Más sobre asma / More on asthma

Mayo 2, 2018. No. 3069

Muertes relacionadas con el asma Asthma-related deaths. D'Amato G1, Vitale C2, Molino A3, Stanziola A3, Sanduzzi A4, Vatrella A2, Mormile M3, Lanza M3, Calabrese G3, Antonicelli L5, D'Amato M3. Multidiscip Respir Med. 2016 Oct 12;11:37. eCollection 2016. Abstract Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthmadeaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide. KEYWORDS: Asthma mortality trends; Asthma-deaths; Inhaled corticosteroids; Near fatal asthma PDF Ketamina en estado asmático. Una revisión Ketamine in status asthmaticus: A review. Goyal S1, Agrawal A. Author information Indian J Crit Care Med. 2013 May;17(3):154-61. doi: 10.4103/0972-5229.117048. Abstract BACKGROUND AND AIMS: Status asthmaticus is a common cause of morbidity and mortality. The addition of ketamine to the standard treatment regimen of severe asthma has shown to improve outcome and alleviate the need for mechanical ventilation. The purpose of this review is to determine the pulmonary effects of ketamine and to determine whether sufficient evidence exists to support its use for refractory status asthmaticus. DATA SOURCE: MEDLINE, EMBASE, Google Scholar, and Cochrane data bases (from their inception to Jan 2012) using key words "ketamine", "asthma", "bronchospasm", "bronchodilator", and "mechanical ventilation" were searched to identify the reports on the use of ketamine as a bronchodilator in acute severe asthma or status asthmaticus, and manual review of article bibliographies was done. Relevant databases were searched for the ongoing trials on use of ketamine as a bronchodilator. Outcome measures were analyzed using following clinical questions: Indication, dose and duration of ketamine use, main effects on respiratory mechanics, adverse effects, and mortality. RESULTS: Twenty reports illustrating the use of ketamine as a bronchodilator were identified. In total, 244 patients aged 5 months to 70 years received ketamine for bronchospasm. Twelve case reports, 3 double-blind randomized placebo-controlled trials, 2 prospective observational studies, 2 clinical evaluation study, and 1 retrospective chart review were retrieved. Most of the studies showed improved outcome with use of ketamine in acute severe asthma unresponsive to conventional treatment. Patients who received ketamine improved clinically, had lower oxygen requirements, and obviated the need for invasive ventilation. Mechanically-ventilated patients for severe bronchospasm showed reduction in peak inspiratory pressures, improved gas exchange, dynamic compliance and minute ventilation, and could be weaned off successfully following introduction of ketamine. CONCLUSION: In various studies, ketamine has been found to be a potential bronchodilator in severe asthma. However, a large prospective clinical trial is warranted before laying down any definitive recommendations on its use in status asthmaticus. KEYWORDS: Bronchodilator; emergency department; intensive care unit; ketamine; status asthmaticus PDF ¿Es la ketamina un agente salvavidas en el asma infantil aguda grave? Is ketamine a lifesaving agent in childhood acute severe asthma? Hendaus MA1, Jomha FA2, Alhammadi AH1. Author information Ther Clin Risk Manag. 2016 Feb 22;12:273-9. doi: 10.2147/TCRM.S100389. eCollection 2016. Abstract Children with acute severe asthma exacerbation are at risk of developing respiratory failure. Moreover, conventional aggressive management might be futile in acute severe asthma requiring intubation and invasive ventilation. The aim of this review is to detail evidence on the use of ketamine in childhood asthma exacerbations. A search of the MEDLINE, EMBASE, and Cochrane databases was performed, using different combinations of the following terms: ketamine, asthma, use, exacerbation, and childhood. In addition, we searched the references of the identified articles for additional articles. We then reviewed titles and included studies that were relevant to the topic of interest. Finally, the search was limited to studies published in English and Spanish from 1918 to June 2015. Due to the scarcity in the literature, we included all published articles. The literature reports conflicting results of ketamine use for acute severe asthma in children. Taking into consideration the relatively good safety profile of the drug, ketamine might be a reasonable option in the management of acute severe asthma in children who fail to respond to standard therapy. Furthermore, pediatricians and pediatric emergency clinicians administering ketamine should be knowledgeable about the unique actions of this drug and its potential side effects. KEYWORDS: asthma; children; ketamine PDF Manejo anestésico en asma Anaesthetic management in asthma. Burburan SM1, Xisto DG, Rocco PR. Author information Minerva Anestesiol. 2007 Jun;73(6):357-65. Epub 2006 Nov 20. Abstract Anaesthetic management in asthmatic patients has been focused on avoiding bronchoconstriction and inducing bronchodilation. However, the definition of asthma has changed over the past decade. Asthma has been defined as a clinical syndrome characterized by an inflammatory process that extends beyond the central airways to the distal airways and lung parenchyma. With this concept in mind, and knowing that asthma is a common disorder with increasing prevalence rates and severity worldwide, a rational choice of anaesthetic agents and procedures is mandatory. Thus, we pursued an update on the pharmacologic and technical anaesthetic approach for the asthmatic patient. When feasible, regional anaesthesia should be preferred because it reduces airway irritation and postoperative complications. If general anaesthesia is unavoidable, a laryngeal mask airway is safer than endotracheal intubation. Lidocaine inhalation, alone or combined with albuterol, minimizes histamine-induced bronchoconstriction. Propofol and ketamine inhibit bronchoconstriction, decreasing the risk of bronchospasm during anaesthesia induction. Propofol yields central airway dilation and is more reliable than etomidate or thiopental. Halothane, enflurane, and isoflurane are potent bronchodilators and can be helpful even in status asthmaticus. Sevoflurane has shown controversial results in asthmatic patients. Vecuronium, rocuronium, cisatracurium, and pancuronium do not induce bronchospasm, while atracurium and mivacurium can dose-dependently release histamine and should be cautiously administered in those patients. Further knowledge about the sites of action of anaesthetic agents in the lung, allied with our understanding of asthma pathophysiology, will establish the best anaesthetic approach for people with asthma. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Líquido cefalorraquídeo / Cerebrospinal fluid

Abril 25, 2018. No. 3062

Circulación del líquido cefalorraquídeo: ¿Qué sabemos y cómo lo sabemos? Cerebrospinal fluid circulation: What do we know and how do we know it? Khasawneh AH, Garling RJ, Harris CA. Brain Circ 2018;4:14-8. Abstract The central nervous system's (CNS) complicated design is a double-edged sword. On the one hand, the complexity is what gives rise to higher order thinking; but on the other hand, damage to the CNS evokes its unforgiving nature. The cerebrospinal fluid (CSF) circulation system is an intricate system embedded in and around the CNS that has been the topic of debate since it was first described in the 18thcentury. It is underscored by the choroid plexus's distinct vascular network which has conventionally been seen as the most prominent structure in CSF production through a variety of active transporters and channels. Despite the ubiquity of this circulation system in vertebrates, some aspects remain understudied. Recent advances in scientific methodology and experimentation have proven to be effective tools for elucidating the mechanisms of the CSF circulation system and the pathological conditions associated with its malfunction. In this review, we capitulate the classical understanding of CSF physiology as well as a new, emerging theory on CSF production. Keywords: Absorption, circulation, CSF flow, production PDF Interacción entre la barrera hematoencefálica y el sistema glimfático en la eliminación de solutos. Interaction between blood-brain barrier and glymphatic system in solute clearance. Verheggen ICM1, Van Boxtel MPJ2, Verhey FRJ2, Jansen JFA3, Backes WH3. Author information Neurosci Biobehav Rev. 2018 Mar 30;90:26-33. doi: 10.1016/j.neubiorev.2018.03.028. [Epub ahead of print] Abstract Neurovascular pathology concurs with protein accumulation, as the brain vasculature is important for waste clearance. Interstitial solutes, such as amyloid-β, were previously thought to be primarily cleared from the brain by blood-brain barrier transport. Recently, the glymphatic system was discovered, in which cerebrospinal fluid is exchanged with interstitial fluid, facilitated by the aquaporin-4 water channels on the astroglial endfeet. Glymphatic flow can clear solutes from the interstitial space. Blood-brain barrier transport and glymphatic clearance likely serve complementary roles with partially overlapping mechanisms providing a well-conditioned neuronal environment. Disruption of these mechanisms can lead to protein accumulation and may initiate neurodegenerative disorders, for instance amyloid-β accumulation and Alzheimer's disease. Although both mechanisms seem to have a similar purpose, their interaction has not been clearly discussed previously. This review focusses on this interaction in healthy and pathological conditions. Future health initiatives improving waste clearance might delay or even prevent onset of neurodegenerative disorders. Defining glymphatic flow kinetics using imaging may become an alternative way to identify those at risk of Alzheimer's disease. KEYWORDS: Alzheimer's disease; Amyloid-β; BBB; Blood-brain barrier; Clearance; Glymphatic system; Imaging PDF El papel de las barreras cerebrales en el movimiento de fluidos en el SNC: ¿existe un sistema "glimfático"? The role of brain barriers in fluid movement in the CNS: is there a 'glymphatic' system? Abbott NJ1, Pizzo ME2,3, Preston JE4, Janigro D5,6, Thorne RG7,8,9,10,11,12. Acta Neuropathol. 2018 Mar;135(3):387-407. doi: 10.1007/s00401-018-1812-4. Epub 2018 Feb 10. Author information Abstract Brain fluids are rigidly regulated to provide stable environments for neuronal function, e.g., low K+, Ca2+, and protein to optimise signalling and minimise neurotoxicity. At the same time, neuronal and astroglial waste must be promptly removed. The interstitial fluid (ISF) of the brain tissue and the cerebrospinal fluid (CSF) bathing the CNS are integral to this homeostasis and the idea of a glia-lymph or 'glymphatic' system for waste clearance from brain has developed over the last 5 years. This links bulk (convective) flow of CSF into brain along the outside of penetrating arteries, glia-mediated convective transport of fluid and solutes through the brain extracellular space (ECS) involving the aquaporin-4 (AQP4) water channel, and finally delivery of fluid to venules for clearance along peri-venous spaces. However, recent evidence favours important amendments to the 'glymphatic' hypothesis, particularly concerning the role of glia and transfer of solutes within the ECS. This review discusses studies which question the role of AQP4 in ISF flow and the lack of evidence for its ability to transport solutes; summarizes attributes of brain ECS that strongly favour the diffusion of small and large molecules without ISF flow; discusses work on hydraulic conductivity and the nature of the extracellular matrix which may impede fluid movement; and reconsiders the roles of the perivascular space (PVS) in CSF-ISF exchange and drainage. We also consider the extent to which CSF-ISF exchange is possible and desirable, the impact of neuropathology on fluid drainage, and why using CSF as a proxy measure of brain components or drug delivery is problematic. We propose that new work and key historical studies both support the concept of a perivascular fluid system, whereby CSF enters the brain via PVS convective flow or dispersion along larger caliber arteries/arterioles, diffusion predominantly regulates CSF/ISF exchange at the level of the neurovascular unit associated with CNS microvessels, and, finally, a mixture of CSF/ISF/waste products is normally cleared along the PVS of venules/veins as well as other pathways; such a system may or may not constitute a true 'circulation', but, at the least, suggests a comprehensive re-evaluation of the previously proposed 'glymphatic' concepts in favour of a new system better taking into account basic cerebrovascular physiology and fluid transport considerations. KEYWORDS: Blood-brain barrier; Cerebrospinal fluid; Extracellular space; Glymphatic; Interstitial fluid; Perivascular space PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Resultados de 10 años después de la reconstrucción del LCA

www.ortotrauma.xyz/academia/resultados-de-10-anos-despues-de-la-reconstruccion-del-lca/

Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study.

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29543512

http://journals.sagepub.com/doi/abs/10.1177/0363546517749850?journalCode=ajsb

https://www.anatomia-fisioterapia.es/rodilla/articles/systems/musculoskeletal/lower-extremity/knee/resultados-de-10-anos-despues-de-la-reconstruccion-del-lca

De:

MOON Knee Group1, Spindler KP1, Huston LJ1, Chagin KM1, Kattan MW1, Reinke EK1, Amendola A1, Andrish JT1, Brophy RH1, Cox CL1, Dunn WR1, Flanigan DC1, Jones MH1, Kaeding CC1, Magnussen RA1, Marx RG1, Matava MJ1, McCarty EC1, Parker RD1, Pedroza AD1, Vidal AF1, Wolcott ML1, Wolf BR1, Wright RW1.

Am J Sports Med. 2018 Mar;46(4):815-825. doi: 10.1177/0363546517749850.

Todos los derechos reservados para:

Copyright © 2018, © SAGE Publications

Copyright © 2018 by American Orthopaedic Society for Sports Medicine

Abstract

BACKGROUND:

The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown. Hypothesis/Purpose: Our objective was to identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years.

CONCLUSION:

Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome.

KEYWORDS:

ACL reconstruction; IKDC; KOOS; Marx; anterior cruciate ligament; articular cartilage; follow-up; meniscus; outcomes; revision ACL reconstruction; subsequent surgery

En este estudio, se identificaron factores de riesgo constantes, modificables y no modificables, que son predictivos de resultados inferiores a 10 años después de la reconstrucción del LCA (RLCA).

Los hallazgos proporcionaron además apoyo contra las creencias más comunes que se cree que afectan negativamente los resultados a largo plazo. Clínicamente, la información obtenida puede proporcionar información sobre los pronósticos después de la intervención quirúrgica.

Este estudio prospectivo longitudinal revisó 1592 pacientes que se sometieron a una ACLR primaria o de revisión. La medición de resultados por parte de los pacientes (IKDC, KOOS y Marx) se administraron debido al punto de observación único del análisis de las intervenciones y se administraron al inicio del estudio, 2 años, 6 años y 10 años de seguimiento.

Los factores de riesgo consistentes para los informes inferiores a los 10 años incluyeron: puntaje basal más bajo, IMC más alto, fumador al inicio del estudio y someterse a un procedimiento anterior de menisco medial antes de la ACLR. Otros factores notables incluidos; sexo femenino, edad avanzada, nivel de educación más bajo, revisión quirúrgica, tener cartílago articular grado 3 a 4 o tener más cirugía después de ACLR.

Coincidentemente, no se encontró que el tipo de deporte, el nivel de competencia, el tipo de injerto, las lesiones de MCL o LCL en el momento del ACLR o la selección del cirujano tengan un impacto negativo en el resultado a 10 años. Además, se encontró que las puntuaciones de IKDC y KOOS aumentaron después de la ACLR y se mantuvieron con un seguimiento de 10 años.

Los autores sugieren que los hallazgos de este estudio pueden ayudar a centrar la educación en el manejo de las expectativas al considerar la cirugía de ACLR, así como ayudar a reconocer la necesidad de más investigación sobre factores de riesgo modificables que puedan mejorar los resultados después de la ACLR.

> De: MOON Knee Group, Am J Sports Med 46 (2018) 815-825. Todos los derechos reservados: The Author(s). Pincha aquí para acceder al resumen. Traducido por Nelson Adrian.

PMID:  29543512  DOI:  10.1177/0363546517749850