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BACKGROUND: Recent trends in prostate biopsy analgesia suggest a combination anesthetic to provide better pain relief than periprostatic nerve block (PPNB) alone. This study aimed to demonstrate the efficacy and safety of three intrarectal local anesthesia (IRLA) combined with PPNB in patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsy. METHODS: In this prospective, randomized study, 120 prostate biopsy patients were equally divided into four IRLA groups: group 1 (placebo) received simple lubrication; group 2 received 2% lidocaine gel; group 3 received 100 mg indomethacin suppository and group 4 received 5% prilocaine/lidocaine (EMLA) cream. PPNB with 2% lidocaine was applied in all groups. A ten-point visual analog scale evaluated both pain associated with the probe insertion and pain associated with prostate sampling. Adverse effects or complications due to anesthesia during and after the procedure were documented. RESULTS: Compared with group 1, groups 3 and 4 had significantly lower pain scores at both probe insertion and prostate sampling while group 2 showed no significant differences at both pain scores. Moreover, group 4 showed significantly lower pain scores at probe insertion compared to group 3, while no significant difference was observed at prostate sampling. Mild complications were observed in all groups with no significant difference in the incidence of complications between groups. CONCLUSION: Intrarectal application of EMLA cream is a more efficient pain reduction than either 2% lidocaine gel or 100 mg indomethacin suppository when applied combined with PPNB. This combination represents an effective option of pain relief for patients undergoing TRUS-guided prostate biopsy.

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El principal objetivo de este trabajo es brindar las bases para un esfuerzo coordinado con el fin de crear capacidad de análisis de riesgos para la inocuidad de los alimentos en la región de América Latina y el Caribe (ALC) reuniendo a organizaciones internacionales (Organización Panamericana de la Salud-OPS, Organización de las Naciones Unidas para la Alimentación y la Agricultura -FAO e Instituto Interamericano de Cooperación para la Agricultura-IICA) y universidades (Universidad de Nebraska-Lincoln, Universidad de Maryland, Universidad de Minnesota y Universidad Tecnológica de Texas) mediante la Alianza Estratégica para la Creación de Capacidades en Análisis de Riesgos para la Inocuidad de los Alimentos (AECAR). Esperamos que este trabajo, creado por la alianza, logre: a) generar confianza y fortalecer la comunicación entre todas las organizaciones que trabajan en la región; b) proporcionar las bases para enfoques coordinados, consistentes y efectivos para crear capacidad y desarrollar programas de estudio; y c) facilitar la implementación del marco para análisis de riesgos en la región. Este trabajo presenta los recursos actuales de los autores, considera algunos ejemplos exitosos de implementación de análisis de riesgos en la región (de los sectores académicos y gubernamentales), los desafíos experimentados al implementar el análisis de riesgos, y una hoja de ruta para la creación de capacidad propuesta por esta alianza para ampliar la adopción de análisis de riesgos en la región.

The main goal of this paper is to provide the foundation for a coordinated effort for food safety risk analysis capacity building in the Latin American and Caribbean (LAC) region by bringing together international organizations (Panamerican Health Organization-PAHO, Food and Agriculture Organization of the United Nations-FAO and the Interamerican Institute for Cooperation in Agriculture-IICA) and universities (University of Nebraska-Lincoln, University of Maryland, University of Minnesota and Texas Tech University) through the Strategic Alliance in Risk Analysis Capacity Building (SARAC). We expect that this paper, authored by the alliance, will: a) build trust and strengthen communication among all the organizations that work in the region; b) provide the foundation for coordinated, consistent, and effective approaches to capacity building and curriculum development; and c) facilitate the implementation of the risk analysis framework within the region. This paper provides the current resources by the authors, discusses some successful examples of risk analysis implementation in the region (from academia and government sectors), the challenges experienced on implementing risk analysis and a capacity building roadmap proposed by this alliance to enhance the adoption of risk analysis in the region.

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BACKGROUND: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients. METHODS: Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained. RESULTS: The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels. CONCLUSIONS: A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.

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