Massive pulmonary embolism and thrombus-in-transit via a patent foramen ovale: a case report of successful use of extracorporeal membrane oxygenation to manage post-embolectomy severe right ventricular dysfunction.

BACKGROUND: Pulmonary embolism with thrombus-in-transit through a patent foramen ovale is rare. It may present with neurological sequalae and rapid diagnosis is needed to prevent mortality and morbidity. The European Society of Cardiology (ESC) published guidelines in 2019 for diagnosis and management of acute pulmonary embolism which were useful in this case. CASE SUMMARY: A 32-year-old sedentary male presented with sudden onset shortness of breath, syncope, a probable seizure, and chest pain. Investigations showed an acute pulmonary embolism with mobile thrombus in the right atrium and right ventricle and also thrombus-in-transit passing through a patent foramen ovale into the left atrium. He was resuscitated and rapidly transferred to theatre where he underwent surgical thromboembolectomy. There was difficulty in separating him from cardiopulmonary bypass due to right ventricular failure and he was initiated on extracorporeal membrane oxygenator support. He recovered fully and was discharged home after 43 days. DISCUSSION: This case report highlights the presentation of this rare diagnosis and discusses the management of acute pulmonary embolism according to recent ESC guidelines.

Pycnogonids from marine docks located along the west coast of the Gulf of California, Mexico.

Sea spiders (Class Pycnogonida Latreille, 1810) are chelicerate arthropods, with an extraordinarily reduced body armed with eight to twelve elongated legs. A literature review of taxonomic and ecological studies of pycnogonids from Mexico identified 49 nominal species (~3.6% out of 1,335 species described worldwide). This low species richness is likely caused by limited taxonomic research and intermittent sampling and research efforts initially carried out by foreign scientists (1893-1996) and later by Mexican scientists. The present study investigates the latitudinal gradient of species richness of the pycnogonids associated with nine marine docks located between Cabo San Lucas (22°53'N) and Santa Rosalía (26°58'N) along the west coast of the Gulf of California, 22°53'N Mexico and provides a detailed morphological re-description of each nominal species using light and scanning electron microscopy. Nine nominal pycnogonid species and one unidentified species in the genus Tanystylum were collected and identified from the biological samples collected between 2011-2017. The highest pycnogonid species richness was recorded at Bahía de La Paz (seven species, 24°14'N) and the lowest species richness at Cabo San Lucas (one species) without an evident latitudinal species richness gradient. Anoplodactylus californicus Hall, 1912 and Ammothella spinifera Cole, 1904 were the most abundant species (52% of the total number of individuals). Tanystylum occidentale (Cole, 1904) and Nymphon apheles Child, 1979 were new geographical records for Mexico and Ammothella symbia Child, 1979 and A. californicus were new records for Baja California Sur state. Adding these new geographical records of pycnogonids increased the species richness previously recorded at Baja California Sur from 20 to 24 nominal species and for Mexico, the species richness increased from 49 to 51 nominal species.

Brugada Syndrome: anesthetic considerations and management algorithm.

Brugada Syndrome is characterized by arrhythmogenic risk that may be exacerbated by different metabolic and pharmacological factors. Since its first description, knowledge of this syndrome and its detection by physicians belonging to different specialties have gradually increased. The risk of arrhythmias is well known to increase in the postoperative period, and this risk is particularly accentuated in patients with Brugada Syndrome. The purpose of this review is to analyze the relationship between this syndrome and anesthesia; establish recommendations for the safe management of these patients in the surgical setting; and update the relevant concepts regarding the safety of drug administration in individuals with Brugada Syndrome.

Endosonographic Characteristics of Subepithelial Lesions of the Upper Digestive Tract: Experience of a Referral Center in Colombia

Introduction: Subepithelial lesions (SELs), described as bulges or masses covered by healthy-looking mucosa, are usually found incidentally during endoscopic studies. They are typically asymptomatic and are estimated to be identified in 1% of esophagogastroduodenoscopies performed. Materials and methods: A descriptive study was conducted with retrospective data collection. We included all patients treated at the Unión de Cirujanos, a referral gastroenterology unit of the Coffee Region in Manizales, between January 2020 and January 2022, who underwent endoscopic ultrasonography to study subepithelial-looking lesions located in the esophagus, stomach, and duodenum. Results: 152 endoscopic ultrasounds were performed, finding 108 SELs; 66.6% of the patients were women, and the average age was 58. Most SELs were located in the stomach (78.7%), the antrum being the most frequent location. The average diameter of the gastric SELs was 14.6 mm, and 47% of the lesions depended on the fourth echolayer; the most frequent presumptive diagnoses were gastrointestinal stromal tumor (GIST; 65.8%) and lipoma (11.7%). Conclusions: SELs of the GI tract originate in the muscularis mucosae, submucosa, or muscularis propria. They are most frequently located in the stomach, and their characterization usually requires endoscopic ultrasonography and histopathology. Treatment of these lesions remains controversial due to their low frequency, histological variety, and low malignant potential.

Introducción: las lesiones subepiteliales (LSE), descritas como abultamientos o masas cubiertas por mucosa de aspecto sano, se encuentran usualmente de manera incidental durante estudios endoscópicos; suelen ser asintomáticas y se estima que se identifican en el 1% de las esofagogastroduodenoscopias realizadas. Métodos: se realizó un estudio descriptivo con recolección retrospectiva de la información. Se incluyeron todos los pacientes atendidos en Unión de Cirujanos, unidad de gastroenterología de referencia del Eje Cafetero ubicada en la ciudad de Manizales, entre enero de 2020 y enero de 2022, a quienes se les realizó ultrasonografía endoscópica como parte del estudio de lesiones de aspecto subepitelial localizadas en el esófago, estómago y duodeno. Resultados: se realizaron 152 endosonografías y se encontraron 108 lesiones subepiteliales, 66,6% de los pacientes eran mujeres y el promedio de edad fue 58 años. La mayoría de las LSE se localizaron en el estómago (78,7%) y, de estas, la localización más frecuente fue el antro; el diámetro promedio de las LSE gástricas fue de 14,6 mm y el 47% de las lesiones eran dependientes de la cuarta ecocapa; los diagnósticos presuntivos más frecuentes fueron el tumor del estroma gastrointestinal (GIST; 65,8%) y lipoma (11,7%). Conclusiones: las LSE del tracto gastrointestinal se originan en la muscular de la mucosa, submucosa o muscular propia, de manera más frecuente se localizan en el estómago y su caracterización suele requerir la realización de ultrasonografía endoscópica y estudio histopatológico. El tratamiento de estas lesiones sigue siendo controversial debido a su baja frecuencia, variedad histológica y bajo potencial maligno.

[Concomitant treatment with gemcitabine and radiotherapy in patients with advanced stages of epidermoid carcinoma originating in the head and neck. A phase II sutdy]. / Tratamiento concomitante con gemcitabina y radioterapia en pacientes con carcinoma epidermoide locorregionalmente avanzado de cabeza y cuello. Estudio fase II.

BACKGROUND: Surgery, radiotherapy or radiotherapy alone (RTA) constitute conventional treatment regimes for advanced stages of squamous cell carcinoma originating in the head and neck mucosa. Nevertheless, the results in advanced regional carcinoma (ARC) are disappointing. The chemotherapy-radiotherapy (CHT-RT) association has shown to be superior to RTA in irresectable disease and in resectable disease it could substitute initial surgery as a rescue alternative. OBJECTIVE: Our objective is to report the response rate and toxicity of concurrent treatment with Gemcitabine and Radiotherapy (GRT) in patients with ARC. In a prospective design, patients with ARC received concurrent GRT; the global, complete and partial response rate as well as toxicity were assessed. MATERIAL AND METHODS: 15 patients were included, 5 women and 10 men, 73% in stage IVa; 13/15 showed a global response (87%), a complete response was observed in 9 cases (60%) (RC) and 2 showed progress. RESULTS: All patients included showed toxicity, the most frequent one was level 4 mucositis in 46%, of this 40% required nutritional support by catheter or gastrostomy. One patient in RC died due to sepsis. None of them suspended treatment. CONCLUSION: The GRT association offers a complete response rate of 60%; nevertheless morbidity was not insignificant; randomized studies with a larger number of patients will be required to allow us to outline the optimal therapeutic scheme.

[Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis]. / Terapia hemodinâmica alvo-dirigida no intraoperatório de cirurgia não cardíaca: revisão sistemática e meta-análise.

BACKGROUND: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. METHODS: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis. RESULTS: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p<0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p=0.30). Quality sensitive analyses confirmed the main overall results. CONCLUSIONS: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

Perioperative Use of Clevidipine: A Systematic Review and Meta-Analysis.

BACKGROUND: Clevidipine is an ultrashort-acting drug for rapid reduction of blood pressure by selectively acting on the L-type Ca2+ channels on arteriolar smooth muscle. The drug's ultrashort action in reducing the blood pressure is due to its rapid hydrolysis by blood and extravascular tissue esterases, which does not depend on hepato-renal metabolism and excretion. An analysis of the perioperative management of blood pressure should be considered to compare with other intravenous antihypertensive agents. METHODS: Analyses of the available evidence in randomized clinical trials following the PRISMA methodology as well as clinical significance according to the GRADE system were conducted. Placebo versus other antihypertensive drugs studies were included. Statistical assessments were done using the X2 and I2 tests. RESULTS: Clevidipine was more effective in maintaining the blood pressure within pre-specified ranges compared with other antihypertensive drugs (MD, -17.87 CI 95%: -29.02 to -6.72; p = 0.02). The use of Clevidipine versus placebo and rescue antihypertensive intravenous drug showed a clear reduction in rates of treatment failure (RR 0.10; IC 95%; 0.05-0.18; p <0.0001). There was no difference in the incidence of adverse events compared with placebo (RR 1.47; 95% CI 0.89 to 2.43, p = 0.14) and with other antihypertensive drugs (RR 0.78, 95% CI 0.45 to 1.35; p = 0.37). In addition, there was no difference in the incidence of atrial fibrillation (AF) between clevidipine and control groups (RR 1.09, IC del 95%: 0.65 a 1.83; p = 0.73). CONCLUSIONS: Clevidipine is an ultrafast-acting drug that is highly effective for management of perioperative arterial hypertension. It is devoid of adverse effects associated with the use of other IV antihypertensives. Its favorable pharmacodynamic and pharmacokinetic properties make clevidipine the drug of choice for the management of acute perioperative hypertension. It is important to emphasize the need for further studies with a larger number of patients to confirm these findings and increase the degree of evidence.

Perioperative goal-directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis.

STUDY OBJECTIVE: Goal-directed fluid therapy (GDHT) has been proposed as a method to reduce complications and mortality. DESIGN: Meta-analysis of the effects of perioperative GDHT in adult noncardiac surgery on mortality and postoperative complications was performed using the PRISMA methodology. A systematic search was performed in MEDLINE, PubMed, EMBASE, and the Cochrane Library (last update, October 2014). Inclusion criteria were as follows: randomized clinical trials (RCTs) in which perioperative GDHT was compared with conventional fluid management in noncardiac surgery. Exclusion criteria were as follows: trauma and pediatric surgery studies. End points were mortality and number of patients with complications. SETTING: District general hospital. PATIENTS: Thirty-nine RCTs were initially identified, with 8 fulfilling the inclusion criteria. Two RCTs were added by manual search, resulting in 10 RCTs in the final analysis, including 1527 patients. MEASUREMENTS: Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by supraphysiological or physiological hemodynamic goal and by time the intervention was carried out, perioperative or postoperative), and predefined sensitivity analysis. MAIN RESULTS: A significant reduction was observed in mortality associated with GDHT compared with conventional fluid therapy (risk ratio, 0.63; 95% confidence interval, 0.42-0.94; P = .02). However, no differences were found in the number of patients with complications (risk ratio, 0.75; 95% confidence interval, 0.50-1.17; P = .21), and the sensitivity analysis did not confirm the results. CONCLUSIONS: This meta-analysis, with its limitations, shows that the use of perioperative GDHT may reduce postoperative mortality, but it is unable to show a reduction in the number of patients with complications.

Restrictive versus liberal transfusion strategy for red blood cell transfusion in critically ill patients and in patients with acute coronary syndrome: a systematic review, meta-analysis and trial sequential analysis.

INTRODUCTION: The risks and benefits of transfusing critically ill patients continue to evoke controversy. Specifically, the critically ill patients with active ischemic cardiac disease continue to represent a "gray area" in the literature. EVIDENCE ACQUISITION: Meta-analysis of the effects of lower versus higher hemoglobin thresholds on mortality in critically ill patients was carried out using PRISMA methodology. A systematic research was performed in PubMed, Embase, and the Cochrane Library (last update, December 2014). INCLUSION CRITERIA: Anemic critically ill adult patients admitted to intensive care units and/or anemic patients with acute coronary syndrome in which a restrictive vs. liberal transfusion therapy was compared. PRIMARY ENDPOINT: mortality. Included studies were subjected to quantifiable analysis, predefined subgroup analysis, trial sequential analysis and predefined sensitivity analysis. EVIDENCE SYNTHESIS: Thirty RCT's were initially identified; 6 fulfilled the inclusion criteria, including 2156. There were no differences in mortality between the restrictive and liberal groups (RR: 0.86, 95% CI 0.70-1.05 P=0.14), neither in patients with chronic cardiovascular disease subgroup (RR: 1.13, 95% IC 0.88-1.46 P=0.34). However, there is a trend towards decreased mortality in the subgroup critically ill (RR: 0.86, 95% CI 0.73-1.01 P=0.06); while in the subgroup of patients with acute myocardial infarct seems like it might be a non-significant trend towards increased mortality (RR: 3.85, 95% CI 0.82-18.0 P=0.09). CONCLUSIONS: Restrictive strategy is at least as effective to liberal strategy in critically ill patients. Nevertheless, there is insufficient evidence to recommend a restrictive strategy for patients with acute coronary syndrome.

Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis.

BACKGROUND: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. METHODS: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis. RESULTS: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p<0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p=0.30). Quality sensitive analyses confirmed the main overall results. CONCLUSIONS: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

[Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions]. / Coloides versus cristaloides em fluidoterapia guiada por objetivos, revisão sistemática e metanálise. Demasiadamente cedo ou demasiadamente tarde para obter conclusões.

INTRODUCTION: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to kidney failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids, in GDFT, to determine complications and mortality associated associated. METHODS: A bibliographic research was carried out in Medline, Pubmed, Embase and Cochrane Library, corroborating randomized clinical trials in those crystalloids are compared to colloids in GDFT for mayor non-cardiac surgery in adults. RESULTS: One hundred thirty references were found, among those 38 were selected, and 29 analyzed; of these, 6 were included for systematic review and meta-analysis, including 390 patients. It was perceived that the use of colloids it not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% IC] 3.87 [1.121, 13, 38]); I(2)=0.0%; p=0.635). CONCLUSIONES: Due to this meta-analysis' limitations for small number of randomized clinical trials and patients included, the results should be taken cautiously, and it is proposed to carry out new randomized clinical trials, with enough statistical power, comparing balanced and non-balanced colloids to balanced and non-balanced crystalloids, following the protocols of GDFT, respecting current guidelines and suggestions made by groups of experts.

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions.

INTRODUCTION: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. METHODS: A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. RESULTS: One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121-13.38]; I(2)=0.0%; p=0.635). CONCLUSIONS: Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts.

Pycnogonids associated with the giant lion´s-paw scallop Nodipecten subnodosus (Sowerby) in Ojo de Liebre Bay, Guerrero Negro, Baja California Sur, Mexico.

Five species of epibenthic pycnogonids collected on the giant lion´s-paw scallop Nodipecten subnodosus are recorded. A new species of Eurycyde, Eurycyde bamberi, is described. Of the 19 species known in this genus; the new species is closest to Eurycyde hispida Kroyer, 1844 but differs from it in the absence of plumose spines and the shapes of the lateral process, first coxa, and ocular tubercle. The new species represents the third member of Eurycyde from the eastern Pacific in addition to Eurycyde spinosa Hilton, 1916 and Eurycyde clitellaria Stock, 1955. Besides Eurycyde bamberi, the following species were collected: Nymphopsis duodorsospinosa Hilton, 1942c; Callipallene californiensis (Hall, 1913); Nymphon lituus Child, 1979; and Pycnogonum rickettsi Schmitt, 1934. Pycnogonum rickettsi is recorded for first time from Mexican waters, as is Nymphon lituus from the western coast of Baja California Peninsula. Each of these four species are re-described and re-illustrated in order to fill in existing gaps in the literature of the region.

[Change of the weight/ foot area coefficient in relation to aggregation in Tarebia granifera]. / Modificación del coeficiente peso/área del pié en relación con la agregación en Tarebia granifera.

OBJECTIVE: To analyze specimens dispersion in a population of Tarebia granifera and its relationship with the change of morphometric parameters. METHODS: Two samplings by parcels including two types of substrata in opposite aggregation conditions were carried out, and the specimen abundance was compared between both samplings and substrata. The samples were stratified into classes according to shell height and for each of these the coefficient weight/foot-area was calculated and correlated with class size. It was experimentally evaluated whether specimens with a lower foot load had a better persistence in emerged substratum as well as the interaction between two class groups of shell height. RESULTS: The abundance difference between samplings was t=5.874 (p<0.001), and t=10.15 (p<0.001) between emerged rocky and sandy substrata, only under conditions of high aggregation where foot load decreases with the size for higher specimens (r=-0.98, p<0.05). Experimentally, the abundance of specimens of opposed sizes were mutually limited (r=-0.87, p<0.01), waves' height limits the abundance of smaller snails (r=-0.94, p<0.01) but it is tolerated by larger ones (r=0.72, p<0.05), and foot load diminishes with the waves' height (r=-0.93, p<0.001). CONCLUSIONS: Under high aggregation conditions larger specimens emigrate toward substratum of difficult capture by smaller ones, which are limited by the environment's mechanical influence. The decrease of foot load facilitates specimens' dispersion.

Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis / Terapia hemodinâmica alvo-dirigida no intraoperatório de cirurgia não cardíaca: revisão sistemática e meta-análise

Abstract Background: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. Methods: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis. Results: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality sensitive analyses confirmed the main overall results. Conclusions: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

Resumo Justificativa: A terapia hemodinâmica alvo-dirigida (THAD) é uma abordagem focada no uso do débito cardíaco (DC) e parâmetros relacionados, como desfechos para fluidos e medicamentos para aprimorar a perfusão tecidual e o fornecimento de oxigênio. Objetivo primário: determinar os efeitos da THAD sobre as taxas de complicações no pós-operatório. Métodos: Metanálise dos efeitos da THAD em cirurgias não cardíacas de adultos sobre as complicações pós-operatórias e mortalidade, com a metodologia PRISMA. Uma busca sistemática foi feita no Medline PubMed, Embase e Biblioteca Cochrane (última atualização, outubro de 2014). Os critérios de inclusão foram estudos clínicos randômicos (ECRs) nos quais a THAD no intraoperatório foi comparada com a terapia convencional de reposição de líquidos em cirurgia não cardíaca. Os critérios de exclusão foram traumatismo e estudos de cirurgia pediátrica e aqueles que usaram cateter de artéria pulmonar. Os desfechos, primário e secundário, foram complicações pós-operatórias e mortalidade, respectivamente. Os estudos que atenderam aos critérios de inclusão foram examinados na íntegra e submetidos à análise quantitativa, análise de subgrupo pré-definido (estratificada por tipo de monitor, terapia e objetivo hemodinâmico) e análise de sensibilidade pré-definida. Resultados: 51 ECRs foram identificados inicialmente, 24 atenderam aos critérios de inclusão. Cinco ECRs foram adicionados por busca manual, resultando em 29 ECRs para análise final, incluindo 2.654 pacientes. Uma redução significativa das complicações para a THAD (RR: 0,70, IC de 95%: 0,62-0,79, p < 0,001). Nenhuma diminuição significativa na mortalidade foi observada (RR: 0,76, IC de 95%: 0,45-1,28, p = 0,30). Análises de sensibilidade qualitativa confirmaram os principais resultados gerais. Conclusões: THAD no intraoperatório com monitoração minimamente invasiva diminui as complicações no pós-operatório de cirurgia não cardíaca, embora não tenha mostrado uma redução significativa da taxa de mortalidade.

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions / Coloides versus cristaloides em fluidoterapia guiada por objetivos, revisão sistemática e metanálise. Demasiadamente cedo ou demasiadamente tarde para obter conclusões / Coloides versus cristaloides en fluidoterapia guiada por objetivos, revisión sistemática y metaanálisis. Demasiado pronto o demasiado tarde para obtener conclusiones

Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality.

Foram feitos múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), muitos deles com o uso de coloides para aprimoramento da pré-carga. Após a decisão da Agência Europeia de Medicamentos, existe ainda controvérsia sobre seu uso, seus benefícios e sua possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas.

Se han realizado múltiples ensayos clínicos en fluidoterapia guiada por objetivos (FGO), muchos de ellos con el uso de coloides para la optimización de la precarga. Tras la decisión de la Agencia Europea del Medicamento, existe cierta controversia en cuanto a su utilización, beneficios y su posible contribución al fallo renal. El objetivo de esta revisión sistemática y metaanálisis es comparar el uso de coloides de última generación, derivados del maíz, con cristaloides en FGO para determinar las complicaciones y la mortalidad asociadas.

Tratamiento concomitante con gemcitabina y radioterapia en pacientes con carcinoma epidermoide locorregionalmente avanzado de cabeza y cuello: estudio fase II / Concomitant treatment with gemcitabine and radiotherapy in patients with advanced stages of epidermoid carcinoma originating in the head and neck: a phase II sutdy

Antecedentes: En casos avanzados el tratamiento clásico del carcinoma epidermoide originado en mucosas de cabeza y cuello es cirugíaradioterapia o radioterapia sola (RTS). Sin embargo los resultados en carcinoma localmente avanzado (CLA) son decepcionantes. La asociación quimioterapia-radioterapia (QT-RT) ha demostrado ser superior a RTS en enfermedad irresecable y, en enfermedad resecable podría sustituir a la cirugía inicial y dejarla como rescate. Objetivo: El objetivo de este estudio es conocer la tasa de respuesta y la toxicidad del tratamiento concomitante Gemcitabina-Radioterapia (GRT) en pacientes con CLA. Material y métodos: Estudio prospectivo en el que pacientes con CLA recibieron GRT concomitante; se evaluó la tasa de respuesta global, completa, parcial y la toxicidad. Se incluyeron 15 pacientes, 5 mujeres y 10 hombres, 73% en etapa IVa. Resultados: Trece de 15 pacientes tuvieron respuesta global (87%), en 9(60%) fue completa (RC) y 2 tuvieron progresión. Todos tuvieron toxicidad, la más frecuente fue mucositis grado 4 en 46%; de éstos 40% requirió apoyo nutricio por sonda o gastrostomía. Un paciente en RC murió por sepsis. Ninguno abandonó el tratamiento. Conclusiones: La asociación GRT ofrece tasa de respuesta completa en 60%; sin embargo, la morbilidad no es despreciable; se requieren estudios aleatorizados con mayor número de pacientes que permitan definir el mejor esquema terapéutico.

BACKGROUND: Surgery, radiotherapy or radiotherapy alone (RTA) constitute conventional treatment regimes for advanced stages of squamous cell carcinoma originating in the head and neck mucosa. Nevertheless, the results in advanced regional carcinoma (ARC) are disappointing. The chemotherapy-radiotherapy (CHT-RT) association has shown to be superior to RTA in irresectable disease and in resectable disease it could substitute initial surgery as a rescue alternative. OBJECTIVE: Our objective is to report the response rate and toxicity of concurrent treatment with Gemcitabine and Radiotherapy (GRT) in patients with ARC. In a prospective design, patients with ARC received concurrent GRT; the global, complete and partial response rate as well as toxicity were assessed. MATERIAL AND METHODS: 15 patients were included, 5 women and 10 men, 73% in stage IVa; 13/15 showed a global response (87%), a complete response was observed in 9 cases (60%) (RC) and 2 showed progress. RESULTS: All patients included showed toxicity, the most frequent one was level 4 mucositis in 46%, of this 40% required nutritional support by catheter or gastrostomy. One patient in RC died due to sepsis. None of them suspended treatment. CONCLUSION: The GRT association offers a complete response rate of 60%; nevertheless morbidity was not insignificant; randomized studies with a larger number of patients will be required to allow us to outline the optimal therapeutic scheme.

Evaluación de Eucyclops speratus (Copepoda: Cyclopoida) como una nueva alternativa para el control biológico de larvas de mosquitos en Cuba / Assessment of Eucyclops speratus (Copepoda: Cyclopoida) as a new alternative of biological control of mosquito larvae in Cuba

Se muestran los resultados obtenidos en dos experimentos de depredación del copépodo cyclópido Eucyclops speratus, sobre larvas del mosquito Culex quinquefasciatus desarrollados en 24 horas. En el primero, dirigido a valorar la densodependencia del depredador sobre las larvas, se varió la densidad de copépodos (5, 10, 15, 20 y 25 animales por recipiente de 1000 ml), manteniéndose fija la de larvas (120); cada situación contó con 10 réplicas. La media de las larvas depredadas muestra una fuerte dependencia de la densidad del depredador, obteniéndose diferencias significativas en todos los casos. En el segundo experimento, dirigido a valorar la influencia de la densidad de las larvas sobre la eficiencia del depredador, se varió la cantidad de larvas en los frascos (40, 60, 80, 100, 120 y 150 por frascos de 1000 ml, con 10 réplicas en cada situación), manteniéndose siempre una misma cantidad de copépodos (10). Se determinó que la media de larvas depredadas en los dos primeros casos difiere significativamente entre sí y con el resto de los tratamientos, pero no se encontraron diferencias significativas entre las larvas depredadas cuando estas fueron 80, 100, 120 y 150 por litro. Se concluye que Eucyclops speratus, un copépodo común de la fauna dulceacuícola cubana, incrementa la eficiencia de depredación con su densidad, al menos con valores menores a 25 animales / litro, y que la eficiencia de depredación aumenta hasta una relación de 1 copépodo / 7 larvas; cuando la proporción de larvas supera esta proporción, la depredación no experimenta aumentos significativos.[AU]

Modificación del coeficiente peso/área del pié en relación con la agregación en Tarebia granifera / Change of the weight/foot area coefficient in relation to aggregation in Tarebia granifera

OBJETIVO: Analizar la dispersión de los ejemplares de una población de Tarebia granifera y su relación con la modificación de los parámetros morfométricos. METODOS: Se colectó por parcelas incluyendo dos tipos de substratos en condiciones opuestas de agregación y se comparó la abundancia relativa tanto entre muestreos, como entre sustratos. Se delimitaron 7 clases de alto a las cuales se les determinó el coeficiente peso/área del pié, el cual se correlacionó con la talla por clase. Se evaluó experimentalmente si los individuos con menor carga del pié tienen mayor persistencia en substratos emergidos, así como la interacción entre dos grupos de clases de alto. RESULTADOS: La diferencia de la abundancia entre los muestreos fue de t=5.874 (p<0.001) y de t=10.15 (p<0.001) entre el substrato rocoso emergido y el arenoso, sólo en condiciones de alta agregación, en las que la carga del pié de los individuos más grandes se reduce con la talla (r=-0.98, p<0.05). Experimentalmente, la abundancia de los ejemplares de tallas opuestas está mutuamente limitada (r=-0.87, p<0.01), la altura del oleaje limita la abundancia de los ejemplares menores (r=-0.94, p<0.001) siendo tolerada por los mayores (r=0.72, p<0.05). La carga promedio del pie disminuye con la altura del oleaje (r=-0.93, p<0.001). CONCLUSIONES: Con elevada agregación los ejemplares mayores emigran hacia substratos de difícil conquista por los menores, que están limitados por la acción mecánica del medio. La disminución de la carga del pie facilita la dispersión de los individuos