Do we know everything? Alempijevic T1, Zec S1, Milosavljevic T1. Author information World J Hepatol. 2017 Apr 8;9(10):491-502. doi: 10.4254/wjh.v9.i10.491. Abstract Interest in drug-induced liver injury (DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating the current state of the art, the latest scientific findings, controversies, and guidelines, this review will attempt to answer the question: Do we know everything? Since the first descriptions of hepatotoxicity over 70 years ago, more than 1000 drugs have been identified to date, however, much of our knowledge of diagnostic and pathophysiologic principles remains unchanged. Clinically ranging from asymptomatic transaminitis and acute or chronic hepatitis, to acute liver failure, DILI remains a leading causes of emergent liver transplant. The consumption of unregulated herbal and dietary supplements has introduced new challenges in epidemiological assessment and clinician management. As such, numerous registries have been created, including the United States Drug-Induced Liver Injury Network, to further our understanding of all aspects of DILI. The launch of LiverTox and other online hepatotoxicity resources has increased our awareness of DILI. In 2013, the first guidelines for the diagnosis and management of DILI, were offered by the Practice Parameters Committee of the American College of Gastroenterology, and along with the identification of risk factors and predictors of injury, novel mechanisms of injury, refined causality assessment tools, and targeted treatment options have come to define the current state of the art, however, gaps in our knowledge still undoubtedly remain. KEYWORDS: Acetaminophen toxicity; Acute liver failure; Cholestatic injury; Drug-induced liver injury; Hepatoxicity; Herbal-induced liver injury; Hy's law; Liver biopsy; Pharmacoepidemiology PDF RUCAM en daño hepático inducido por hierbas y fármacos. Actualización RUCAM in Drug and Herb Induced Liver Injury: The Update. Danan G1, Teschke R2. Author information Int J Mol Sci. 2015 Dec 24;17(1). pii: E14. doi: 10.3390/ijms17010014. Abstract RUCAM (Roussel Uclaf Causality Assessment Method) or its previous synonym CIOMS (Council for International Organizations of Medical Sciences) is a well established tool in common use to quantitatively assess causality in cases of suspected drug induced liver injury (DILI) and herb induced liver injury (HILI). Historical background and the original work confirm the use of RUCAM as single term for future cases, dismissing now the term CIOMS for reasons of simplicity and clarity. RUCAM represents a structured, standardized, validated, and hepatotoxicity specific diagnostic approach that attributes scores to individual key items, providing final quantitative gradings of causality for each suspect drug/herb in a case report. Experts from Europe and the United States had previously established in consensus meetings the first criteria of RUCAM to meet the requirements of clinicians and practitioners in care for their patients with suspected DILI and HILI. RUCAMwas completed by additional criteria and validated, assisting to establish the timely diagnosis with a high degree of certainty. In many countries and for more than two decades, physicians, regulatory agencies, case report authors, and pharmaceutical companies successfully applied RUCAM for suspected DILI and HILI. Their practical experience, emerging new data on DILI and HILI characteristics, and few ambiguous questions in domains such alcohol use and exclusions of non-drug causes led to the present update of RUCAM. The aim was to reduce interobserver and intraobserver variability, to provide accurately defined, objective core elements, and to simplify the handling of the items. We now present the update of the well accepted original RUCAM scale and recommend its use for clinical, regulatory, publication, and expert purposes to validly establish causality in cases of suspected DILI and HILI, facilitating a straightforward application and an internationally harmonized approach of causality assessment as a common basic tool. KEYWORDS: CIOMS; RUCAM; causality assessment; dietary supplements; drug hepatotoxicity; drug induced liver injury; drugs; herb induced liver injury; herbal hepatotoxicity; herbs PDF Trasplante hepático en falla hepática inducida por fármacos Liver transplantation for drug-induced acute liver failure. Biolato M1, Araneo C, Marrone G, Liguori A, Miele L, Ponziani FR, Gasbarrini A, Grieco A. Author information Eur Rev Med Pharmacol Sci. 2017 Mar;21(1 Suppl):37-45. Abstract OBJECTIVES: To summarize the different clinical features of drug-induced acute liver failure, the diagnostic work-up, conservative management and the prognostic scores currently used to list patients for liver transplantation. EVIDENCE AND INFORMATION SOURCES: The current review is based on an analysis of the current literature and the caseload experience of the Authors on this topic. STATE OF THE ART: Drug-induced liver injury is the leading cause of acute liver failure in the adult population in Western countries, with a transplant-free survival rate of less than 50%. Main subtypes include paracetamol and idiosyncratic drug-induced injury, which differ in epidemiology, clinical course, prognosis and conservative management. In cases of a high likelihood of death, urgent hepatic transplantation is indicated, but the decision whether and when to put a patient with drug-induced acute liver failure on the list for urgent liver transplant is extremely difficult and requires constant interdisciplinary exchange and continuous updating of the clinical picture. CONCLUSIONS: Intensive management should be done in a clinical tertiary referral center which has a specialized team of hepatologists and a liver transplant center. PDF International Anesthesia Research Society Annuals Meetings USA Informes / Information

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

Libro digital sobre Resucitación / E-Book on Resucitation

Diciembre 11, 2017. No. 2929

Aspectos de resucitación Resuscitation Aspects Edited by Theodoros Aslanidis, ISBN 978-953-51-3664-4, Print ISBN 978-953-51-3663-7, 196 pages, Publisher: InTech, Chapters published December 06, 2017 under CC BY 3.0 license DOI: 10.5772/66212 Edited Volume In an era of transition from "classic" Cardiopulmonary resuscitation (CPR) to assisted device-CPR or hemodynamic driven CPR, this book, published by InTechOpen, highlights some interesting aspects of resuscitation. Divided in three sections, the research presented emphasizes the details of resuscitation in special circumstances to possible future applications in the field. The authors offer us not only a "vigorous" review of the current literature but also a research road map for further advancement. Libro / Book International Anesthesia Research Society Annuals Meetings USA Informes / Information

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

Recidiva de Hallux valgus (juanete)

http://www.clinicadeartroscopia.com.mx/uncategorized/recidiva-de-hallux-valgus-juanete/


Recidiva de Hallux valgus (juanete) por hipermovilidad cuneo-metatarsal se procede a realizar artrodesis tipo lapidus con grapas de compresión y artrodesis 2, 3 dedo por dedos en garra con tornillo de compresión

III REUNIÓN NACIONAL DE PROFESORES TITULARES DE RESIDENCIA EN ORTOPEDIA

http://www.bibliomanazteca.com.mx/academia/iii-reunion-nacional-de-profesores-titulares-de-residencia-en-ortopedia/

CONVOCADA POR EL CONSEJO MEXICANO DE ORTOPEDIA

1 y 2 Diciembre 2017, WTC, CDMX

Sedación en urgencias / Sedation in emergency department

Diciembre 4, 2017. No. 2922

Incidencia de eventos adversos en adultos sometidos a sedación para procedimientos en el servicio de urgencias: revisión sistemática y metaanálisis. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Bellolio MF1,2, Gilani WI1, Barrionuevo P3,2, Murad MH3,2, Erwin PJ4, Anderson JR1, Miner JR5,6, Hess EP1,2. Acad Emerg Med. 2016 Feb;23(2):119-34. doi: 10.1111/acem.12875. Epub 2016 Jan 22. Author information Abstract OBJECTIVES: This was a systematic review and meta-analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED). METHODS: Eight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta-analysis was performed using a random-effects model and reported as incidence rates with 95% confidence intervals (CIs). RESULTS: The search yielded 2,046 titles for review. Fifty-five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately. CONCLUSIONS: Serious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision-making, risk communication, and informed consent. PDF Ketamina-Propofol versus propofol para la sedación de procedimiento en el servicio de urgencias: una revisión sistemática y metanálisis. Ketamine-Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Yan JW1,2, McLeod SL1,2, Iansavitchene A2. Author information Acad Emerg Med. 2015 Sep;22(9):1003-13. doi: 10.1111/acem.12737. Epub 2015 Aug 20. Abstract OBJECTIVES: Propofol is an agent commonly used for procedural sedation and analgesia (PSA) in the emergency department (ED), but it can cause respiratory depression and hypotension. The combination of ketamine-propofol (K-P) is an alternative that theoretically provides a reduction in adverse events compared to propofol. The primary objective of this review was to determine if K-P has a lower frequency of adverse respiratory events in patients undergoing PSA in the ED than propofol alone. Secondary objectives were to compare the proportion of overall adverse events, sedation time, procedure time, and recovery time between K-P and propofol. METHODS: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) published in English comparing the use of K-P to propofol alone for PSA in the ED were included. RESULTS: Six RCTs were included with a combined total of 932 patients (K-P = 520, propofol = 412). Five RCTs reported the proportion of adverse respiratory events; the pooled estimate revealed fewer adverse respiratory events with K-P compared to propofol (29.0% vs. 35.4%; risk ratio [RR] = 0.82; 95% confidence interval [CI] = 0.68 to 0.99). There was no significant difference with respect to the proportion of overall adverse events (38.8% vs. 42.5%; RR = 0.88; 95% CI = 0.75 to 1.04). Procedure time was similar when the groups were compared. CONCLUSIONS: The premise of combining ketamine with propofol is based on the many synergies that theoretically exist between these two agents. In this study, K-P had a lower frequency of adverse respiratory events in patients undergoing PSA in the ED compared to propofol alone. PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

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