Difference in ketone bodies levels between diurnal and nocturnal fasting in children: observational study

Introduction Children are susceptible to developing preoperative ketonemia, which can be affected by changes in the circadian rhythm and counter-regulatory hormones. It is unclear whether ketonemia depends on the timing of fasting. Objective To assess the effect of preoperative fasting time (diurnal vs. night) on the preoperative concentration of ketone bodies in children. Methods We conducted a prospective-observational clinical study between September 2020 and March 2021, including children under 48 months of age scheduled for elective surgery. Two groups were identified based on fasting time, as follows: diurnal fasting (group A, n = 40) and nocturnal fasting (group B, n = 52). Demographic data, duration of fasting, time of excess fasting, type of food intake, the concentration of ketone bodies and capillary blood glucose, level of anxiety, and dehydration were analyzed in both groups. Results Diurnal fasting was associated with higher incidence of ketonemia compared with nocturnal fasting (Group A: 62.5% (95% CI 48.1-82.0); group B: 38,5% (95% CI 26.5-52.5), P=0.02). Most of the patients exceeded the duration of fasting recommended by preoperative fasting guidelines (95.6%). The type of food eaten before surgery was significantly associated with the presence of ketonemia (P=0.01). Conclusions Preoperative ketonemia is relatively common in patients under 48 months of age, especially among those who undergo diurnal fasting compared to nocturnal fasting.

Introducción Los niños son susceptibles a desarrollar cetonemia preoperatoria que puede verse afectada por cambios en el ritmo circadiano y las hormonas contrarreguladoras. No está claro si la cetonemia depende de la hora del ayuno. Objetivo Evaluar el efecto del momento del ayuno preoperatorio (diurno vs. nocturno) sobre la concentración preoperatoria de los cuerpos cetónicos en niños. Métodos Llevamos a cabo un estudio clínico observacional entre septiembre de 2020 y marzo de 2021, en niños menores de 48 meses, programados para cirugía electiva. Se identificaron dos grupos basados en la hora del ayuno, como sigue: ayuno diurno (grupo A, n = 40) y ayuno nocturno (grupo B, n = 52). En ambos grupos se analizaron los datos demográficos, la duración del ayuno, el tiempo excesivo de ayuno, el tipo de ingesta de alimentos, la concentración de cuerpos cetónicos, la glicemia capilar, el nivel de ansiedad y la deshidratación. Resultados El ayuno diurno se asocio con una mayor incidencia de cenotemia en comparación con el ayuno nocturno (Grupo A: 62,5% (IC 95% 48,1-82,0); grupo B: 38,5% (95% CI 26.5-52.5), P=0.02). La mayoría de los pacientes excedieron el tiempo de ayuno recomendado según las guías de ayuno preoperatorio (95,6%). El tipo de alimentos ingeridos antes de la cirugía se asoció de manera importante con la presencia de cetonemia (P=0,01). Conclusiones La cetonemia preoperatoria es relativamente común en pacientes menores de 48 meses de edad, especialmente entre quienes se someten a ayuno diurno en comparación con ayuno nocturno.

Preoperative ultrasound evaluation of gastric contents in children one hour after ingestion of clear liquid: An observational study.

Background: Gastric ultrasound is an effective, non-invasive method to assess the nature and volume of gastric content in the pediatric population. Recently, the UK, European, and French Pediatric Anesthesia Societies recommend fast for clear fluids in children for 1 h. However, studies showing that 1 h of fasting is safe in the pediatric population are still scarce. This study aims to verify by ultrasound evaluation if 1 h of fasting for clear liquids is sufficient to have an empty stomach before anesthetic induction. Methodology: Patients between 11 months and 16 years of age scheduled for elective outpatient surgery were included. A qualitative and quantitative ultrasound evaluation was performed by calculating the cross-sectional area (CSA) of the gastric antrum, 1 h after ingesting a volume of 3 mL/kg of a non-carbonated sports drink, before anesthetic induction. Results: Fifty patients were included. The average CSA measured by ultrasound was 2.85 ± 1.64 cm2 with an average calculated total volume of 12.9 ± 11.06 mL. All patients had an empty stomach criterion (calculated volume ≤1.5 mL/kg) during the ultrasound evaluation, with an average of 0.40 ± 0.23 mL/kg. With the qualitative assessment of gastric volume, 19 patients (38%) were classified as grade 0, 31 patients (62%) as grade 1, and none as grade 2. Conclusion: One hour of fasting after ingestion of 3 mL/kg of a non-carbonated sports drink is sufficient to meet ultrasound criteria for an empty stomach in a pediatric population undergoing elective outpatient surgery.

Social determinants for health and neonatal anesthesia in Colombia

The social determinants of health are the social characteristics in which people's lives and work develop, giving them the capacity to act in specific contexts and are responsible for the health conditions of individuals and populations. Recent World Bank data show that Colombia has made modest progress in terms of social equity. These data reveal that neonatal mortality in remote areas of the country is similar to that found in Sub-Saharan Africa. In these regions, there is no access to specialized neonatal health services. As for anesthesia services, this age group has the highest mortality and perioperative complication rates related to prematurity, the quality of health services and, especially, the expertise of the anesthesiologist. In Colombia, efforts to implement formal university programs for sub-specialization in pediatric anesthesiology have not received governmental support. Meanwhile, the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), through its Committee of Pediatric Anesthesiology, has created ongoing education opportunities, which, although important, are insufficient to meet the needs of the country. For this reason, a State policy is required, aimed at meeting its social debt and that considers the specialized training of human resources as a pillar for the promotion of equity in health, so that the surgical neonate does not have to travel in the procurement of services, but rather have the State bring those services to them.

Los determinantes sociales de la salud son las características sociales en las que se desarrollan la vida y el trabajo de las personas, que otorgan capacidad de actuación en contextos específicos y son responsables de las condiciones de salud del individuo y las poblaciones. Datos recientes del Banco Mundial evidencian el poco progreso que tiene Colombia en materia de equidad social. Esos datos revelan cómo la mortalidad neonatal en zonas apartadas del país es similar a la encontrada en el África Subsahariana. En estas regiones es nulo el acceso a servicios de salud especializados en neonatología. En cuanto al servicio de anestesia, este grupo de edad presenta las tasas de mortalidad y complicaciones perioperatorias más altas, relacionadas con la prematurez, la calidad de los servicios de salud y, especialmente, con la experticia del anestesiólogo. En Colombia, los esfuerzos por implementar programas universitarios formales de subespecialización en Anestesiología Pediátrica no han recibido apoyo gubernamental. Entre tanto, la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), a través de su Comité de Anestesiología Pediátrica, ha creado espacios de capacitación y entrenamiento permanentes, que, aunque importantes, resultan insuficientes para las necesidades del país. Por ello, se requiere una política de Estado orientada a sanar la deuda social y que considere la formación especializada del talento humano como un pilar para construir equidad en salud, de tal manera que el neonato quirúrgico no deba desplazarse en búsqueda de los servicios, sino que el Estado llegue a suplirlos.

Reactive Thrombocytosis Associated with Acute Myocardial Infarction following STEMI with Percutaneous Coronary Intervention.

The etiology of thrombocytosis can be classified into reactive and essential forms. The rate of thromboembolic events is higher in essential thrombocytosis, and these events include strokes, transient ischemic attacks, retinal artery or retinal vein occlusions, digital ischemia, and acute coronary syndrome. In a study of 732 medical and surgical patients with thrombocytosis, 88% had reactive thrombocytosis. Patients with reactive thrombocytosis do not require cytoreductive medications or antiplatelet treatment. We report a healthy 40-year-old man without any medical problems who developed a new episode of myocardial infarction associated with thrombocytosis after an episode of myocardial infarction followed by percutaneous coronary intervention. He had thrombocytosis, and his platelet function test did not reveal adequate inhibition. To treat his acute coronary syndrome, therapeutic enoxaparin was added, and clopidrogel was substituted with ticagrelor. We decided to start hydroxyurea to reduce platelets counts. Enoxaparin and hydroxyurea were discontinued when platelet count returned to baseline. JAK-2 and BCR/ABL mutations were negative. This case report highlights a clinical dilemma (reactive thrombocytosis), which is challenging in terms of management and pathophysiology.

Giant coronary artery aneurysm seen on blood-pool study.

An 81-year-old man was incidentally found to have a large pericardial cyst on a chest computed tomography. Before surgical removal, an echocardiogram demonstrated that the cyst was more likely a large (7.5 cm) right coronary arterial aneurysm. A cardiac blood-pool study demonstrated a blood-filled structure adjacent to the heart, roughly the same size as the combined size of both the right and left ventricles. Coronary angiography confirmed the presence of a large right coronary artery aneurysm. A coronary aneurysm should be considered when a blood-filled structure is seen adjacent to the heart on a multigated acquisition scan.

Triaryl-1,3,5-triazinane-2,4,6-triones functionalized with electron-rich Fe(II) and Ru(II) acetylide complexes: new organometallic octupoles with large hyperpolarizabilities.

The synthesis and study of a series of trinuclear organometallic triaryl-1,3,5-triazinane-2,4,6-triones functionalized by d(6)-transition metal acetylides complexes at their periphery are reported. Remarkably large hyperpolarizabilities, far superior to those of related purely organic derivatives, are measured by hyper-Rayleigh scattering (HRS) for these new octupolar chromophores.

(E)-1-(3-Bromo-phen-yl)-3-(3,4-dimeth-oxy-phen-yl)prop-2-en-1-one.

The mol-ecular structure of the title compound, C(17)H(15)BrO(3), consists of a bromo-phenyl and a 3,4-dimeth-oxy-phenyl group linked through a prop-2-en-1-one spacer. The C=C double bond displays an E conformation, while the carbonyl group shows an S-cis conformation relative to the double bond.

trans-Bis[1,2-bis-(diphenyl-phosphan-yl)ethane]-chlorido(ethyn-yl)ruthenium(II).

The mol-ecular structure of the title compound, trans-[Cu(C2H)Cl(C26H24P2)2], consists of an Ru(II) cation, located on an inversion centre, in an octa-hedral environment defined by two chelating phosphines, one acetyl-ide and one chloride ligand. The -C CH and the chlorine ligands are disordered over two equivalent positions (0.5 occupancy each). The coordination geometry is distorted octa-hedral, with the -C CH fragment and the Cl ligand in trans positions. The four P atoms occupy the equatorial plane of the octa-hedron and the chloride and acetyl-ide ligands the axial positions.

Synthesis, spectral, structural, second-order nonlinear optical properties and theoretical studies on new organometallic donor-acceptor substituted nickel(II) and copper(II) unsymmetrical Schiff-base complexes.

The synthesis, spectroscopic and structural characterization, linear and nonlinear optical properties, as well as the electrochemical behavior of a series of robust neutral binuclear M[Fc-C(O)CH=C(CH(3))N-X-N=CH-(2-O,5-R-C(6)H(3))] (M = Ni (4), Cu (5), X = o-C(6)H(4), R = H; M = Ni (9), X = CH(2)CH(2), R = OH), and their corresponding ionic trinuclear [M{Fc-C(O)CH=C(CH(3))N-X-N=CH-(eta(6)-2-O,5-R-C(6)H(3))RuCp*}][PF(6)] (6, 7, 10), M[ONNO]-type unsymmetrical Salophen and salen complexes featuring ferrocenyl (Fc) donor and the mixed sandwich acceptor [Cp*Ru(eta(6)- salicylidene)](+) as a push-pull moiety are reported in this paper (Fc = CpFe(eta(5)-C(5)H(4)); Cp = eta(5)-C(5)H(5); Cp* = eta(5)-C(5)Me(5)). The single-crystal X-ray structure of the bimetallic iron-nickel derivative 4 indicates a bowed structure of the unsymmetrical Schiff base skeleton. The Ni(II) ion is tetracoordinated in a square planar environment, with two nitrogen atoms and two oxygen atoms as donors. The new metalloligand [Fc-C(O)CH=C(CH(3))N(H)CH(2)CH(2)N=CH-(2,5-(OH)(2)C(6)H(3))] (8) obtained from the Schiff base condensation of 2,5-dihydroxobenzaldehyde with the half-unit precursor, Fc-C(O)CH=C(CH(3))N(H)CH(2)CH(2)NH(2) (2), is reported with its crystal structure showing partial delocalization of the heteroconjugated [O-C-C-C-N] frameworks with a dihedral angle between the respective planes of 60.76 degrees. Second order nonlinear optical (NLO) measurements were achieved using the Harmonic Light Scattering technique to probe the role of the M[ONNO] chromophores and of the pi-complexation of the salicylidene ring in the nonlinearity. All the complexes exhibit a second-order nonlinear response increasing with the nuclearity, the hyperpolarizability (beta) value of the trinuclear complex 10 being 1.5 time larger than that of the metalloligand 8 (beta = 155 x 10(-30) esu). A rationalization of the structural, electronic, and redox properties of the title compounds is provided, based on a theoretical investigation at the density functional theory (DFT) level. Their UV-visible spectra has been assigned with the help of time-dependent (TD) DFT calculations. They are dominated by LMCT, MLCT, and pi-pi* transitions.

"Acute takeoff" of the circumflex artery: a newly recognized coronary anatomic variant with potential clinical consequences.

Human coronary anatomy allows for a wide range of anatomic variants while maintaining certain consistent features. The use of specific descriptions and names is helpful in talking about variants that have an implicit potential for clinical consequences. In reviewing the angiograms of 813 patients, we newly identified a coronary pattern that we propose to name "acute takeoff of the circumflex artery" in 16 patients (2%). This previously unreported pattern angiographically features a