Rejuvenecimiento periorbitario fisiológico / Physiological periorbital rejuvenation

Pivoting Brow Lift es una nueva opción terapéutica cuyas ventajas son tres mínimas incisiones, prácticamente imperceptibles, bien aceptadas por pacientes de todas las edades, sexo y incluso pacientes calvos. Una incisión se realiza en la región temporal y otra dentro del cuero cabelludo en la región medio frontal o en una arruga en pacientes calvos. La disección en región frontal es sub-perióstica, muchas veces llega a la punta nasal para reposicionarla. La disección en la región temporal se realiza entre las hojas superficiales y profundas extendiéndose hasta el tarso y canto externo del ojo; en la región palpebral la disección se realiza entre la piel y el musculo. La fijación son dos puntos externos en el cuero cabelludo y unos papeles adherentes. Los puntos del cuero cabelludo se retiran a los 14 días. Evita las complejas fijaciones que se realizan actualmente con tornillos, puntos internos o Endotime. La sencillez del procedimiento hace que este se pueda realizar entre 30 y 45 minutos, con anestesia local y sedación; esto permite lograr una mayor seguridad operatoria. Se han documentado pacientes tratados hace 9 años donde se demuestra la duración en el tiempo. El bajo índice de complicaciones y la alta satisfacción de los pacientes documentadas en encuestas hace que este procedimiento pueda ser considerado como una nueva opción terapéutica.

Papel del Delta de PCO2 en la evaluación pronóstica de morbimortalidad en una cohorte de pacientes de un hospital latinoamericano / Role of PCO2 Delta in the Prognostic Evaluation of Morbidity and Mortality in a Cohort of Patients from a Latin American Hospital

Introducción. El shock séptico es la manifestación más grave de sepsis con tasas de letalidad que pueden llegar hasta el 80%. En los últimos años, ha cobrado relevancia la diferencia arteriovenosa de dióxido de carbono, por su implicación teórica en el metabolismo anaerobio y su significado respecto del normal funcionamiento celular. Por lo antes mencionado, creemos necesario realizar un estudio que nos permita establecer la utilidad de la diferencia arteriovenosa de dióxido de carbono en el paciente con shock séptico de la unidad de cuidados intensivos, como medida indirecta de la perfusión tisular y de la utilización de oxígeno por los tejidos, que nos permita establecer un diagnóstico precoz y el pronóstico de los pacientes críticamente enfermos. Métodos. Estudio observacional, descriptivo y transversal. Muestra de veintiocho pacientes adultos. Resultados. Como se ha registrado en otras series, la mayor parte de los pacientes afectados por shock séptico, en nuestro estudio, fueron hombres mayores de 65 años, con al menos una comorbilidad, siendo el principal sitio de infección el respiratorio (67,9%), asociado a una alta tasa de mortalidad (67%). Conclusiones. Los pacientes con diferencia arteriovenosa de PCO2 mayor a 6 mmHg tienen un riesgo aumentado de muerte de 3,2 veces. (AU)

Introduction. Septic shock is the most serious manifestation of sepsis with mortality rates that can reach up to 80%. In recent years, the arteriovenous carbon dioxide difference has gained relevance, due to its theoretical implication in anaerobic metabolism and its significance with respect to normal cell function. Due to the aforementioned, we believe it is necessary to carry out a study that allows us to establish the usefulness of the arteriovenous carbon dioxide difference in the patient with septic shock in the intensive care unit as an indirect measure of tissue perfusion and utilization. of oxygen through the tissues, which allows us to establish an early diagnosis and prognosis of critically ill patients. Methods. Observational, descriptive and cross-sectional study. Sample of 28 adult patients. Results. As has been reported in other series, most of the patients affected by septic shock in our study were men over 65 years of age, with at least one comorbidity, the main site of infection being respiratory (67.9%), associated with a high mortality rate (67%) Conclusions. Patients with an arteriovenous PCO2 difference greater than 6 mmHg have a 3.2-fold increased risk of death. (AU)

Role of Pv-aCO2 gradient and Pv-aCO2/Ca-vO2 ratio during cardiac surgery: a retrospective observational study

Abstract Introduction: Arterial lactate, mixed venous O2 saturation, venous minus arterial CO2 partial pressure (Pv-aCO2) and the ratio between this gradient and the arterial minus venous oxygen content (Pv-aCO2/Ca-vO2) were proposed as markers of tissue hypoperfusion and oxygenation. The main goals were to characterize the determinants of Pv-aCO2 and Pv-aCO2/Ca-vO2, and the interchangeability of the variables calculated from mixed and central venous samples. Methods: 35 cardiac surgery patients were included. Variables were measured or calculated: after anesthesia induction (T1), end of surgery (T2), and at 6-8 hours intervals after ICU admission (T3 and T4). Results: Macrohemodynamics was characterized by increased cardiac index and low systemic vascular resistances after surgery (p < 0.05). Hemoglobin, arterial-pH, lactate, and systemic O2 metabolism showed significant changes during the study (p < 0.05). Pv-aCO2 remained high and without changes, Pv-aCO2/Ca-vO2 was also high and decreased at T4 (p < 0.05). A significant correlation was observed globally and at each time interval, between Pv-aCO2 or Pv-aCO2/Ca-vO2 with factors that may affect the CO2 hemoglobin dissociation. A multilevel linear regression model with Pv-aCO2 and Pv-aCO2/Ca-vO2 as outcome variables showed a significant association for Pv-aCO2 with SvO2, and BE (p < 0.05), while Pv-aCO2/Ca-vO2 was significantly associated with Hb, SvO2, and BE (p < 0.05) but not with cardiac output. Measurements and calculations from mixed and central venous blood were not interchangeable. Conclusions: Pv-aCO2 and Pv-aCO2/Ca-vO2 could be influenced by different factors that affect the CO2 dissociation curve, these variables should be considered with caution in cardiac surgery patients. Finally, central venous and mixed values were not interchangeable.

Dinámicas de producción y emisiones modeladas de gases de efecto invernadero en sistemas regionales de producción lechera de Honduras / Production dynamics and greenhouse gas modeled emissions from regional dairy production systems in Honduras

RESUMEN El objetivo del estudio fue la caracterización productiva y de emisiones modeladas de gases de efecto invernadero (GEI) en 61 sistemas lecheros localizados en cinco regiones de Honduras. Durante las fases inicial (FI) y final (FF), con encuestas aplicadas individualmente a los productores, se identificaron aspectos técnicos y de productividad. Variables numéricas expresadas en Microsoft Excel ® permitieron, con el modelo FAO de evaluación ambiental de la ganadería global-interactivo (GLEAM-i, por sus siglas en inglés) de ciclo de vida, estimar emisiones anuales de metano (CH4), óxido nitroso (N2O) y dióxido de carbono (CO2) en cada finca. Cálculos intermedios (GEI/animal) fueron derivados de la modelización GLEAM-i en Excel®. Durante la FI las fincas conjuntamente emitieron 25.038 t CO2 equivalente (CO2-eq), mientras que dichas emisiones fueron 10,5% menores en la FF. Emisiones de GEI/animal (2,85 ± 0,08 t CO2-eq) y de GEI/kg de proteína láctea (96,91 ± 4,50 kg CO2-eq) durante la FI fue-ron 13 y 21% menores en la FF, respectivamente. Valores de 52,82 ± 1,64 (CH4) y 2,66 ± 0,10 (N2O) kg/animal en la FI fueron 13% y 17% menores en la FF, respectivamente. La región Centro-Sur-Oriente emitió la menor cantidad de CH4 (42,95 ± 2,37 kg/animal) y N2O (1,82 ± 0,15 kg/animal, mientras las regiones Occidente y Norte experimentaron una reducción del 27% en GEI/kg proteína láctea entre la FI y FF. Se concluyó que la metodologia usada identificó los impactos productivos y medioambientales, derivados de alternativas técnicas implementadas en sistemas de producción lechera de Honduras.

ABSTRACT The study aimed to characterize production dynamics and greenhouse gas (GHG) emissions from 61 dairy farms in five regions in Honduras. Farm data were collected through individual surveys during the initial and final phases (IP; FP). Using Microsoft Excel, data was incorporated into the global livestock environmental assessment model-interactive (GLEAM-i, FAO) life cycle framework to estimate annual emissions of methane (CH4), nitrous oxide (N2O), and carbon dioxide (CO2) at the farm system level. Animal emissions (GHG/animal) were derived in Excel® from the GLEAM-i predictions. Together, farms during the IP emitted 25.038 t CO2 equivalent (CO2-eq) while these emissions were 10,5% lower in the FP. Emissions of GHG/animal (2,85 ± 0,08 t CO2-eq) and GHG/kg of milk protein (96,91 ± 4,50 kg CO2-eq) during the IP were 13% and 21% lower in the FP, respectively. Methane and N2O emission values (52,82 ± 1,64 vs. 2,66 ± 0,10 kg/animal) were 13% and 17% higher in the IP than in FP. The South-Central region emitted the lowest amount of CH4 and N2O (42,95 ± 2,37 kg/animal vs. 1,82 ± 0,15 kg/animal) while 27% lower GHG/kg milk protein was observed between the IP and FP of the Western and Northern regions. It was concluded that the used methodology identified productive and environmental impacts derived from implemented technical interventions in dairy production systems in Honduras.

Determinantes de la salud ambiental en el Perú: curva de Kuznets 1990-2015 / Determinants of environmental health in Peru: Kuznets curve 1990-2015

El ambiente es el lugar donde vive, trabaja y se desarrolla el hombre, compuesto básicamente por dos sistemas interrelacionados e independientes: por una parte, es el hombre conviviendo en una sociedad con características muy diferentes, y por el otro lado, los elementos de la naturaleza siendo transformados por los hombres donde viven inmersos. En ese sentido, la degradación y contaminación ambiental, tienen efectos notables en la vidad de los seres humanos, siendo responsable de la muerte de cientos de millones de personas que sufren de enfermedades respiratorias asociadas con la contaminación externa e interior del aire. En ese sentido, ya a partir de las últimas décadas, las emisiones de dióxido de carbono han alcanzado cifras record superando las 10 gigatoneladas. Este incremento está asociado al sector energético (47%), la industria (30%) y el transporte (11%) principalmente, lo que ha logrado un calentamiento global progresivo de la superficie terrestre con las consecuencias típicas asociadas al derretimiento de los glaciares, cambios en los ciclos hidrológicos, falta de alimentos, aumento de los fenómenos meteorológicos, migraciones descontroladas, enfermedades y pandemias. De este modo, surge la economía ambiental, una disciplina que intenta dar repuestas integrales entre ambos tópicos, medio ambiente y economía, donde diversas teorías tratan de explicar los fenómenos observados. El concepto de las Curvas de Kuznets Ambientales (CKA), señala una relación dinámica entre el PIB y la calidad del medio ambiente. El objetivo del artículo ha sido determinar si en el Perú, durante el periodo 1990-2015, ha habido una relación en forma de U invertida entre la producción interna y la contaminación del aire. La investigación prueba que, en el Perú, durante el periodo 1990-2015, no ha habido una relación en forma de U invertida entre la producción interna y la contaminación del aire, sino que la producción interna ha tenido un impacto positivo y lineal sobre el dióxido de carbono y el óxido de nitrógeno(AU)

The environment is the place where man lives, works and develops, basically composed of two interrelated and independent systems: on the one hand, it is man living together in a society with very different characteristics, and on the other hand, the elements of the nature being transformed by men where they live immersed. In this sense, environmental degradation and pollution have notable effects on the lives of human beings, being responsible for the death of hundreds of millions of people who suffer from respiratory diseases associated with external and internal air pollution. In this sense, already in recent decades, carbon dioxide emissions have reached record figures, exceeding 10 gigatons. This increase is mainly associated with the energy sector (47%), industry (30%) and transport (11%), which has achieved a progressive global warming of the earth's surface with the typical consequences associated with the melting of glaciers, changes in hydrological cycles, lack of food, increased weather events, uncontrolled migrations, diseases and pandemics. In this way, environmental economics arises, a discipline that tries to provide comprehensive answers between both topics, environment and economy, where various theories try to explain the observed phenomena. The concept of the Environmental Kuznets Curves (EKC), indicates a dynamic relationship between GDP and the quality of the environment. The objective of the article has been to determine if in Peru, during the period 1990-2015, there has been an inverted U-shaped relationship between internal production and air pollution. The research proves that, in Peru, during the period 1990-2015, there has not been an inverted U-shaped relationship between domestic production and air pollution, but rather that domestic production has had a positive and linear impact on air pollution. carbon dioxide and nitrogen oxide(AU)

Fisiología respiratoria: transporte de gases en sangre / Respiratory physiology: transport of oxygen and carbon dioxide in the blood

La sangre normalmente transporta pequeñas cantidades de oxígeno (O2) disuelto en el plasma y altas cantidades combinadas en forma química con la hemoglobina. La presión parcial depende solo del oxígeno disuelto físicamente, lo que determina cuánto oxígeno se combinará con hemoglobina. La curva de disociación de la hemoglobina describe la reversibilidad de la reacción entre oxígeno y hemoglobina. Los factores habituales que aumentan o disminuyen la afinidad de la hemoglobina por el oxígeno son el pH, presión parcial de CO2, temperatura y 2,3 difosfoglicerato. La sangre también transporta grandes cantidades en forma de bicarbonato y bajas cantidades de CO2 disuelto en plasma y combinado con proteínas como compuestos carbamino. La desoxihemoglobina favorece la formación de compuestos carbamínicos y promueve el transporte del CO2 como bicarbonato uniéndose al hidrógeno proveniente de la disociación del ácido carbónico. A continuación se describe en forma detallada los mecanismos fisiológicos del transporte de gases en sangre.

Blood normally carries small amounts of oxygen dissolved in plasma and large amounts chemically combined with hemoglobin. Partial pressure of oxygen depends only on physically dissolved oxygen which determines how much oxygen will combine with hemoglobin. The oxygen-hemoglobin dissociation curve (or oxyhemoglobin dissociation curve) describes the reversibility of the reaction between oxygen and hemoglobin. The usual factors that increase or decrease the affinity of hemoglobin for oxygen are pH, CO2 partial pressure, temperature, and 2,3 diphosphoglycerate. Blood also carries large amounts of CO2 as bicarbonate and low amounts dissolved in plasma and combined with proteins as carbamino compounds. Deoxyhemoglobin favors the formation of carbamino compounds and promotes the transport of CO2 as bicarbonate by joining the hydrogen from the dissociation of carbonic acid. The physiological mechanisms of gas transport in blood are described in detail below.

Fisiología respiratoria: difusión de gases / Gas diffusion

El principal objetivo del sistema respiratorio es permitir un adecuado aporte de oxígeno y remoción del dióxido de carbono. Para esto, debe ocurrir una adecuada difusión de gases en la membrana alvéolo-capilar, proceso pasivo en el que el oxígeno se mueve hacia el capilar y el dióxido de carbono hacia el alvéolo. La ley de Fick establece los determinantes de la difusión, los que están dados por propiedades de la membrana alvéolo-capilar y de los gases. Las características únicas de la membrana alvéolo-capilar favorecen la difusión de gases, pero es el gradiente de presión parcial de los gases el principal determinante. El oxígeno pasa fácilmente por la membrana alvéolo-capilar y se une rápidamente a la hemoglobina, saturándola, cuando se iguala la presión parcial de oxígeno alveolar y la capilar se detiene la difusión de este gas; por lo que la difusión de oxígeno en reposo está limitada por perfusión. El dióxido de carbono difunde 20 veces más rápido que el oxígeno en la membrana alvéolo-capilar, y aunque su gradiente de presión sea menor, el equilibrio se logra aproximadamente en el mismo tiempo. La difusión del oxígeno es más lenta que la del dióxido de carbono debido a su menor solubilidad. En condiciones patológicas tanto el oxígeno como el dióxido de carbono pueden ser limitados por difusión. Para medir la capacidad de difusión la técnica más utilizada es la capacidad de difusión de monóxido de carbono, ya que este gas solo está limitado por difusión.

The main objective of the respiratory system is allowing an adequate supply of oxygen and the removal of carbon dioxide from the tissues. To achieve this, an adequate diffusion of gases must occur in the alveolus-capillary membrane, which is a passive process in which oxygen moves towards the capillary and carbon dioxide towards the alveolus. Fick's law establishes the determinants of diffusion, which are given by properties of the alveolar-capillary membrane and properties of gases. The unique characteristics of the capillary-alveolar membrane favor the diffusion of gases, but it is the partial pressure gradient of the gases the main determinant. Oxygen passes easily through the alveolar-capillary membrane and rapidly binds to hemoglobin, saturating it. When the partial pressure of alveolar oxygen is matched, the diffusion of this gas stops; therefore, the diffusion of oxygen is limited by perfusion. Carbon dioxide diffuses 20 times faster than oxygen in the capillary-alveolar membrane, and although its pressure gradient is less than oxygen, equilibrium is achieved in approximately the same time. The diffusion of oxygen is slower than that of carbon dioxide due to its lower solubility. Under pathological conditions both oxygen and carbon dioxide can be diffusion-limited. To measure the diffusion capacity, the most used technique is the carbon monoxide diffusion capacity, since this gas is only limited by diffusion.

Antidiabetic and hypolipidemic potential of Campomanesia xanthocarpa seed extract obtained by supercritical CO2 / Potencial Antidiabético e hipolipidêmico do extrato das sementes de Campomanesia xanthocarpa obtido por CO2 supercrítico

Abstract Campomanesia xanthocarpa, a plant belonging to the Myrtaceae family, is popularly known as gabiroba. Leaves of gabiroba has been popularly used to treat various diseases, including inflammatory, renal, and digestive, among others. Additionally, studies have shown an effect to reduce blood cholesterol levels. The aim of this study was to evaluate the antihyperglycemic and hypolipidemic effects of Campomanesia xanthocarpa seed extract in hyperglycemic rats. The results showed that 400 mg/kg of seed extract was able to decrease blood glucose levels and to increase the muscular and hepatic glycogen content as well as to inhibit the sucrase and maltase activity. At doses of 200 mg/kg and 800 mg/kg, the activity of these enzymes was also reduced. In the lipid profile 400 mg/kg produced a decrease in total and LDL cholesterol serum levels; and with 200 mg/kg there was an increase in HDL cholesterol levels. The extract did not present hepatic and renal toxic effects at the different doses tested. The results suggest that the treatment with Campomanesia xanthocarpa seeds extract is useful in reducing glycemia, total cholesterol and LDL levels with potential adjuvant therapeutic in the treatment of diabetes and hypercholesterolemia, however, additional pharmacological and toxicological studies are still required.

Resumo Campomanesia xanthocarpa, planta pertencente à família Mirtaceae, é popularmente conhecida como gabiroba. Folhas da gabiroba são popularmente usadas para tratar de doenças inflamatórias, renais, digestivas entre outras. Além disso, estudos têm mostrado um efeito redutor dos níveis de colesterol. O objetivo deste estudo foi avaliar os efeitos anti-hiperglicêmico e hipolipidêmico do extrato de sementes de Campomanesia xanthocarpa em ratos hiperglicêmicos. Os resultados mostraram que 400 mg/kg do extrato da semente foi capaz de reduzir os níveis de glicose sanguínea e aumentar o conteúdo de glicogênio hepático e muscular, bem como inibir a atividade da maltase e sacarase. Na dose de 200 mg/kg e 800 mg/kg, a atividade das enzimas também foi reduzida. No perfil lipídico, 400 mg/kg produziu uma redução nos níveis séricos de colesterol total e LDL e com 200 mg/kg houve um aumento nos níveis de colesterol HDL. O extrato não apresentou efeitos tóxicos hepáticos e renais nas doses testadas. Os resultados sugerem que o tratamento com o extrato de Campomanesia xanthocarpa é eficaz na redução da glicemia, de colesterol total e LDL com potencial para tratamento adjuvante do diabetes e hipercolesterolemia, no entanto estudos farmacológicos e toxicológicos adicionais são necessários.

Hemodynamic monitoring with two blood gases: "a tool that does not go out of style" / Monitoreo hemodinámico con dos gasometrías: "Una herramienta que no pasa de moda"

Abstract Hemodynamic monitoring of a critically ill patient is an indispensable tool both inside and outside intensive care; we currently have invasive, minimally invasive and non-invasive devices; however, no device has been shown to have a positive impact on the patient's evolution; arterial and venous blood gases provide information on the patient's actual microcirculatory and metabolic status and may be a hemodynamic monitoring tool. We aimed to carry out a non-systematic review of the literature of hemodynamic monitoring carried out through the variables obtained in arterial and venous blood gases. A non-systematic review of the literature was performed in the PubMed, OvidSP and ScienceDirect databases with selection of articles from 2000 to 2019. It was found that there are variables obtained in arterial and venous blood gases such as central venous oxygen saturation (SvcO2), venous-to-arterial carbon dioxide pressure (Δpv-aCO2), venous-to-arterial carbon dioxide pressure/arteriovenous oxygen content difference (Δpv-aCO2/ΔCavO2) that are related to cellular oxygenation, cardiac output (CO), microcirculatory veno-arterial flow and anaerobic metabolism and allow to assess tissue perfusion status. In conclusion, the variables obtained by arterial and venous blood gases allow for non-invasive, accessible and affordable hemodynamic monitoring that can guide medical decision-making in critically ill patients.

Resumen El monitoreo hemodinámico de un paciente en estado crítico es una herramienta indispensable tanto dentro como fuera de la terapia intensiva; actualmente se cuenta con dispositivos invasivos, mínimamente invasivos y no invasivos; sin embargo, ningún dispositivo ha demostrado tener impacto positivo en la evolución del paciente; la gasometría arterial y venosa proporcionan información del estado microcirculatorio y metabólico real del paciente pudiendo ser una herramienta de monitoreo hemodinámico. El objetivo de esta revisión fue realizar una revisión no sistemática de la literatura del monitoreo hemodinámico realizado mediante las variables obtenidas en la gasometría arterial y venosa. Se estudiaron las bases de datos de PubMed, OvidSP y ScienceDirect con selección de artículos del 2000 al 2019. Se encontró que hay variables obtenidas en la gasometría arterial y venosa como la saturación venosa central de oxígeno (SvcO2), la diferencia de presión venoarterial de dióxido de carbono (Δpv-aCO2), la diferencia de presión venoarterial de dióxido de carbono/diferencia del contenido arteriovenoso de oxígeno (Δpv-aCO2/ΔCa-vO2) que están relacionadas con la oxigenación celular, con el gasto cardiaco (GC), con el flujo venoarterial microcirculatorio y con el metabolismo anaerobio que permiten realizar una valoración del estado de perfusión tisular. En conclusión, las variables obtenidas por gasometría arterial y venosa permiten realizar un monitoreo hemodinámico no invasivo, accesible y asequible que pueden guiar la toma de decisiones médicas en el paciente en estado crítico.

Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation

ABSTRACT Purpose To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. Methods Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. Results Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). Conclusions When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic / Filtragem do CO² durante a insuflação e esvaziamento do pneumoperitônio em pacientes submetidos a videolaparoscopia durante pandemia de COVID-19

ABSTRACT The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

RESUMO A atual pandemia do Covid-19 tem sido o assunto mais discutido do ano de 2020, principalmente no que se refere a proteção e as formas de limitar a disseminação do vírus. No cenário hospitalar, mais especificamente no centro cirúrgico, a viabilidade da cirurgia laparoscópica foi questionada, em relação a transmissibilidade do vírus por aerossol. Este artigo sugere uma forma de minimizar os riscos em cirurgias laparoscópicas durante esse cenário, com o uso de filtros eletrostáticos de ventilação mecânica. Uma alternativa simples, eficaz e de baixo custo.

Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation

ABSTRACT Purpose To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. Methods Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. Results Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). Conclusions When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

Determinación de emisión de dióxido de carbono (Co2) y el impacto económico y medioambiental en la construcción de viviendas de interés social de El Salvador: aplicación en sector construcción / Determination of carbon dioxide (Co2) emission and the economic and environmental impact in the construction of low-income housing in El Salvador: application in the construction sector

El objetivo de este proyecto fue crear un informe técnico del valor económico y el impacto ambiental del dióxido de carbono (CO2), que genera la construcción de las viviendas de interés social en El Salvador. Se procedió a reconocer terminología técnica sobre los diferentes factores que intervienen en el análisis de la relación de costos económicos y medioambientales. Luego se identificaron los modelos de cuantificación de Emisiones de CO2 para construcciones. Finalmente se creó una herramienta para el levantamiento de información de tipo cualitativa y cuantitativa de viviendas y para la obtención de datos técnicos. De acuerdo con lo investigado, se encontró que los materiales de construcción con mayores emisiones de CO2 por kilogramo son el acero y el hormigón armado utilizado en las partes estructurales, así como el vidrio y losas para las envolventes, seguidos de la madera y el cemento, siendo el menor el hormigón premezclado, ladrillos rojos y arena.

The objective of this project was to create a technical report of the economic value and the environmental impact of carbon dioxide (CO2), generated by the construction of social housing in El Salvador. We proceeded to recognize technical terminology on the different factors involved in the analysis of the relationship between economic and environmental costs. Then the quantification models of CO2 Emissions for constructions were identified. Finally, a tool was created to collect qualitative and quantitative information on housing and to obtain technical data. According to what was investigated, it was found that the construction materials with the highest CO2 emissions per kilogram are steel and reinforced concrete used in the structural parts, as well as glass and slabs for the envelopes, followed by wood and cement, the least being pre-mixed concrete, red bricks and sand.

Determinants of minute ventilation-carbon dioxide production relationship in Chagas cardiomyopathy

Abstract INTRODUCTION: The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) is among the main prognostic factors of Chagas cardiomyopathy whose determinants remain unknown. METHODS: Seventy-eight patients with Chagas cardiomyopathy were evaluated using clinical assessment, cardiopulmonary exercise test, echocardiography, and International Physical Activity Questionnaire. RESULTS: Age, functional class, International Physical Activity Questionnaire score, and dilated cardiomyopathy with systolic dysfunction were independent determinants of VE/VCO2 slope, and these variables explained 63% of its variance. CONCLUSIONS: The VE/VCO2 slope was related to age, functional class, physical activity level, and dilated cardiomyopathy with systolic dysfunction in patients with Chagas cardiomyopathy.

Método de filtrado de CO2 para cirugía laparoscópica en tiempos de pandemia de COVID-19 / Carbon dioxide filtering system for laparoscopic surgery in times of COVID-19 pandemic

RESUMEN Antecedentes: la pandemia de COVID-19 presentó nuevos desafíos en el manejo de la patología quirúrgica laparoscópica. Objetivos: presentar el sistema de filtrado de bajo costo utilizado para la laparoscopia durante la pandemia en nuestro Servicio de Cirugía. Material y métodos: se realizó búsqueda bibliográfica y se diseñó un protocolo y sistema de filtrado para evacuar el CO2 contenido en el neumoperitoneo para evitar el contagio por el virus SARS-CoV-2. Resultados: se pone en práctica el empleo de un sistema de filtrado del neumoperitoneo en época de pandemia, el cual es de bajo costo y armado sencillo con materiales disponibles habitualmente en las áreas quirúrgicas. Conclusiones: la cirugía laparoscópica es factible durante la pandemia de SARS-CoV-2 utilizando un método sencillo y económico de filtrado del neumoperitoneo.

ABSTRACT Background: Background: the COVID-19 pandemic gave rise to new challenges in the management of laparoscopic surgery. Objectives: the aim of this study is to present a low-cost filtering system used for laparoscopic surgery during the pandemic in our Department of Surgery. Material and methods : a bibliographic search was conducted and a protocol and filtering system were designed to evacuate the pneumoperitoneum avoiding contact with the SARS-CoV-2. Results: this low-cost filtering system to evacuate the pneumoperitoneum during the pandemic is easy to assemble using materials that are usually available at the operating room. Conclusions: laparoscopic surgery is feasible during the COVID-19 pandemic using a simple, low-cost carbon dioxide filtering system.

Panic disorder respiratory subtype: psychopathology and challenge tests - an update

Panic disorder (PD) pathophysiology is very heterogeneous, and the discrimination of distinct subtypes could be very useful. A subtype based on respiratory symptoms is known to constitute a specific subgroup. However, evidence to support the respiratory subtype (RS) as a distinct subgroup of PD with a well-defined phenotype remains controversial. Studies have focused on characterization of the RS based on symptoms and response to CO2. In this line, we described clinical and biological aspects focused on symptomatology and CO2 challenge tests in PD RS. The main symptoms that characterize RS are dyspnea (shortness of breath) and a choking sensation. Moreover, patients with the RS tended to be more responsive to CO2 challenge tests, which triggered more panic attacks in this subgroup. Future studies should focus on discriminating respiratory-related clusters and exploring psychophysiological and neuroimaging outcomes in order to provide robust evidence to confirm RS as a distinct subtype of PD.

Uso da CPAP como alternativa para realização do teste de apneia durante determinação da morte encefálica em pacientes hipoxêmicos. Relato de dois casos / Use of CPAP as an alternative to the apnea test during the determination of brain death in hypoxemic patients. Report of two cases

RESUMO O teste de apneia com desconexão do ventilador mecânico representa riscos durante a determinação da morte encefálica, especialmente em pacientes hipoxêmicos. Descrevemos a realização do teste de apneia sem desconexão do ventilador mecânico em dois pacientes. O primeiro caso é o de um menino de 8 anos, admitido com hipoxemia grave por pneumonia. Apresentou parada cardiorrespiratória, seguida de coma não responsivo por encefalopatia hipóxico-isquêmica. Dois exames clínicos constataram ausência de reflexos de tronco, e o Doppler transcraniano revelou parada circulatória encefálica. Realizaram-se três tentativas de teste de apneia, que foram interrompidas por hipoxemia, sendo então realizado teste de apneia sem desconexão do ventilador mecânico, ajustando a pressão contínua nas vias aéreas em 10cmH2O e fração inspirada de oxigênio em 100%. A saturação de oxigênio manteve-se em 100% por 10 minutos. A gasometria pós-teste foi a seguinte: pH de 6,90, pressão parcial de oxigênio em 284,0mmHg, pressão parcial de dióxido de carbono em 94,0mmHg e saturação de oxigênio em 100%. O segundo caso é de uma mulher de 43 anos, admitida com hemorragia subaracnóidea (Hunt-Hess V e Fisher IV). Dois exames clínicos constataram coma não responsivo e ausência de todos os reflexos de tronco. A cintilografia cerebral evidenciou ausência de captação de radioisótopos no parênquima cerebral. A primeira tentativa do teste de apneia foi interrompida após 5 minutos por hipotermia (34,9oC). Após reaquecimento, o teste de apneia foi repetido sem desconexão do ventilador mecânico, evidenciando-se manutenção do volume residual funcional com tomografia de bioimpedância elétrica. Gasometria pós-teste de apneia apresentava pH em 7,01, pressão parcial de oxigênio em 232,0mmHg, pressão parcial de dióxido de carbono 66,9mmHg e saturação de oxigênio em 99,0%. O teste de apneia sem desconexão do ventilador mecânico permitiu a preservação da oxigenação em ambos os casos. O uso de pressão contínua nas vias aéreas durante o teste de apneia parece ser uma alternativa segura para manter o recrutamento alveolar e a oxigenação durante determinação da morte encefálica.

ABSTRACT The apnea test, which involves disconnection from the mechanical ventilator, presents risks during the determination of brain death, especially in hypoxemic patients. We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical ventilator, adjusting the continuous airway pressure to 10cmH2O and the inspired fraction of oxygen to 100%. The oxygen saturation was maintained at 100% for 10 minutes. Posttest blood gas analysis results were as follows: pH, 6.90; partial pressure of oxygen, 284.0mmHg; partial pressure of carbon dioxide, 94.0mmHg; and oxygen saturation, 100%. The second case involved a 43-year-old woman admitted with subarachnoid hemorrhage (Hunt-Hess V and Fisher IV). Two clinical exams revealed unresponsive coma and absence of all brainstem reflexes. Brain scintigraphy showed no radioisotope uptake into the brain parenchyma. The first attempt at the apnea test was stopped after 5 minutes due to hypothermia (34.9°C). After rewarming, the apnea test was repeated without disconnection from the mechanical ventilator, showing maintenance of the functional residual volume with electrical bioimpedance. Posttest blood gas analysis results were as follows: pH, 7.01; partial pressure of oxygen, 232.0mmHg; partial pressure of carbon dioxide, 66.9mmHg; and oxygen saturation, 99.0%. The apnea test without disconnection from the mechanical ventilator allowed the preservation of oxygenation in both cases. The use of continuous airway pressure during the apnea test seems to be a safe alternative in order to maintain alveolar recruitment and oxygenation during brain death determination.

Teste de apneia para diagnóstico de morte encefálica em adultos sob oxigenação por membrana extracorpórea: revisão / Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review

RESUMO Entre as potenciais complicações da oxigenação por membrana extracorpórea, as disfunções neurológicas, incluindo morte encefálica, não são desprezíveis. No Brasil, o processo diagnóstico é regulamentado pela resolução 2.173 de 2017 do Conselho Federal de Medicina. Entre os testes diagnósticos, está o de apneia, que objetiva verificar se existe resposta ventilatória ao estímulo hipercápnico. Contudo, trocas gasosas, incluindo a remoção de dióxido de carbono, são mantidas sob oxigenação por membrana extracorpórea, tornando o teste desafiador. Somado ao fato de que a citada resolução não contempla as especificidades do processo diagnóstico sob oxigenação por membrana extracorpórea, publicações sobre o tema são escassas. Esta revisão objetivou identificar estudos de casos (e/ou séries de casos) publicados nas bases PubMed® e Cochrane que descrevessem o processo. Foram identificadas 17 publicações (2011 - 2019). As estratégias práticas descritas foram: prover oxigenação suplementar pré-teste, via ventilador mecânico e oxigenação por membrana extracorpórea (fração inspirada de oxigênio = 1,0), e, ao início do teste, titular o sweep flow (0,5 - 1,0L/minuto), a fim de minimizar a remoção de dióxido de carbono. Recomenda-se também incrementar o fluxo sanguíneo e/ou do sweep ante hipoxemia e/ou hipotensão, podendo associar à infusão de fluidos e/ou ao escalonamento de drogas inotrópicas/vasoativas. Se o limiar da pressão parcial de dióxido de carbono não for alcançado, repetir o teste sob suplementação de dióxido de carbono exógeno ao circuito é uma alternativa. Finalmente, nos casos de oxigenação por membrana extracorpórea venoarterial, para mensurar a variação de gases e excluir hipóxia diferencial, recomenda-se coletar amostras sanguíneas provenientes das circulações nativa e extracorpórea (pós-oxigenador).

Abstract Among the potential complications of extracorporeal membrane oxygenation, neurological dysfunctions, including brain death, are not negligible. In Brazil, the diagnostic process of brain death is regulated by Federal Council of Medicine resolution 2,173 of 2017. Diagnostic tests for brain death include the apnea test, which assesses the presence of a ventilatory response to hypercapnic stimulus. However, gas exchange, including carbon dioxide removal, is maintained under extracorporeal membrane oxygenation, making the test challenging. In addition to the fact that the aforementioned resolution does not consider the specificities of the diagnostic process under extracorporeal membrane oxygenation, studies on the subject are scarce. This review aims to identify case studies (and/or case series) published in the PubMed® and Cochrane databases describing the process of brain death diagnosis. A total of 17 publications (2011 - 2019) were identified. The practical strategies described were to provide pretest supplemental oxygenation via mechanical ventilation and extracorporeal membrane oxygenation (fraction of inspired oxygen = 1.0) and, at the beginning of the test, titrate the sweep flow (0.5 - 1.0L/minute) to minimize carbon dioxide removal. It is also recommended to increase blood flow and/or sweep flow in the presence of hypoxemia and/or hypotension, which may be combined with fluid infusion and/or the escalation of inotropic/vasoactive drugs. If the partial pressure of carbon dioxide threshold is not reached, repeating the test under supplementation of carbon dioxide exogenous to the circuit is an alternative. Last, in cases of venoarterial extracorporeal membrane oxygenation, to measure gas variation and exclude differential hypoxia, blood samples of the native and extracorporeal (post-oxygenator) circulations are recommended.