Traqueostomías en pacientes con SARS COV-2 Protocolo de seguridad del equipo de cabeza y cuello / TRACHEOSTOMY IN PATIENTS WITH SARS CoV-2 HEAD AND NECK EQUIPMENT SAFETY PROTOCOL

Introducción: El virus SARS-CoV-2, se presentó en la ciudad de Wuhan, una provincia de Hubei en China, a finales del mes de diciembre de 2019, como un brote de neumonía viral consecuencia de un nuevo tipo de coronavirus B, el cual fue denominado COVID-19; posteriormente, de manera oficial, se declarará al virus como SARS-Cov-2. Los cirujanos de cabeza y cuello realizan traqueostomías en pacientes con COVID-19, lo que supone mayor exposición de aerosolización para estos especialistas. El presente trabajo tiene como finalidad describir la técnica quirúrgica de la traqueostomía abierta con la adecuada protección del equipo de cirugía de cabeza y cuello en los pacientes con SAR-CoV-2-. Métodos: Este estudio se realizó en el Centro Médico Docente la Trinidad, a cargo del servicio de cabeza y cuello. El equipo multidisciplinario estuvo conformado por cirujanos de cabeza y cuello, intensivistas y enfermeros especialistas del área. La traqueostomía fue abierta y fue realizada en los pacientes ingresados en la unidad de cuidados intensivos con resultado positivo de la infección por SARS-CoV-2, en el periodo entre agosto de 2020 a agosto de 2021, previa discusión con el equipo multidisciplinario y con el consentimiento de los familiares del paciente, idealmente, entre el día 15 y 21. Resultados: Se realizaron 14 traqueotomías abiertas, la primera traqueostomía se llevó a cabo el 01/08/2020 y la ultima el 28/08/2021. Todas fueron realizadas en la unidad de terapia intensiva. El personal médico fue el mínimo posible y consto de: Cirujano de cabeza y cuello, primer y segundo ayudante, instrumentista, intensivista, residente de terapia intensiva y enfermera de terapia intensiva. En todos los casos se llevó a cabo la adecuada higiene de manos y colocación del equipo de protección personal. Conclusiones: Mantener a los pacientes relajados durante el procedimiento, desinflar el manguito del tubo endotraqueal y cerrar el circuito previo a la incisión y rápidamente luego de la incisión en tráquea, insertar el traqueostomo y conectar el sistema de circuito cerrado, parece ser una técnica que preserva la seguridad del equipo quirúrgico

Introduction: The SARS-CoV-2 virus appeared in the city of Wuhan, a province of Hubei in China, at the end of December 2019, as an outbreak of viral pneumonia because of a new type of coronavirus B, the was called COVID-19; later, officially, the virus will be declared as SARS-Cov-2. Head and neck surgeons perform tracheostomies in patients with CIVD-19, which results in increased aerolization exposure. The present work aims to describe the surgical technique of open tracheostomy with adequate protection of the head and neck surgery team in patients with SAR-CoV-2. Methods: This study was carried out at the La Trinidad Teaching Medical Center, in charge of the head and neck service. The multidisciplinary team was made up of head and neck surgeons, intensivists, and specialist nurses in the area. The technique was open tracheostomy in patients admitted to the intensive care unit with a positive result for SARS-CoV-2 infection, in the period between August 2020 to August 2021, after discussion with the multidisciplinary team and with the consent of the patient's relatives, ideally between the 15th and 21st. Results: 14 open tracheostomies were performed, the first tracheostomy was performed on 01 / 08/2020 and the last one on 08/28/2021. All tracheostomies were performed in the intensive care unit. The medical staff was the minimum possible and consisted of: Head and neck surgeon, first and second assistant, scrub nurse, intensivist, intensive care resident and intensive care nurse. In all cases, proper hand hygiene and placement of personal protective equipment was carried out. Conclusions: Keeping patients relaxed during the procedure, deflating the endotracheal tube cuff, and closing the circuit prior to the incision and quickly after the incision in the trachea and inserting the tracheostoma, connecting the closed-circuit system, seems to be a technique that preserves the safety of the surgical team

HPLC method with solid-phase extraction for determination of (R)- and (S)-ketoprofen in plasma without caffeine interference: application to pharmacokinetic studies in rats.

A fast and reproducible high-performance liquid chromatography method has been developed for the determination of (R)- and (S)-ketoprofen. Ketoprofen enantiomers were determined in plasma samples (50 µL), after solid-phase extraction, using diclofenac as internal standard. Analyses were performed on a (S, S)-Whelk-O 1 stainless steel column (5 µm, 250 × 4.6 mm) using hexane-ethanol-acetic acid (93:7:0.5, v/v/v) as the mobile phase and detection at 254 nm. The method was selective for ketoprofen enantiomers in the presence of caffeine and endogenous plasma compounds. Standard curves were linear (R(2) > 0.999) over the concentration range of 0.25-12.50 and 0.25 µg/mL was taken as the limit of quantification. The intra- and interday precision (relative standard deviation) values were <15.0% and the accuracy (relative error) was within ±12.0% at 1.0, 5.0 and 10.0 µg/mL. Enantiomer recoveries yielded 100.0 ± 15%. No significant differences were determined in plasma samples stored at room temperature for 24.0 h, after two freeze-thaw cycles, and between 0 and 4 weeks at -20°C (P > 0.05). The validated method was successfully applied in determination of (S)-ketoprofen in Wistar rats after oral administration of 3.2 mg/kg of (S)-ketoprofen alone or 3.2 mg/kg of (S)-ketoprofen + 17.8 mg/kg of caffeine.

High-performance liquid chromatographic assay for metamizol metabolites in rat plasma: application to pharmacokinetic studies.

In order to evaluate the pharmacokinetics of metamizol in the presence of morphine in arthritic rats, after subcutaneous administration of the drugs, an easy, rapid, sensitive and selective analytical method was proposed and validated. The four main metamizol metabolites (4-methylaminoantipyrine, 4-aminoantipyrine, 4-acetylaminoantipyrine and 4-formylaminoantipyrine) were extracted from plasma samples (50-100µl) by a single solid-phase extraction method prior to reverse-phase high performance liquid chromatography with diode-array detection. Standard calibration graphs for all metabolites were linear within a range of 1-100µg/ml (r(2)≥0.99). The intra-day coefficients of variation (CV) were in the range of 1.3-8.4% and the inter-day CV ranged from 1.5 to 8.4%. The intra-day assay accuracy was in the range of 0.6-9.6% and the inter-day assay accuracy ranged from 0.9 to 7.5% of relative error. The lower limit of quantification was 1µg/ml for all metabolites using a plasma sample of 100µl. Plasma samples were stable at least for 4 weeks at -20°C. This method was found to be suitable for studying metamizol metabolites pharmacokinetics in arthritic rats, after simultaneous administration of metamizol and morphine, in single dose.

High-performance liquid chromatographic assay for morphine in small plasma samples: application to pharmacokinetic studies in rats.

In order to perform a reliable pharmacokinetic study of morphine during subchronic treatment in rats, an easy, rapid, sensitive and selective analytical method was proposed and validated. The analyte and internal standard (naloxone) were extracted from plasma samples (100 microL) by a single solid-phase extraction method prior to reverse-phase high performance liquid chromatography (HPLC) along with electrochemical detection (ED). Standard calibration graphs were linear within a range of 3.5-1,000 ng/mL (r=0.999). The intra-day coefficients of variation (CV) were in the range of 5.8-8.5% at eight concentration levels (7-1,000 ng/mL) and the inter-day coefficient of variation ranged from 7.4 to 8.8%. The intra-day assay accuracy was in the range of -5-10% and the inter-day assay accuracy ranged from 3.0 to 9.3% of relative error (RE). The limit of quantification was 3.5 ng/mL using a plasma sample of 100 microL (15.8% of CV and 12.8% of RE). Plasma samples were stable for 2 months at -20 degrees C. This method was found to be suitable for pharmacokinetic studies in rats, after subcutaneous administration of morphine (5.6 mg/kg per day) in subchronic treatment for 6 and 12 days.

Comparison of dissolution profiles for albendazole tablets using USP apparatus 2 and 4.

The in vitro dissolution of albendazole from three different commercially available products (200 mg tablets) was studied using U.S. Pharmacopeia (USP) Apparatus 2 and USP Apparatus 4 in order to compare the release performance of the drug in two essentially different dissolution systems. For both cases, 0.1 N HCl was used as dissolution medium. Only the reference product and one of the generic products studied met the 80% USP 24 specification for albendazole dissolved at 30 min, using USP Apparatus 2. Although the reference product reached 80% of albendazole dissolved at 30 min when Apparatus 4 was used, the generic products' dissolution performance was markedly reduced in this system. Though dissolution rate was slower using Apparatus 4, the total quantity of albendazole dissolved from the reference product, represented by area under the dissolution profile, was practically the same regardless of the system used. Dissolution kinetics of albendazole was adequately described by Weibull's function for all the products. The dissolution time (t(d)) derived from data fitting to this function showed significant differences among the products studied. Data analysis based on analysis of variance (ANOVA) showed nonequivalence among the dissolution profiles of generic products compared with the reference product either with the dissolution vessel system or the flow-through cell, as well as nonequivalence among the dissolution profiles using both apparatuses with the same product. Though differences in the dissolution profiles for generic products against the reference product in both systems were found, USP Apparatus 4 showed higher discriminative capacity in differentiating the release characteristics of the products tested.

Perianal cytomegalovirus ulcer in an HIV infected patient: case report and review of literature.

We report the case of a 25-year-old man with acquired immunodeficiency syndrome, presenting with perianal ulcer and diarrhea. He had positive immunocytochemical tests for Cytomegalovirus (CMV) in circulating polymorphonuclear cells (PMN). The biopsy specimen was suggestive of CMV infection, and specific immunoperoxidase for CMV antigens positively stained endothelial cells and fibroblasts. In this report we review cutaneous CMV infection in immunocompromised patients.