Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate.

INTRODUCTION AND AIM: Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. MATERIAL AND METHODS: A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. RESULTS: A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. CONCLUSIONS: Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.

[Molecular and biophysical mechanisms and modulation of ventilator-induced lung injury]. / Mecanismos biofísicos, celulares y modulación de la lesión pulmonar inducida por la ventilación mecánica.

Ventilator-induced lung injury (VILI) is associated to a high rate of mortality with an important social impact. Mechanical ventilation induces structural and ultrastructural alterations in all cell types of the lung and can derive in the transduction of intracellular signals, as well as in changes in the expression of genes, a process known as mechanotransduction. Some of the conditions involved, such as inflammation and/or coagulation, apoptosis/necrosis can lead to the propagation of the injury outside the lung, resulting in multiorganic failure. VILI can be modulated by means of diverse interventions as the use of protective ventilatory modes, therapeutic approaches based on vasoactive and antioxidative drugs, and more recently treatments based on the use of repairing substances of the surfactant like poloxamers among others. Knowledge of the mechanisms involved in VILI is definitive for a better approach to this condition.

Evaluación del Sequential Organ Failure Assessmente (SOFA) score para predecir mortalidad en los pacientes críticos, y comparación con los scores APACHE II Y SAPS II / Sequential Organ Failure Assessment Assessed (SOFA) score to predict mortality in critically ill patients, and comparison with APACHE II scores and SAPS II

Objetivos: 1) Determinar la utilidad del SOFA score y sus variables derivadas como predictores de mortalidad 2) correlacionar la mortalidad estmada por el SOFA score y derivadas, con la predicha por APACHE II y SAPS II. Materiales y métodos: Diseño: cohorte prospectiva. Lugar UTI polivalente de un hospital escuela. Pacientes: los ingresados desde el 1/5/01 al 14/4/03. Al ingreso se calcularon los scores pronósticos APACHE II y SAPS II y SOFA inicial, y diariamente (hasta 30 días de internación), el score SOFA con los peores valores del día anterior. Adicionalmente se calcularon las siguintes variables derivadas: SOFA medio: valor promedio de la internación; SOFA total: suma de todos los valores diarios; delta SOFA 48hs: diferencia entre el SOFA inicial y a las 48 hs del ingreso; y SOFA máximo: el valor más alto registrado. Análisis estadístico: primeramente, se calculó el área bajo la curva ROCd (AUC) correspondiente a las 5 variables citadas, a APACHE IIy a SAPS II, y luego se compararon con refencia a la que presentó mayor AUC en el procedimeinto anterior...