Geriatric epidemiology of trauma in a hospital in Southern Colombia

Objective: To describe the clinical and sociodemographic characteristics of geriatric patients who were treated at a university hospital in southern Colombia. <br> Methods: A database of trauma patients over 65 admitted between June 2014 and December 2015 was constructed. Univariate analysis was performed. Measures of central tendency and dispersion for continuous variables were calculated. <br> Results: A total of 760 patients were analyzed, the median age was 74 years (65–98). The median injury severity score was 9 (4–25) the 71.97% were men, and overall mortality was 25.39%. The 92.10% was blunt trauma, and the main mechanism of injury was falls. <br> Conclusions: Trauma in the elderly is a common condition with high risk of mortality. It is important to know the frequency of these injuries to provide the best possible handling. In our hospital we found that geriatric trauma is a common disease, the main cause is falls without embargos traffic accidents are common in this population.

Evaluation of Stress Response and Apoptosis on Leucocytes in TIVA versus Balanced Anesthesia

Background: The aim of this study was to assess the stress response and apoptosis on leucocytes, in patients under two different anesthetics techniques. Methods: Thirty patients ASA I-II were prospectively randomized into two groups to receive either total intravenous anesthesia with propofol-remifentanil (TIVA Group, n = 15) or balanced inhalation anesthesia with sevoflurane-remifentanil (BAL Group, n = 15). The hemodynamic response: systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at different time points: baseline, after intubation, after skin incision and at the end of surgery, was measured along with plasma levels of lactate, glucose, cortisol and leucocytes count. The biomarkers of apoptosis (Annexin V and Propidium Iodide) in neutrophils, monocytes and lymphocytes were evaluated at baseline, intraoperatively and two hours after surgery. Results: The study groups were comparable with respect to anthropometric data. No significant intergroup differences in SBP and DBP were revealed. The HR in the BAL group was lower after intubation (p = 0.007). In both groups, lactate, plasma glucose, cortisol and leucocytes count remained stable during surgery and two hours post-operatively. In the BAL group there were significant differences in Annexin V in neutrophils, baseline moment (p = 0.010). No significant differences were found in apoptosis markers (Annexin V and Propidium Iodide) in neutrophils, monocytes and lymphocytes, at different time points. Conclusion: Both TIVA and BAL were effective in suppressing the surgical stress, without inducing apoptosis in immune cells, in patients undergoing VCL.

Massive Pericardial Effusion as the First Manifestation of Hypothyroidism in a Male Patient

This article intends to report a rare case of massive pericardial effusion as the first manifestation of hypothyroidism. A 45-year-old male patient, accompanied by a cardiology department, suddenly started to present signs of dyspnea and tiredness. He was submitted to an echocardiogram and diagnosed with dilated cardiomyopathy associated with a moderate pericardial effusion and low ejection of fraction. The laboratory tests showed elevated TSH levels （13.20 mIU/L）, what leads to the hypothyroidism diagnose and enable to start the treatment with levothyroxine. The patient has not followed correctly the treatment, reason why he has not showed any improves. He was admitted in the hospital to cardiology monitoring and the chest radiography confirmed an intense pericardial effusion. Then, the patient was submitted to the pericardiocentesis procedure, which was capable of remove the pericardial fluid for laboratory analysis and fragment of the pericardial sac for neoplastic cell research. After the hospital discharge, he was maintained in outpatient follow-up, when showed an important improvement in the clinical state.

Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac

Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.

A novel supplement with yeast b-glucan, prebiotic, minerals and Silybum marianum synergistically modulates metabolic and inflammatory pathways and improves steatosis in obese mice

Objective: To evaluate the synergic effects of a novel oral supplement formulation, containing prebiotics,yeast b-glucans, minerals and silymarin(Silybum marianum), on lipid and glycidic metabolism, inflammatory and mitochondrial proteins of the liver, in control and high-fat diet-induced obese mice.Methods: After an acclimation period, 32 male C57 BL/6 mice were divided into the following groups:nonfat diet(NFD) vehicle, NFD supplemented, high-fat diet(HFD) vehicle and HFD supplemented. The vehicle and experimental formulation were administered orally by gavage once a day during the last four weeks of the diet(28 consecutive days). We then evaluated energy homeostasis, inflammation, and mitochondrial protein expression in these groups of mice.Results: After four weeks of supplementation, study groups experienced reduced glycemia, dyslipidemia,fat, and hepatic fibrosis levels. Additionally, proliferator-activated receptor-α, AMP-activated protein kinase-1α, peroxisome proliferator-activated receptor γ co-activator-1α, and mitochondrial transcription factor A expression levels were augmented;however, levels of inhibitor of nuclear factor-κB kinase subunit a and p65 nuclear factor-κB expression, and oxidative markers were reduced. Notably, the cortisol/C-reactive protein ratio, a well-characterized marker of the hypothalamic–pituitary–adrenal axis immune interface status, was found to be modulated by the supplement.Conclusion: We discovered that the novel supplement was able to modify different antioxidant, metabolic and inflammatory pathways, improving the energy homeostasis and inflammatory status, and consequently alleviated hepatic steatosis.