Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A Delphi technique-based consensus

AIM To propose several alternatives treatment of type 1 hepatorenal syndrome(HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.METHODS A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature.Each expert was designated to review and answer a question.They generated draft statements for evaluation by all the experts.Additional input was obtained from medical community.In order to reach consensus,a modified three-round Delphi technique method was used.According to United States Preventive Services Task Force criteria,the quality of the evidence and level of recommendation supporting each statement was graded.RESULTS Nine questions were formulated.The available evidence was evaluated considering its quality,number of patients included in the studies and the consistency of its results.The generated questions were answered by the expert panel with a high level of agreement.Thus,a therapeutic algorithm was generated.The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice.On the other hand the use of the combination of octreotide,midodrine and albumin without vasoconstrictors was discouraged.The role of several other options was also evaluated and the available evidence was explored and discussed.Liver transplantation is considered the definitive treatment for HRS-1.The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature,the quality of the evidence and the benefits,adverse effects and availability of the therapeutic tools described.CONCLUSION Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.

Assessment of Organic Compounds as Vehicular Emission Tracers in the AburráValley Region of Colombia

The Aburrá Valley region in Colombia, with Medellín as its main city, is an urban centre with about three million people. An investigation was carried out to deter-mine a set of baseline concentrations for VOC compounds associated with diesel fuel and gasoline, as vehicular emission tracers in the region. The VOC measurement campaigns, based on TENAX tube sampling and analysis according to TO-17 EPA method, were done in areas of low and high vehicular flow as well as on-board measurements covering major Medellín road networks during 24 hours. The results showed that there was a relation between VOCs concentrations and vehicular activi-ty. The diesel fuel sulfur content was also found as an important factor on VOC hy-drocarbon formation.