Acidosis láctica asociada a metformina

Metformin is an oral antidiabetic that belongs to the group of the biguainides. It is the drug of choice for the treatment of type II diabetes due to its efficacy and safety. It is a small molecule, whose elimination half-life is 8 to 20 hours in people with normal renal function. Severe lactic acidosis associated with metformin is a serious, infrequent disease (its incidence is estimated between 3-8 cases per 100,000 diabetic patients and year) but with high mortality (around 40% in accidental poisonings), which is defined in presence of a pH <7.35, lactate> 2 mmol / L and a paCO2 in normal limits. We present the case of a diabetic patient under treatment with metformin, hypertense and dyslipidemic, polymedicated, with severe lactic acidosis, in a Reanimation Care unit, after postoperative exploratory laparotomy due to suspicion of intestinal ischemia. He arrives in a state of circulatory shock, with little response to the administration of volume and vasoactive drugs. We describe some data about its incidence, pathophysiology, prognosis and treatment, as well as the importance of an early and differential diagnosis with other causes of metabolic acidosis that elevate the GAP anion.La acidosis láctica severa asociada a metformina es una enfermedad grave, poco frecuente, pero con elevada mortalidad que se define en presencia de un pH < 7,35, Lactato > 2 mmol/L y una paCO2  en límites normales.  Presentamos el caso de una paciente en tratamiento con metformina, hipertensa y dislipémica, polimedicada, con acidosis láctica grave ingresada en Reanimación, tras postoperatorio de laparotomía exploradora por sospecha de una isquemia intestinal.  Llega en estado de shock circulatorio, con escasa respuesta a administración de volumen y drogas vasoactivas. Describimos algunos datos sobre su incidencia, la fisiopatología, el pronóstico y el tratamiento, así como la importancia de un diagnóstico precoz y diferencial con otras causas de acidosis metabólicas que eleven el anion GAP

Integrative assessment of in situ combined bioremediation strategies applied to remediate soils spilled with sewage sludges

Landfills and waste disposal sites in the Basque Country are summarized in the inventory of soils that either currently support or have supported potentially polluting activities or facilities (Law 4/2015). Notably, “Landfill 17,” located in Gernika-Lumo, has been receiving, for decades, sewage sludges from the local wastewater treatment plant (WWTP) as agricultural amendment. In order to decontaminate and recover soil functionality, a combination of bioremediation (which involved bioagumentation and phyto- and vermitechnologies) and complementary bioremediation strategy (i.e., promotion and maintenance of the native vegetation) was implemented in situ. Physicochemical and ecotoxicological characterization were achieved. Furthermore, an ecotoxicological assessment of the soils upon flora and fauna was carried out through the application of different bioassays and biomarkers. Additionally, an integrative biomarker response (IBR/n) index was calculated to provide a holistic view of the soil general status. Critical pollutants [Cd, Cr, Ni, Pb, benzo(a)pyrene, and dieldrin] were observed in most of the treated sites. Microbial parameters did not present remarkable differences among sites. However, plant indicators pointed the non-treated site (MN8) as the unhealthiest. This was also observed in earthworms’ immune system, where cytotoxicity appears when exposed to non-treated soils. In conclusion, this field study showed that the combination of bioaugmentation, phytoremediation with native species, and vermiremediation is highly useful in eliminating mixed contamination, improving soil health, and ultimately restoring ecosystem functionality and biodiversity

Acidosis láctica asociada a metformina

La acidosis láctica severa asociada a metformina es una enfermedad grave, poco frecuente, pero con elevada mortalidad que se define en presencia de un pH &lt; 7,35, Lactato &gt; 2 mmol/L y una paCO2  en límites normales.  Presentamos el caso de una paciente en tratamiento con metformina, hipertensa y dislipémica, polimedicada, con acidosis láctica grave ingresada en Reanimación, tras postoperatorio de laparotomía exploradora por sospecha de una isquemia intestinal.  Llega en estado de shock circulatorio, con escasa respuesta a administración de volumen y drogas vasoactivas. Describimos algunos datos sobre su incidencia, la fisiopatología, el pronóstico y el tratamiento, así como la importancia de un diagnóstico precoz y diferencial con otras causas de acidosis metabólicas que eleven el anion GAP.  ABSTRACT Lactic acidosis associated with metformin Metformin is an oral antidiabetic that belongs to the group of the biguainides. It is the drug of choice for the treatment of type II diabetes due to its efficacy and safety. It is a small molecule, whose elimination half-life is 8 to 20 hours in people with normal renal function. Severe lactic acidosis associated with metformin is a serious, infrequent disease (its incidence is estimated between 3-8 cases per 100,000 diabetic patients and year) but with high mortality (around 40% in accidental poisonings), which is defined in presence of a pH &lt;7.35, lactate&gt; 2 mmol / L and a paCO2 in normal limits. We present the case of a diabetic patient under treatment with metformin, hypertense and dyslipidemic, polymedicated, with severe lactic acidosis, in a Reanimation Care unit, after postoperative exploratory laparotomy due to suspicion of intestinal ischemia. He arrives in a state of circulatory shock, with little response to the administration of volume and vasoactive drugs. We describe some data about its incidence, pathophysiology, prognosis and treatment, as well as the importance of an early and differential diagnosis with other causes of metabolic acidosis that elevate the GAP anion.</jats:p

Development of an in vitro culture method for cells and tissues from the zebra mussel (Dreissena polymorpha)

Despite the successful transfer of mammalian in vitro techniques for use with fish and other vertebrates, little progress has been made in the area of invertebrate tissue culture. This paper describes the development of an in vitro technique for the culture of both cells in suspension and tissue explants from the gill, digestive gland and mantle of the zebra mussel (Dreissena polymorpha) and their successful maintenance in culture for up to 14 days. Cell suspensions from the gills and digestive gland were the most successful technique developed with viability >80% maintained for up to 8 days in culture, suitable for use in short term toxicity tests. Tissue explants from the mantle were also maintained in culture for up to 14 days. This paper describes the challenges involved in the development of a novel in vitro culture technique for aquatic invertebrates