RESUMO
BACKGROUND: Several guidelines have put forward recommendations about the perioperative process of cholecystectomy. Despite the recommendations, controversy remains concerning several topics, especially in low- and middle-income countries. The aim of this study was to develop uniform recommendations for perioperative practices in cholecystectomy in Mexico to standardize this process and save public health system resources. METHODS: A modified Delphi method was used. An expert panel of 23 surgeons anonymously completed two rounds of responses to a 29-item questionnaire with 110 possible answers. The consensus was assessed using the percentage of responders agreeing on each question. RESULTS: From the 29 questions, the study generated 27 recommendations based on 20 (69.0%) questions reaching consensus, one that was considered uncertain (3.4%), and six (20.7%) items that remained open questions. In two (6.9%) cases, no consensus was reached, and no recommendation could be made. CONCLUSIONS: This study provides recommendations for the perioperative management of cholecystectomy in public hospitals in Mexico. As a guide for public institutions in low- and middle-income countries, the study identifies recommendations for perioperative tests and evaluations, perioperative decision making, postoperative interventions and institutional investment, that might ensure the safe practice of cholecystectomy and contribute to conserving resources.
Assuntos
Colecistectomia , Hospitais Públicos , Consenso , Técnica Delphi , Humanos , MéxicoRESUMO
INTRODUCTION: Essential amino acid α-keto acid analogs are used in the treatment of chronic kidney disease to delay the symptoms of uremia. However, it is unknown whether essential amino acid α-keto acid analogs affect the oxidative stress and the inflammation in acute renal injury such as those produced by ischemia-reperfusion. OBJECTIVE: To evaluate the effect of essential amino acid α-keto acid analogs on renal ischemia-reperfusion injury in Wistar rats. MATERIALS AND METHODS: Rats were divided into 11 groups (n=6/group): Two groups received physiological saline with or without ischemia-reperfusion injury (45 min/24 h), six groups received essential amino acid α-keto acid analogs (400, 800, or 1,200 mg/kg/24 h/7d) with or without ischemia-reperfusion injury (essential amino acid α-keto acid analogs + ischemia-reperfusion), and two groups received allopurinol (50 mg/kg/24 h/7d) with or without ischemia-reperfusion injury. Biochemical markers included creatinine and blood urea nitrogen (BUN), proinflammatory cytokines (IL-1ß, IL-6, and TNF-α), renal damage markers (cystatin C, KIM-1, and NGAL), and markers of oxidative stress such as malondialdehyde (MDA) and total antioxidant activity. RESULTS: The essential amino acid α-keto acid analog- and allopurinol-treated groups had lower levels of creatinine, BUN, renal damage markers, proinflammatory cytokines, and MDA than their corresponding ischemia-reperfusion groups. These changes were related to the essential amino acid α-keto acid analogs dosage. Total antioxidant activity was lower in essential amino acid α-keto acid analog- and allopurinol-treated groups than in the corresponding ischemia-reperfusion groups. CONCLUSIONS: This is a new report on the nephroprotective effects of essential amino acid α-keto acid analogs against ischemia-reperfusion injury. Essential amino acid α-keto acid analogs decreased the levels of biochemical markers, kidney injury markers, proinflammatory cytokines, and MDA while minimizing total antioxidant consumption.
Introducción. Los α-cetoanálogos de aminoácidos esenciales se utilizan en el tratamiento de la enfermedad renal crónica para retrasar los síntomas de la uremia. Sin embargo, se desconoce si los α-cetoanálogos de aminoácidos esenciales afectan el estrés oxidativo y la inflamación en la lesión renal aguda tal como en la producida por la isquemia-reperfusión. Objetivo. Evaluar el efecto de las α-cetoanálogos de aminoácidos esenciales sobre la lesión renal por isquemia-reperfusión en ratas Wistar. Materiales y métodos. Se emplearon 11 grupos de ratas (n=6): dos grupos recibieron solución salina fisiológica con lesión isquemia-reperfusión o sin ella (45 min/24 h), seis grupos recibieron α-cetoanálogos de aminoácidos esenciales (400, 800 o 1.200 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella (α-cetoanálogos de aminoácidos esenciales + isquemia-reperfusión), y dos grupos recibieron (50 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella. Los marcadores bioquímicos incluyeron creatinina y nitrógeno ureico en sangre (BUN), citocinas proinflamatorias (IL-1ß, IL-6 y TNF-α), marcadores de daño renal (cistatina C, KIM-1 y NGAL) y marcadores del estrés oxidativo como el malondialdehído (MDA) y la actividad antioxidante total. Resultados. Los grupos tratados con α-cetoanálogos de aminoácidos esenciales y alopurinol tuvieron niveles inferiores de creatinina, BUN, marcadores de daño renal, citocinas proinflamatorias, actividad antioxidante total y MDA que los grupos isquemia-reperfusión correspondientes. Estos cambios se asociaron con la dosis. La actividad antioxidante total fue menor en los grupos tratados con α-cetoanálogos de aminoácidos esenciales que en los grupos isquemia-reperfusión correspondientes. Conclusiones. Este es un nuevo informe de los efectos nefroprotectores de las α-cetoanálogos de aminoácidos esenciales contra la lesión isquemia-reperfusión. Los α-cetoanálogos de aminoácidos esenciales disminuyeron los niveles de los marcadores bioquímicos, de los de lesión renal, de las citocinas proinflamatorias y el MDA, a la vez que minimizaron el consumo total de antioxidantes.
Assuntos
Aminoácidos Essenciais/uso terapêutico , Antioxidantes/uso terapêutico , Cetoácidos/uso terapêutico , Rim/irrigação sanguínea , Traumatismo por Reperfusão/tratamento farmacológico , Alopurinol/uso terapêutico , Aminoácidos Essenciais/administração & dosagem , Animais , Antioxidantes/análise , Biomarcadores , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Cistatina C/sangue , Citocinas/sangue , Relação Dose-Resposta a Droga , Avaliação Pré-Clínica de Medicamentos , Cetoácidos/administração & dosagem , Rim/patologia , Lipocalina-2/sangue , Masculino , Malondialdeído/sangue , Estresse Oxidativo/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Wistar , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/prevenção & controleRESUMO
Introduction: Essential amino acid α-keto acid analogs are used in the treatment of chronic kidney disease to delay the symptoms of uremia. However, it is unknown whether essential amino acid α-keto acid analogs affect the oxidative stress and the inflammation in acute renal injury such as those produced by ischemia-reperfusion. Objective: To evaluate the effect of essential amino acid α-keto acid analogs on renal ischemia-reperfusion injury in Wistar rats. Materials and methods: Rats were divided into 11 groups (n=6/group): Two groups received physiological saline with or without ischemia-reperfusion injury (45 min/24 h), six groups received essential amino acid α-keto acid analogs (400, 800, or 1,200 mg/kg/24 h/7d) with or without ischemia-reperfusion injury (essential amino acid α-keto acid analogs + ischemia-reperfusion), and two groups received allopurinol (50 mg/kg/24 h/7d) with or without ischemia-reperfusion injury. Biochemical markers included creatinine and blood urea nitrogen (BUN), proinflammatory cytokines (IL-1ß, IL-6, and TNF-α), renal damage markers (cystatin C, KIM-1, and NGAL), and markers of oxidative stress such as malondialdehyde (MDA) and total antioxidant activity. Results: The essential amino acid α-keto acid analog- and allopurinol-treated groups had lower levels of creatinine, BUN, renal damage markers, proinflammatory cytokines, and MDA than their corresponding ischemia-reperfusion groups. These changes were related to the essential amino acid α-keto acid analogs dosage. Total antioxidant activity was lower in essential amino acid α-keto acid analog- and allopurinol-treated groups than in the corresponding ischemia-reperfusion groups. Conclusions: This is a new report on the nephroprotective effects of essential amino acid α-keto acid analogs against ischemia-reperfusion injury. Essential amino acid α-keto acid analogs decreased the levels of biochemical markers, kidney injury markers, proinflammatory cytokines, and MDA while minimizing total antioxidant consumption.
Introducción. Los α-cetoanálogos de aminoácidos esenciales se utilizan en el tratamiento de la enfermedad renal crónica para retrasar los síntomas de la uremia. Sin embargo, se desconoce si los α-cetoanálogos de aminoácidos esenciales afectan el estrés oxidativo y la inflamación en la lesión renal aguda tal como en la producida por la isquemia-reperfusión. Objetivo. Evaluar el efecto de las α-cetoanálogos de aminoácidos esenciales sobre la lesión renal por isquemia-reperfusión en ratas Wistar. Materiales y métodos. Se emplearon 11 grupos de ratas (n=6): dos grupos recibieron solución salina fisiológica con lesión isquemia-reperfusión o sin ella (45 min/24 h), seis grupos recibieron α-cetoanálogos de aminoácidos esenciales (400, 800 o 1.200 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella (α-cetoanálogos de aminoácidos esenciales + isquemia-reperfusión), y dos grupos recibieron (50 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella. Los marcadores bioquímicos incluyeron creatinina y nitrógeno ureico en sangre (BUN), citocinas proinflamatorias (IL-1ß, IL-6 y TNF-α), marcadores de daño renal (cistatina C, KIM-1 y NGAL) y marcadores del estrés oxidativo como el malondialdehído (MDA) y la actividad antioxidante total. Resultados. Los grupos tratados con α-cetoanálogos de aminoácidos esenciales y alopurinol tuvieron niveles inferiores de creatinina, BUN, marcadores de daño renal, citocinas proinflamatorias, actividad antioxidante total y MDA que los grupos isquemia-reperfusión correspondientes. Estos cambios se asociaron con la dosis. La actividad antioxidante total fue menor en los grupos tratados con α-cetoanálogos de aminoácidos esenciales que en los grupos isquemia-reperfusión correspondientes. Conclusiones. Este es un nuevo informe de los efectos nefroprotectores de las α-cetoanálogos de aminoácidos esenciales contra la lesión isquemia-reperfusión. Los α-cetoanálogos de aminoácidos esenciales disminuyeron los niveles de los marcadores bioquímicos, de los de lesión renal, de las citocinas proinflamatorias y el MDA, a la vez que minimizaron el consumo total de antioxidantes.
Assuntos
Isquemia , Traumatismo por Reperfusão , Estresse Oxidativo , Insuficiência Renal Crônica , Inflamação , Modelos TeóricosRESUMO
BACKGROUND: Oxidative stress and the inflammatory process are involved in ischemia-reperfusion (I/R) injury. Juglans mollis has been reported as having antioxidant activity, which could attenuate the damage caused by I/R. We evaluated whether a methanolic extract of Juglans mollis (JM) exhibits nephroprotective activity in a Wistar rat model of I/R injury. METHODS: Four groups of six rats were used: Sham, I/R, JM, and JM + I/R. Two groups were dosed with JM (300 mg/kg) for 7 days before I/R. I/R injury was induced by clamping the renal hilums for 45 min and then reperfusing the kidneys for 15 h. Blood samples were taken to evaluate the levels of alanine aminotransferase (ALT), blood urea nitrogen, creatinine, superoxide dismutase (SOD), malondialdehyde (MDA), interleukin 1ß (IL-1ß), IL-6, and tumor necrosis factor α (TNF-α). RESULTS: The levels of creatinine, ALT, MDA, IL-1ß, IL-6, and TNF-α were lower in JM + I/R than in I/R rats, whereas SOD level only was higher in JM + I/R than in Sham rats. No biochemical or histological damage was observed in JM rats compared with Sham rats; however, less histological damage was observed in JM + I/R rats compared with I/R rats. CONCLUSIONS: To our knowledge, this is the first report of nephroprotective activity of J. mollis against damage induced by I/R. This activity may be related to decreased levels of proinflammatory cytokines (IL-1ß, IL-6, and TNF-α) and modulation of oxidative stress markers (SOD and MDA) observed in the present study.
Assuntos
Anti-Inflamatórios/administração & dosagem , Juglans/química , Extratos Vegetais/administração & dosagem , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Creatinina/metabolismo , Humanos , Rim/efeitos dos fármacos , Rim/imunologia , Rim/metabolismo , Masculino , Malondialdeído/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Traumatismo por Reperfusão/genética , Traumatismo por Reperfusão/imunologia , Traumatismo por Reperfusão/metabolismo , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismoRESUMO
ANTECEDENTES: El preacondicionamiento isquémico remoto (PIR) en trasplante hepático ha sido sugerido en el ámbito experimental como estrategia para disminuir la lesión por isquemia- reperfusión. OBJETIVO: Evaluar el efecto del PIR sobre el injerto hepático en donante cadáver y el impacto de diversos mediadores inflamatorios en este proceso. MÉTODO: Se incluyeron 10 receptores de trasplante hepático, 5 controles y 5 con PIR, el cual fue realizado en los donantes cadavéricos mediante la aplicación de un torniquete neumático en ambos muslos por 10 minutos seguido de 10 minutos de reperfusión. Se determinaron interleucina (IL)-1, IL-6, factor de necrosis tumoral alfa (FNT-α), factor de crecimiento endotelial vascular (FCEV) y molécula de adhesión intracelular (ICAM)-1, parámetros hematológicos y bioquímicos en diversas fases del trasplante hepático. RESULTADOS: Se observó un aumento significativo de la aspartato aminotransferasa (AST), la alanino aminotransferasa (ALT) y la fosfatasa alcalina en las fases tempranas tras el trasplante hepático, y a las 72 horas los sujetos con PIR mostraron mejor respuesta, con recuperación de plaquetas, que persistió hasta los 3 meses en este grupo. La IL-6 participa en las fases tempranas de la lesión por isquemia- reperfusión, contrario al FNT-α, que se incrementa hasta el día 7, mientras que la ICAM-1 aumentó en todas las fases. CONCLUSIONES: En este estudio piloto, el PIR disminuyó el daño por lesión por isquemia- reperfusión, aunque el mayor efecto se observó después de 72 horas. BACKGROUND: Remote ischemic preconditioning (RIP) in liver transplantation has been suggested experimentally as a strategy to reduce ischemia-reperfusion injury. OBJECTIVE: Evaluate the effect of RIP on liver graft in cadaveric donors and the impact of various inflammatory mediators in this process. METHOD: Ten liver transplantation recipients, 5 controls and 5 PIR, were made in the cadaver donors by applying a pneumatic tourniquet in the upper third of both thighs for a period of 10 minutes followed by 10 minutes reperfusion. The determination of interleukine (IL)-1, IL-6, tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), intracellular adhesion molecule (ICAM)-1 was performed as well as hematological and biochemical parameters at various stages of liver transplantation. RESULTS: Significant increase of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase in the early stages of post-liver transplantation were observed, after 72 hours subjects who received liver transplantation subjected to RIP they showed a better response, which was also evident in platelet recovery, which persisted until phase 3 months in this group. IL-6 appears to participate in the early stages of the ischemia-reperfusion injury, contrary to TNF-α that increases until day 7 while ICAM-1 was increased in all phases. CONCLUSIONS: In this pilot study the PIR decreased the damage by ischemia-reperfusion injury, although the greatest effect was observed after 72 hours.
Assuntos
Precondicionamento Isquêmico/métodos , Transplante de Fígado , Fígado/irrigação sanguínea , Sobrevivência de Tecidos , Adulto , Citocinas/sangue , Feminino , Humanos , Molécula 1 de Adesão Intercelular/sangue , Masculino , Pessoa de Meia-Idade , Fator A de Crescimento do Endotélio Vascular/sangueRESUMO
OBJECTIVE: To assess the knowledge and attitude towards organ donation within health professionals in different institutions of Nuevo Leon. METHODS: A prospective, open, observational, descriptive study of parallel groups, through application of a survey formulated by the Hospital Universitario (HU) "Dr. José Eleuterio González". We applied 208 surveys in the HU (n = 100) and other institutions like IMSS, ISSTE (n = 108). RESULTS: From all the participants, 86% had a positive attitude towards organ donation, associated to a higher education, and information regarding organ donation received by other health professionals. Though having a positive attitude toward organ donation, 14% of health professionals don't support it due to being afraid of not receiving medical assistance, knowing their status of donators, religious reasons, and fear of organ trafficking. CONCLUSIONS: Our study shows that, even within the health professionals, there is a need for information regarding organ donation. A well-instructed health professional shows a higher interest in organ donation; this could have a positive impact in the attitude of the population toward organ donation, as well as in the obtainment of organs inside the medical institutions.
Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Transplante de Órgãos/psicologia , Obtenção de Tecidos e Órgãos , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Tráfico de Órgãos/psicologia , Estudos Prospectivos , Religião e Psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND AIMS: The protective effect of ischemic preconditioning (IP) in liver transplantation (LT) has been studied with controversial results. We undertook this study to investigate whether IP of cadaveric donor livers is protective to allografts. METHODS: IP (LT + IP, n = 6) was induced by 10-min hilar clamping. These were compared to cadaver donors with no IP (LT, n = 7). Clinical data and blood were obtained in donors and recipients for biochemical and inflammatory mediator (IM) measurements (P-selectin, leukotriene B4, myeloperoxidase, ICAM-1, IL-1, IL-6, and TNF-α). Liver tissue samples were obtained from donors and recipients (90 min after reperfusion). RESULTS: No significant differences were found in demographic characteristics between donors and recipients. When comparing both groups (LT + IP vs. LT only), ICU stay was longer in LT + IP group. For biochemical parameters, a significant difference was found only with a higher total bilirubin at postoperative day 3 in LT + IP group. There was no statistical difference in IM between LT and LT + IP groups at different stages of the study. Histological analysis of donor grafts indicated the presence of steatosis (50%) in one graft from the LT + IP group. However, in post-reperfusion biopsies neither neutrophil infiltration nor grade of necrosis showed significant difference between groups. No incidence of primary graft nonfunction (PGNF) was observed and graft and patient survival was similar in the two groups at 24 months. CONCLUSION: IP does not seem to protect against I/R injury in cadaveric LT, and no PGNF was seen.
Assuntos
Doença Hepática Terminal/cirurgia , Precondicionamento Isquêmico , Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/prevenção & controle , Adulto , Biomarcadores/sangue , Cadáver , Doença Hepática Terminal/sangue , Feminino , Humanos , Fígado/patologia , Fígado/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Traumatismo por Reperfusão/etiologia , Doadores de Tecidos , Adulto JovemRESUMO
BACKGROUND: In patients with end-stage renal disease, successful renal allotransplantation improves the quality of life and increases survival as compared with long-term dialysis treatment. OBJECTIVE: To show our experience, effectiveness and results of renal transplantations at the University Hospital of UANL. MATERIAL AND METHODS: A retrospective study of renal transplantation performed at University Hospital of UANL was done. The transplant cases from 1967 to July 2001 and January 2003 to June 2011 were included. RESULTS: 280 kidney transplants were performed in 264 patients, 146 men and 118 women; 201 from deceased donor and 79 from living donor. The patient survival at 1, 3, and 5 years was 98.8, 85.9 and 85.9%, respectively. The graft survival at 1, 3, and 5 years, censored for death with functioning graft, was 98.8, 85.7 and 74.9%, respectively. CONCLUSIONS: Our results, in this population with unfavorable socioeconomic conditions, are comparable to those obtained in other institutions.
Assuntos
Transplante de Rim/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Hospitais Universitários , Humanos , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Objetivo: Analizar la experiencia de un hospital universitario en el manejo terapéutico de la lesión diafragmática de origen traumático. Sede: Hospital Universitario "Dr. Eleuterio González", Nuevo León, México. Diseño: Estudio clínico de casos, retrospectivo y observacional, sin diseño estadístico. Pacientes y métodos: Se revisaron los expedientes clínicos de 8721 pacientes hospitalizados de enero de 1988 a diciembre de 1992; (5 años). Se analizaron las siguientes variables: sexo, edad, mecanismo de lesión, síntoma más frecuente, hallazgos radiológicos, lavado peritoneal, tipo de cirugía, lesiones asociadas, características de la lesión del diafragma, colocación de sonda en tórax y su duración, antimicrobianos empleados, complicaciones, días de estancia hospitalaria y mortalidad. Resultados: Se encontraron 54 pacientes con lesión diafragmatica, 53 varones y una mujer. Edad promedio 22 años, 25 por ciento tenían entre 17 y 20 años. Los mecanismos de lesión fueron de tres tipos: herida por arma punzo cortante, herida por proyectil de arma de fuego y traumatismo cerrado múltiple. Al 40 por ciento (22 pacientes) se les tomó telerradiografía de tórax, en 10 se observó hemoneumotórax, 8 del lado izquierdo y 2 del derecho. Se practicó lavado peritoneal a 32 pacientes (59 por ciento), todos resultaron positivos. El abordaje quirúrgico más empleado fue la laparotomía media en 44 sujetos (81 por ciento); el hígado fue el órgano más frecuentemente lesionado en 46 por ciento, le siguió el bazo con un 27 por ciento, todos requirieron esplenectomía. El hemidiafragma más lesionado resultó el izquierdo en 33 pacientes (61 por ciento). En el 74 por ciento (40 enfermos) el material de sutura con que se reparó la herida diafragmática fue la seda. Se colocó sonda de tórax a 30 pacientes con duración promedio de la misma de 5 días, el antimicrobiano más empleado fue la cefaxelina seguido de una combinación de cefalotina con metronidazol. Los días de estancia hospitalaria fueron en promedio de 7. La mortalidad fue del 3.7 por ciento. Conclusión: Las lesiones diafragmáticas son de difícil diagnóstico, se debe sospechar en todo paciente con trauma cerrado de tórax o abdomen superior, la telerradiografía de tórax es un buen método de diagnóstico y el lavado peritoneal lo complementa. La mortalidad es baja