Does the maternal-fetal transmission of SARS-CoV-2 occur during pregnancy?

BACKGROUND AND OBJETIVE: On January 7th, 2020, a new coronavirus, SARS-CoV-2, was identified, as responsible for a new human disease: COVID-19. Given its recent appearance, our current knowledge about the possible influence that this disease can exert on pregnancy is very limited. One of the unknowns to be solved is whether there is a vertical transmission of the infection during pregnancy. PATIENTS AND METHODS: Using the Real-time Polymerase Chain Reaction techniques for SARS-CoV-2 nucleic acids, the possible presence of this germ in vaginal discharge and amniotic fluid was investigated in four pregnant Caucasian patients affected by mild acute symptoms of COVID-19 during the second trimester of pregnancy. RESULTS: There is no laboratory evidence to suggest a possible passage of SARS-CoV-2 from the infected mother to the amniotic fluid. CONCLUSIONS: It is necessary to expand the investigation of COVID-19 cases diagnosed during pregnancy to clarify the real influence that SARS-CoV-2 has on pregnant women and their offspring, as well as those factors that modulate the disease.

¿Existe transmisión materno-fetal del SARS-CoV-2 durante la gestación? / Does the maternal-fetal transmission of SARS-CoV-2 occur during pregnancy?

Antecedentes y objetivo El 07 de enero de 2020 se identificó un nuevo coronavirus, el SARS-CoV-2, responsable de una nueva enfermedad en el humano: la COVID-19. Dada su reciente aparición, nuestro conocimiento actual sobre la posible influencia que esta enfermedad puede ejercer en el embarazo es muy limitado. Una de las incógnitas que hay que despejar es si existe transmisión vertical de la infección durante la gestación. Pacientes y métodos Mediante técnicas de reacción en cadena de la polimerasa en tiempo real para ácidos nucleicos del SARS-CoV-2 se investigó la posible presencia de dicho germen en el flujo vaginal y el líquido amniótico de cuatro pacientes embarazadas de raza caucásica afectadas por cuadros agudos leves de COVID-19 durante el segundo trimestre de la gestación. Resultados No existen evidencias de laboratorio que sugieran un posible paso del SARS-CoV-2 desde la madre infectada al líquido amniótico. Conclusiones Es preciso ampliar la investigación de casos de COVID-19 diagnosticados durante la gestación para poder aclarar la influencia real que el SARS-CoV-2 ejerce sobre las embarazadas y su descendencia, así como aquellos factores que modulan la enfermedad (AU)

Background and objective On January 7th, 2020, a new coronavirus, SARS-CoV-2, was identified, as responsible for a new human disease: COVID-19. Given its recent appearance, our current knowledge about the possible influence that this disease can exert on pregnancy is very limited. One of the unknowns to be solved is whether there is a vertical transmission of the infection during pregnancy. Patients and methods Using the Real-time Polymerase Chain Reaction techniques for SARS-CoV-2 nucleic acids, the possible presence of this germ in vaginal discharge and amniotic fluid was investigated in four pregnant Caucasian patients affected by mild acute symptoms of COVID-19 during the second trimester of pregnancy. Results There is no laboratory evidence to suggest a possible passage of SARS-CoV-2 from the infected mother to the amniotic fluid. Conclusions It is necessary to expand the investigation of COVID-19 cases diagnosed during pregnancy to clarify the real influence that SARS-CoV-2 has on pregnant women and their offspring, as well as those factors that modulate the disease (AU)

Does the maternal-fetal transmission of SARS-CoV-2 occur during pregnancy? / ¿Existe transmisión materno-fetal del SARS-CoV-2 durante la gestación?

BACKGROUND AND OBJECTIVE: On January 7th, 2020, a new coronavirus, SARS-CoV-2, was identified, as responsible for a new human disease: COVID-19. Given its recent appearance, our current knowledge about the possible influence that this disease can exert on pregnancy is very limited. One of the unknowns to be solved is whether there is a vertical transmission of the infection during pregnancy. PATIENTS AND METHODS: Using the Real-time Polymerase Chain Reaction techniques for SARS-CoV-2 nucleic acids, the possible presence of this germ in vaginal discharge and amniotic fluid was investigated in four pregnant Caucasian patients affected by mild acute symptoms of COVID-19 during the second trimester of pregnancy. RESULTS: There is no laboratory evidence to suggest a possible passage of SARS-CoV-2 from the infected mother to the amniotic fluid. CONCLUSIONS: It is necessary to expand the investigation of COVID-19 cases diagnosed during pregnancy to clarify the real influence that SARS-CoV-2 has on pregnant women and their offspring, as well as those factors that modulate the disease.

¿Existe un valor de índice biespectral adecuado para endoscopias digestivas altas en respiración espontánea en el paciente pediátrico? / Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the pediatric patient?

Objetivo: Las cifras del índice biespectral (BIS) en las que un paciente está adecuadamente anestesiado para la realización de endoscopias digestivas altas (EDA) en respiración espontánea están por definir. Por ello se decide realizar este estudio, para determinar un nivel de BIS adecuado, lo menos profundo posible en el paciente pediátrico anestesiado, para la realización de EDA en respiración espontánea sin aparición de reflejo nauseoso y/o respuesta motora. Material y método: Se realizó un estudio prospectivo. La población de estudio fueron niños entre 12 y 167 meses, ASA I-II, que precisaban EDA diagnóstica; se estudiaron un total de 61 pacientes. El periodo analizado fue de octubre de 2011 a marzo de 2013. Intervenciones Realización de EDA aplicando protocolo de anestesia con propofol. La monitorización realizada fue: constantes vitales (frecuencia cardiaca, frecuencia respiratoria, saturación por pulsioximetría y presión arterial no invasiva), puntuación de la escala de Ramsay y valor del BIS. El primer intento de EDA se realizó con BIS 60-69; si no era posible, se procedía a profundización anestésica, realizando el segundo intento con valores del BIS 50-59; si tampoco era posible la realización de la EDA, se procedía de nuevo a profundización anestésica, realizando el tercer intento con BIS 45-49. Las variables de interés fueron: dosis total de propofol (mg kg−1 ), tiempo de inducción (tiempo necesario desde el inicio de la administración de la anestesia hasta inicio de la EDA sin rechazo por parte del paciente), valor del BIS efectivo (BISe) al inicio de la EDA. Se realizó una regresión logística para estimar la posibilidad de realización de EDA según el valor del BIS. Resultados: Sesenta y un pacientes con la siguiente distribución: sexo masculino 40%, femenino 60%. Pacientes menores de 36meses, 11 (18%); mayores, 50 (82%). Datos expresados como media y desviación típica. Edad (meses): 95,9 ± 45,86; peso (kg): 30,5 ± 14,68. BIS efectivo: 56,41 ± 4,63. Tiempo de inducción (min): 11,07 ± 2,69. Dosis de propofol total (por kg): 4.86 ± 1,21. Necesitaron bolo adicional de propofol 38 pacientes (62%): 7/38 (18%) por presencia de movimientos y 31/38 (82%) por aumento del BIS. No hubo diferencias significativas entre valor del BISe por edades. Conclusiones: En base a estos resultados se puede concluir que en la población pediátrica estudiada niveles de BIS menores de 59 predicen que sí es posible realizar la EDA con una sensibilidad del 72,13% y una especificidad del 88,06% (AU)

Objective: The bispectral index (BIS) values that predict appropriate anesthetic level to perform an upper gastrointestinal endoscopy in spontaneous breathing are not well established in Pediatrics. The objective of this study is to determine whether it is possible to find an appropriate, less profound, BIS level in the pediatric patient that would enable an upper gastrointestinal endoscopy (UGE) to be performed in spontaneous breathing without causing gag reflex or motor response. Material and method: A prospective study was designed and included 61 patients from 12- 167 months old, and an ASA I-II who needed a diagnostic UGE. The study was conducted from October 2011 to March 2013.
Intervention: UGE performed with an anesthetic protocol using propofol. The vital signs measured were heart and respiratory rate, pulse oximetry, non-invasive blood pressure. The sedation level score (Ramsay scale) and BIS values were also measured. The first attempt was performed at BIS level 60-69, and this was not feasible, then the anesthetic was deepened and a second attempt made at BIS level 50-59. If this was still not possible a deeper anesthetic level was then achieved and a third attempt made at BIS level 45-49. Variables of interest were: effective BIS level (eBIS), BIS level at which UGE was performed without gag reflex or motor response; propofol total dose (mg kg−1 ), induction time (time from onset of sedation to effective start of UGE). A logistic regression analysis was performed to obtain an equation to estimate the possibility of UGE success. Results: The distribution of the patient was: male 40%, female 60%, with 11 (18%) patients under 36 months. The statistical values are expressed as mean and standard deviation, with following results; age (months): 95.9 ± 45.86; weight (kg): 30.5 ± 14.68; effective BIS: 56.41 ± 4.63; induction time (minutes): 11.07 ± 2.69; total propofol dose (per kg): 4.86 ± 1.21. An additional intraprocedure propofol bolus was given in 38 patients (62%), with 7/38 of them (18%) due to movement, and 31/38 (82%) due to BIS level increase. No statistical differences were found in effective BIS level between older and younger patients. Conclusions: According to the results, BIS levels below 59 predict UGE success, with 72.13% sensitivity and 88.06% specificity in the pediatric population studied (AU)

[Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the pediatric patient?]. / ¿Existe un valor de índice biespectral adecuado para endoscopias digestivas altas en respiración espontánea en el paciente pediátrico?

OBJECTIVE: The bispectral index (BIS) values that predict appropriate anesthetic level to perform an upper gastrointestinal endoscopy in spontaneous breathing are not well established in Pediatrics. The objective of this study is to determine whether it is possible to find an appropriate, less profound, BIS level in the pediatric patient that would enable an upper gastrointestinal endoscopy (UGE) to be performed in spontaneous breathing without causing gag reflex or motor response. MATERIAL AND METHOD: A prospective study was designed and included 61 patients from 12-167 months old, and an ASAI-II who needed a diagnostic UGE. The study was conducted from October 2011 to March 2013. INTERVENTION: UGE performed with an anesthetic protocol using propofol. The vital signs measured were heart and respiratory rate, pulse oximetry, non-invasive blood pressure. The sedation level score (Ramsay scale) and BIS values were also measured. The first attempt was performed at BIS level 60-69, and this was not feasible, then the anesthetic was deepened and a second attempt made at BIS level 50-59. If this was still not possible a deeper anesthetic level was then achieved and a third attempt made at BIS level 45-49. Variables of interest were: effective BIS level (eBIS), BIS level at which UGE was performed without gag reflex or motor response; propofol total dose (mgkg(-1)), induction time (time from onset of sedation to effective start of UGE). A logistic regression analysis was performed to obtain an equation to estimate the possibility of UGE success. RESULTS: The distribution of the patient was: male 40%, female 60%, with 11 (18%) patients under 36 months. The statistical values are expressed as mean and standard deviation, with following results; age (months): 95.9±45.86; weight (kg): 30.5±14.68; effective BIS: 56.41±4.63; induction time (minutes): 11.07±2.69; total propofol dose (per kg): 4.86±1.21. An additional intra-procedure propofol bolus was given in 38 patients (62%), with 7/38 of them (18%) due to movement, and 31/38 (82%) due to BIS level increase. No statistical differences were found in effective BIS level between older and younger patients. CONCLUSIONS: According to the results, BIS levels below 59 predict UGE success, with 72.13% sensitivity and 88.06% specificity in the pediatric population studied.

[Neurogenic stunned myocardium in Pediatrics. A case report]. / Aturdimiento miocárdico neurogénico en Pediatría. A propósito de un caso.

Neurogenic stunned myocardium is an unusual clinical entity. It mimics an acute coronary syndrome with electrocardiographic abnormalities, cardiac dysfunction and elevated cardiac enzymes with absence of obstructive coronary disease. It may occur after a neurosurgical procedure. A case is presented of neurogenic stunned myocardium occurring in a child after removal of a posterior fossa medulloblastoma. The patient developed nodal tachycardia with hemodynamic impairment. The clinical course was satisfactory due to antiarrhythmic therapy, with biochemical, echocardiographic, and clinical improvement within a week.

Utilidad de la monitorización anestésica con el índice biespectral en endoscopias digestivas altas en respiración espontánea / Usefulness of monitoring anaesthesia with the bispectral index in upper gastrointestinal endoscopies with spontaneous breathing

Introducción: El objetivo del presente trabajo es demostrar si la aplicación del índice biespectral (BIS®) en la monitorización de la anestesia general en respiración espontánea en endoscopias digestivas altas (EDA) diagnósticas en el paciente pediátrico es útil para: a) disminuir la dosis de fármaco necesaria; b) disminuir el tiempo del despertar, y c) mejorar la seguridad del paciente. Pacientes y método: estudio prospectivo cuasi experimental de casos y controles en el ámbito de una unidad de cuidados intensivos pediátricos y neonatales de segundo nivel. Pacientes: niños entre 12 meses y 13 años. Caso: paciente ASA I que precisa EDA diagnóstica; sujetos elegibles 36, participantes 30. Población control: serie histórica de pacientes que precisaron EDA (años 2008-2010): 50 pacientes. Intervenciones: realización de EDA, aplicando protocolo de anestesia, monitorización de constantes vitales, nivel de sedación (escala de Ramsay) y nivel BIS. Variables de interésdosis total de propofol (mg/kg), tiempo de inducción, tiempo de EDA y tiempo de despertar (min); índice BIS al inicio de la EDA (BISi) y durante la EDA; efectos adversos. Resultados: Sin diferencias significativas entre casos (B) y controles (C) respecto a sexo, edad y peso. Sin diferencias significativas en: dosis total de propofol (B 4,9 ± 1,4 mg/kg; C 5,2 ± 1,6 mg/kg, p = 0,492), Tiempo de despertar (B 12,2 ± 4,6 min; C 12,8 ± 4,4 min, p = 0,402), tiempo de procedimiento (B 9,5 ± 4,8 min; C 11,3 ± 6,5 min, p = 0,335) y tiempo de inducción (B 11,1 ± 2,6 min; C 10,1 ± 4,2 min, p = 0,059). BISi 55,4 ± 6,9. Sin diferencias significativas en efectos adversos (2 casos de desaturación leve en el grupo control). Conclusiones: La monitorización anestésica con índice biespectral en endoscopias digestivas altas en respiración espontánea en la población pediátrica es factible, pero no parece disminuir ni la dosis de fármaco necesaria ni el tiempo de despertar. Tampoco disminuye la incidencia de efectos adversos de forma significativa (AU)

Introduction: The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. Patients and method A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit. Patients: Children aged 1-13 years. Case: ASA I patient who needed a diagnostic UGE; eligible, 36, participants, 30. Control: historical cohort of patients who needed UGE (years 2008-2010): 50 patients. Intervention: UGE performed with anaesthetic protocol, vital signs monitoring, sedation level (Ramsay scale) and BIS monitoring. Variables of interestpropofol total dose (mg/kg), induction time, time in performing the UGE, awakening time (min); initial BIS (iBIS), and BIS during the UGE; adverse effects. Results: There were no significant differences in sex, age or weight between case (B) and control (C) population. No significant differences in total propofol doses: (B 4.9 ± 1.4 mg/kg; C 5.2 ± 1.6 mg/kg, P=.492), awakening time (B 12.2 ± 4.6 min; C 12.8 ± 4.4 min, P=.402), time for execution of UGE (B 9.5 ± 4.8 min; C 11.3 ± 6.5 min, P=.335) and induction time (B 11.1 ± 2.6 min; C 10.1 ± 4.2 min, P=.059), iBIS 55.4 ± 6.9. There were no significant differences in adverse effects: 2 patients suffered from mild desaturation in the control group. Conclusions: BIS monitoring for diagnostic UGE in spontaneous breathing in a pediatric population is feasible, but does not appear to decrease awakening time or the amount of propofol needed. Furthermore, there was no statistically significant decrease in the number of adverse effects (AU)

[Usefulness of monitoring anaesthesia with the bispectral index in upper gastrointestinal endoscopies with spontaneous breathing]. / Utilidad de la monitorización anestésica con el índice biespectral en endoscopias digestivas altas en respiración espontánea.

INTRODUCTION: The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. PATIENTS AND METHOD: A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit. PATIENTS: Children aged 1-13 years. CASE: ASA I patient who needed a diagnostic UGE; eligible, 36, participants, 30. CONTROL: historical cohort of patients who needed UGE (years 2008-2010): 50 patients. INTERVENTION: UGE performed with anaesthetic protocol, vital signs monitoring, sedation level (Ramsay scale) and BIS monitoring. VARIABLES OF INTEREST: propofol total dose (mg/kg), induction time, time in performing the UGE, awakening time (min); initial BIS (iBIS), and BIS during the UGE; adverse effects. RESULTS: There were no significant differences in sex, age or weight between case (B) and control (C) population. No significant differences in total propofol doses: (B 4.9 ± 1.4 mg/kg; C 5.2 ± 1.6 mg/kg, P=.492), awakening time (B 12.2 ± 4.6 min; C 12.8 ± 4.4 min, P=.402), time for execution of UGE (B 9.5 ± 4.8 min; C 11.3 ± 6.5 min, P=.335) and induction time (B 11.1 ± 2.6 min; C 10.1 ± 4.2 min, P=.059), iBIS 55.4 ± 6.9. There were no significant differences in adverse effects: 2 patients suffered from mild desaturation in the control group. CONCLUSIONS: BIS monitoring for diagnostic UGE in spontaneous breathing in a pediatric population is feasible, but does not appear to decrease awakening time or the amount of propofol needed. Furthermore, there was no statistically significant decrease in the number of adverse effects.

Lung CD57+ cell density is increased in very severe COPD.

Among all inflammatory cells involved in COPD, those with a cytolytic or elastolytic activity are thought to play a key role in the pathogenesis of the disease. However, there is no data about the infiltration of cells expressing the CD57 marker in small airways and parenchyma of COPD patients. In this study, surgical specimens from 43 subjects undergoing lung resection due to lung cancer (9 non-smokers, 18 smokers without COPD and 16 smokers with moderate COPD) and 16 patients undergoing double lung transplantation for very severe COPD were examined. CD57+ cells, neutrophils, macrophages and mast cells infiltrating bronchioles (epithelium, smooth muscle and connective tissue) and parenchymal interstitium were localized and quantified by immunohistochemical analysis. Compared to the other groups, the small airways of very severe COPD patients showed a significantly higher density of CD57+ cells, mainly infiltrated in the connective tissue (p=0.001), and a significantly higher density of neutrophils located characteristically in the epithelium (p=0.037). Also, the density of neutrophils was significantly higher in parenchyma of very severe COPD patients compared with the rest of the groups (p=0.001). Finally, there were significant correlations between the bronchiolar density of CD57+ cells and the FEV1 values (R=-0.43, p=0.022), as well as between the parenchymal density of neutrophils and macroscopic emphysema degree (R=0.43, p=0.048) in COPD groups. These results show that CD57+ cells may be involved in COPD pathogenesis, especially in the most severe stages of the disease.

Seguridad y eficacia del propofol en perfusión continua para la realización de endoscopias digestivas altas diagnósticas en respiración espontánea / Safety and efficacy of continuous infusion propofol for diagnostic upper gastrointestinal endscopy in spontaneous breathing

Introducción: Los procedimientos invasivos (PI) constituyen una parte importante de las causas de ingreso en una unidad de cuidados intensivos pediátrica de segundo nivel. El paciente pediátrico tiene unas características especiales que motivan que para los PI se haga un enfoque anestésico diferente que en el adulto y frecuentemente precisan una sedación profunda. El objetivo de nuestro trabajo fue valorar la seguridad y eficacia del propofol en infusión continua en la población pediátrica para la sedación en endoscopias digestivas altas (EDA) diagnósticas en respiración espontánea. Pacientes y métodos: Estudio prospectivo observacional. Periodo de estudio: septiembre del 2009 a mayo del 2010. Ámbito: unidad de cuidados intensivos pediátricos de un hospital de segundo nivel. Población diana: pacientes pediátricos que precisaban la realización de EDA diagnóstica. Intervenciones: protocolo de sedoanalgesia: fentanilo (bolo inicial 1μg/kg, siguientes dosis a 0,5μg/kg), propofol (bolo inicial lento a 1-2mg/kg e infusión continua a 3-4mg/kg/h, siguientes bolos a 0,5-1mg/kg y aumento de la infusión en 1mg/kg/h hasta un máximo de 6mg/kg/h). Objetivo: alcanzar un grado 5-6 en la escala de Ramsay modificada y amnesia del procedimiento. Variables de interés principales: a) dosis de fármacos administrados; b) tiempo de inducción, duración del procedimiento, tiempo de recuperación; c) grado de sedoanalgesia y amnesia, y d) efectos adversos. Resultados: Se expresan como mediana y valores de rango IQ. Se realizaron 31 sedoanalgesias para 31 EDA diagnósticas. La indicación de EDA fue: sospecha de celiaquía (84%) o dispepsia (16%). Edad 8 años (2-11). Dosis total de propofol administrada 5 (3,8-6,2) mg/kg y el ritmo de infusión continua (IC) 4 (3,8-4,5) mg/kg/h. Dosis de fentanilo administrada 1 (1-1) μg/kg. Tiempo de inducción 6 (5-9) min, duración del procedimiento 15 (10-25) min y el tiempo de despertar/recuperación 10 (9-14) min. Sólo un paciente presentó efectos adversos (vómitos), pudiendo realizarse el procedimiento en el 100%. Los 21 pacientes mayores de 4 años tuvieron amnesia del procedimiento. Conclusiones: La administración de propofol en infusión continua para endoscopias digestiva altas diagnósticas en respiración espontánea parece segura y eficaz (AU)

Introduction: Invasive procedures (IP) are an important reason for admision to PICU. Paediatric patients need a special anaesthetic approach and deep sedation is frequently required. The objective was to evaluate the safety and efficacy of continuous infusion propofol to achieve sedation for diagnostic upper gastrointestinal endoscopy (UGE) in spontaneous breathing. Patients and methods: Prospective observational study. Scope: Secondary hospital Paediatric Intensive Care Unit. Period of study September 2009 to May 2010. Patients: Children subjected to diagnostic UGE. Intervention: sedation-analgesia protocol with: fentanyl (1 ug/kg for first dose and 0.5 ug/kg for the next one), propofol (1-2mg/kg for first dose and continuous infusion at 3-4mg/kg/h, if needed, subsequent doses at 0.5-1mg/kg and increasing infusion from 1mg/kg/h up to 6mg/kg/h maximum). The objective was to reach 5-6 grade for modified Ramsay scale and amnesia related to UGE. Main endpoints: a) dose of drugs, b) time to sedoanalgesia, recovery and length for the procedure, c) sedoanalgesis grade and amnesia related to procedure and d) adverse effects. Results: Expressed as median and interquartile range; 31 sedoanalgesias were performed on 31 children for UGE. Indications for UGE were suspected coeliac disease (84%) or dyspeptic syndrome (16%). Mean age was 8 (2-11) years. Propofol total dose 5 (3.8-6.2) mg/kg. Propofol infusion rate 4 (3.8-4.5) mg/kg/h. Fentanyl dose 1 (1-1) μg/kg. Induction time 6 (5-9) minutes, procedural time 15 (10-25) minutes and recovery/awake time 10 (9-14) minutes. Adverse effects observed consisted of 1 patient vomiting. UGE was successfully achieved in 100%. Amnesia was achieved in all of the 21 patients older than 4 years. Conclusions: Continuous propofol infusion seems to be both effective and safe to achieve sedation for diagnostic upper gastrointestinal endoscopy in spontaneously breathing (AU)

[Safety and efficacy of continuous infusion propofol for diagnostic upper gastrointestinal endscopy in spontaneous breathing]. / Seguridad y eficacia del propofol en perfusión continua para la realización de endoscopias digestivas altas diagnósticas en respiración espontánea.

INTRODUCTION: Invasive procedures (IP) are an important reason for admision to PICU. Paediatric patients need a special anaesthetic approach and deep sedation is frequently required. The objective was to evaluate the safety and efficacy of continuous infusion propofol to achieve sedation for diagnostic upper gastrointestinal endoscopy (UGE) in spontaneous breathing. PATIENTS AND METHODS: Prospective observational study. SCOPE: Secondary hospital Paediatric Intensive Care Unit. Period of study September 2009 to May 2010. PATIENTS: Children subjected to diagnostic UGE. INTERVENTION: sedation-analgesia protocol with: fentanyl (1 ug/kg for first dose and 0.5 ug/kg for the next one), propofol (1-2 mg/kg for first dose and continuous infusion at 3-4 mg/kg/h, if needed, subsequent doses at 0.5-1 mg/kg and increasing infusion from 1 mg/kg/h up to 6 mg/kg/h maximum). The objective was to reach 5-6 grade for modified Ramsay scale and amnesia related to UGE. Main endpoints: a) dose of drugs, b) time to sedoanalgesia, recovery and length for the procedure, c) sedoanalgesis grade and amnesia related to procedure and d) adverse effects. RESULTS: Expressed as median and interquartile range; 31 sedoanalgesias were performed on 31 children for UGE. Indications for UGE were suspected coeliac disease (84%) or dyspeptic syndrome (16%). Mean age was 8 (2-11) years. Propofol total dose 5 (3.8-6.2) mg/kg. Propofol infusion rate 4 (3.8-4.5) mg/kg/h. Fentanyl dose 1 (1-1) µg/kg. Induction time 6 (5-9) minutes, procedural time 15 (10-25) minutes and recovery/awake time 10 (9-14) minutes. Adverse effects observed consisted of 1 patient vomiting. UGE was successfully achieved in 100%. Amnesia was achieved in all of the 21 patients older than 4 years. CONCLUSIONS: Continuous propofol infusion seems to be both effective and safe to achieve sedation for diagnostic upper gastrointestinal endoscopy in spontaneously breathing.

Significant increase of CD57+ cells in pulmonary lymphoid follicles of COPD patients.

Although the presence of pulmonary lymphoid follicles (LFs) has been associated with the progression of chronic obstructive pulmonary disease (COPD), there is no information regarding the pattern of vascularisation, expression of addressins or inflammatory cell densities within these structures in COPD. Histological and immunohistochemical techniques were used to assess the prevalence, structure, localisation, vascularisation and cell proliferation/apoptosis of LFs, as well as the follicular density of B- and T-lymphocytes, macrophages, dendritic cells and CD57(+) cells, in lung tissue of nine nonsmokers, 18 smokers without COPD, 16 smokers with moderate COPD and 16 patients with very severe COPD. The density of CD57(+) cells within LFs of COPD patients was significantly increased compared to that of nonsmokers and smokers without COPD (p<0.05). Moreover, the percentage of LF profiles with cell apoptosis was also significantly higher in COPD patients (p = 0.03). By contrast, no significant differences among groups were observed in the follicular densities of other inflammatory cells, nor in the distribution of blood and lymphatic vessels within LFs. Since CD57(+) cells are important effectors of cytotoxicity and immune regulation, an increase in their follicular density supports the hypothesis of local immune dysfunction in COPD.

Adecuación de diálisis peritoneal aguda en Unidad de Cuidados Intensivos Pediátrica / Adequacy of acute peritoneal dialysis in pediatric patients

La diálisis peritoneal aguda (DPA) continúa siendo una medida útil en el paciente pediátrico crítico. En el shock séptico el fracaso renal agudo puede precisar medidas invasivas de depuración y aunque la hemofiltración es muy efectiva, en ciertas Unidades de Cuidados Intensivos Pediátricas no se dispone aún de ella. La DPA pediátrica se suele iniciar con pases horarios, permanencias cortas y volumen por pase de unos 10 ml/kg. Mostramos la evolución de la DPA de dos pacientes críticos con fallo renal en los que la monitorización de los cocientes dializado/plasma de urea y creatinina y del cociente de concentración de glucosa del dializado (efluente)/concentración de glucosa de la solución de diálisis infundida fue útil para la prescripción de la DPA

Acute peritoneal dialysis (APD) is still a useful tool in the critical pediatric patient. Acute kidney failure due to septic shock often requires invasive depuration procedures and although hemofiltration is very effective, not all pediatric Intensive Care Units have the equipment necessary to establish it. Pediatric APD is generally initiated with short dwell times, every hour exchanges and 10-20 ml/kg filling volumes. We present the evolution of two critical patients with kidney failure on APD who benefited from the measurement of dialysate-to-plasma (D/P) ratios for creatinine and urea, and dialysate-to-solution ratio for glucose (Dt/Do) to optimize APD prescription

[Adequacy of acute peritoneal dialysis in pediatric patients]. / Adecuación de diálisis peritoneal aguda en Unidad de Cuidados Intensivos Pediátrica.

Acute peritoneal dialysis (APD) is still a useful tool in the critical pediatric patient. Acute kidney failure due to septic shock often requires invasive depuration procedures and although hemofiltration is very effective, not all pediatric Intensive Care Units have the equipment necessary to establish it. Pediatric APD is generally initiated with short dwell times, every hour exchanges and 10-20 ml/kg filling volumes. We present the evolution of two critical patients with kidney failure on APD who benefited from the measurement of dialysate-to-plasma (D/P) ratios for creatinine and urea, and dialysate-to-solution ratio for glucose (Dt/Do) to optimize APD prescription.

Polyamines: metabolism to systems biology and beyond.

Polyamines and the metabolic and physiopathological processes in which they are involved represent an active field of research that has been continuously growing since the seventies. In the last years, the trends in the focused areas of interest within this field since the 1970s have been confirmed. The impact of "-omics" in polyamine research remains too low in comparison with its deep impact on other biological research areas. These high-throughput approaches, along with systems biology and, in general, more systemic and holistic approaches should contribute to a renewal of this research area in the near future.

[Utility of inhaled nitric oxide in patient with acute respiratory distress syndrome and un-operated Fallot's tetralogy]. / Utilidad del óxido nítrico inhalado en paciente con síndrome de distrés respiratorio agudo y tetralogía de Fallot no intervenida.

Utility of inhaled nitric oxide in the treatment of acute respiratory distress syndrome (ARDS) with pulmonary hypertension (PHT) is controversial and there are few studies in the literature that evaluate its effects during prolonged administration. We analyze the case of a 45 day old male patient with un-operated Fallot's tetralogy who developed ARDS and PHT with non-cardiac cause, that required prolonged mechanical ventilation (30 days) and administration of inhaled nitric oxide (INO). Before the INO, the oxygenation index was 19, and at a few minutes of its application it decreased to 15. The patient developed a dependence on INO, tolerating its gradual weaning. Administration could be interrupted at 27 days on onset. We did not observe toxic effects during the administration of INO.

Utilidad del óxido nítrico inhalado en paciente con síndrome de distrés respiratorio agudo y tetralogía de Fallot no intervenida / Utility of inhaled nitric oxide in patient with acute respiratory distress syndromeand un-operated Fallot's tetralogy

La utilidad del óxido nítrico inhalado en el tratamiento del síndrome de distrés respiratorio agudo (SDRA) con hipertensión pulmonar (HPP) es controvertida y hay pocos estudios en la literatura que evalúen sus efectos durante una administración prolongada. Analizamos el caso de un paciente de 45 días de vida con tetralogía de Fallot no intervenida, que desarrolló SDRA e HPP de causa no cardíaca, que precisó ventilación mecánica prolongada (30 días) y administración de óxido nítrico inhalado (ONI). Antes del ONI el índice de oxigenación era 19 y a los pocos minutos de su aplicación descendió a 15. El paciente desarrolló dependencia del ONI, tolerando un destete gradual, pudiendo interrumpir la administración a los 27 días de su inicio. No observamos efectos tóxicos durante la administración del ONI

Utility of inhaled nitric oxide in the treatment of acute respiratory distress syndrome (ARDS) with pulmonary hypertension (PHT) is controversial and there are few studies in the literature that evaluate its effects during prolonged administration. We analyze the case of a 45 day old male patient with un-operated Fallot's tetralogy who developed ARDS and PHT with non-cardiac cause, that required prolonged mechanical ventilation (30 days) and administration of inhaled nitric oxide (INO). Before the INO, the oxygenation index was 19, and at a few minutes of its application it decreased to 15. The patient developed a dependence on INO, tolerating its gradual weaning. Administration could be interrupted at 27 days on onset. We did not observe toxic effects during the administration of INO

Enfermedad de Kawasaki: importancia del diagnóstico precoz / Kawasaki´s disease: importance of early diagnosis

No disponible

[Sildenafil in the treatment of pulmonary hypertension]. / Sildenafilo en el tratamiento de la hipertensión pulmonar.

Pulmonary hypertension (PHT) is a rare entity that is difficult to treat. Prognosis is poor. Sildenafil, a selective inhibitor of type 5 phosphodiesterase, has been proposed among the many treatments available for primary and secondary pulmonary hypertension. We report our experience with an infant with pulmonary hypertension due to congenital mitral stenosis and persistent ductus arteriosus, who developed congestive cardiac failure with persistent PHT despite surgical correction. Conventional treatment was unsuccessful and the patient was treated with sildenafil. The clinical course was satisfactory, allowing extubation and withdrawal of vasoactive drugs; pulmonary and left atrial pressure decreased and the patient was discharged. She is currently being treated on an outpatient basis with oral sildenafil and shows satisfactory hemodynamic status. We review alternatives to conventional treatments for pulmonary hypertension with special reference to pediatrics.