Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness.

Objective: Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Design: Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Setting: Intensive care unit in a public hospital. Participants: 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Interventions: Not applicable. Results: Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; p = 0.025), rectus femoris (-20%; p < 0.001) and total quadriceps (-16%; p < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, p < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Conclusion: Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.

Oral propranolol in early stages of retinopathy of prematurity.

OBJECTIVE: To assess the effect of oral propranolol on the progression of early stages of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants. METHODS: We analyzed VLBW infants with ROP (stages 2-3, zones II-III). Newborns received oral propranolol (0.5 mg/kg/dose q8h), and were monitored throughout the treatment period for possible side effects. Propranolol was administered until regression of ROP. A historic control group of patients with equivalent ROP was used. We compared characteristics of both groups and the progression of retinopathy. RESULTS: Forty-seven newborns were included, 20 in the propranolol group and 27 in the control group. There were no significant differences in gestational age, birthweight or gender. The mean duration of treatment with propranolol was 58.2±17.6 days. Most patients started treatment with stage 2 disease (65.0%), and had zone III involvement (55.0%). In the treated group, 90.0% (18/20) of patients did not require intervention with laser or bevacizumab, compared to 51.8% in the control group (P<0.005). No cases of bradycardia, hypotension or hypoglycemia were observed. CONCLUSIONS: Oral propranolol in early stages of ROP could prevent disease progression and reduce the need for invasive rescue therapy with laser or bevacizumab. No significant side effects were reported.

Selección y evolución de pacientes con indicación de trasplante hepático en el Hospital Regional de Temuco / Selection and evolution of patients with indications of liver transplantation in the regional hospital at Temuco

El trasplante hepático construye una alternativa terapéutica de alta eficacia en pacientes con hepatopatías agudas o crónicas irreversibles. Es fundamental efectuar una rigurosa selección de los candidatos; ésta permite evaluar el tipo de enfermedad y su momento evolutivo y, detectar contraindicaciones que disminuyan su eficacia. El objetivo de este trabajo es conocer el número de eventuales candidatos a TH por año en el Hospital Regional de Temuco, sus características clínicas y demográficas. Se efectúa un estudio descriptivo y retrospectivo de los pacientes que ingresaron a los Servicios de Medicina Interna y Cirugía del Hospital Regional de Temuco, para estudio y/o tratamiento de alguna enfermedad hepatobiliar grave e irreversible, aguda o crónica, entre enero de 1993 y diciembre de 1994. Estos individuos fueron considerados como potenciales candidatos a trasplante hepático, y tras la revisión de sus historias clínicas, se efectuá un análisis del diagnóstico etiológico, características clínicas, tiempo de evolución, número de hospitalizaciones, y la evolución en el tiempo, para determinar su real condición de candidatos a trasplante hepático. La indicación y el momento evolutivo adecuado para el trasplante se basó en criterios internacionalmente aceptados. Se intentó conocer el destino y supervivencia de estos individuos, para lo cual se recurrió a las oficinas del Registro Civil e Identificación. De los pacientes inicialmente valorados, se descartaron 36 (58 por ciento), por carecer de indicación precisa de trasplante; por lo tanto, la serie final a estudiar quedó conformada por 26 pacientes, 18 hombres (69 por ciento) y 8 mujeres (31 por ciento), con una edad promedio de 46 años. La etiología que determinó la indicación de trasplante hepático fue: dato hepático hepatocelular (73 por ciento), colestásico (8 por ciento); insuficiencia hepática aguda (15 por ciento); y hepatocarcinoma (4 por ciento). Se constató que al año de seguimiento sólo 7 pacientes (32 por ciento) se encontraban vivos; y a los 2 años, sólo 2 (9 por ciento) persistían vivos