Ultrasound-guided puncture vs conventional technique for arterial blood gas analysis sampling in adults: A systematic review.

AIM: To compare the efficacy of conventional puncture versus ultrasound-guided puncture for arterial blood gas sampling in adults. METHOD: A search protocol was developed and applied to three databases (Medline, Cochrane, and Dialnet). Clinical trials published between January 2013 and January 2023, in Spanish or English, were considered. Outcomes in terms of first-attempt success, number of attempts until success, time taken, self-reported iatrogenic pain, and patient or professional experience were collected. The risk of bias for each included study was assessed. RESULTS: Five randomized clinical trials were selected, with sample sizes ranging from 50 to 238 adult patients treated in emergency settings. Three out of four studies showed higher first-attempt success rates when using ultrasound, and 2 out of 4 studies reported a decrease in iatrogenic pain. Discrepant findings were observed among the studies in terms of time taken and the number of attempts required for success. CONCLUSIONS: Although current evidence is limited and the findings are heterogeneous, ultrasound-guided arterial puncture may have advantages over conventional puncture in terms of first-attempt success and in reducing iatrogenic pain.

Actualización de los tumores cartilaginosos según la clasificación de la OMS de 2020 / Update of cartilaginous tumours according to the WHO classification 2020

Los tumores cartilaginosos son un grupo amplio y heterogéneo de neoplasias caracterizadas por la presencia de una matriz condroide que presenta crecimiento lobular y patrones de calcificación en arcos y anillos o en palomitas de maíz. En RM destaca su hiperintensidad en las secuencias potenciadas en T2, y en las imágenes poscontraste, un relace lobulado o septal. En la clasificación de 2020 de la OMS, los tumores de estirpe condral se clasifican en benignos, intermedios o malignos. A pesar de los avances tecnológicos, siguen suponiendo un reto tanto para el radiólogo como para el patólogo, siendo la principal dificultad la diferenciación entre los tumores benignos y malignos, razón por la que requieren un abordaje multidisciplinar. Este trabajo recoge los principales cambios introducidos en la actualización de 2020, describe las características de imagen de los principales tumores cartilaginosos y proporciona las claves radiológicas para diferenciar entre tumores benignos y malignos.(AU)

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.(AU)

Update of cartilaginous tumours according to the WHO classification 2020.

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.

The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study.

Background: The association between tobacco use and COVID-19 is controversial. During the early course of the pandemic, limited testing prevented studying a wide spectrum of clinical manifestations. Objective: To examine the potential causal association between tobacco use and COVID-19 during the second wave (1 October 2020-30 June 2021) of the pandemic in Stockholm, Sweden. Methods: A population-based cohort study was conducted in the Stockholm region of Sweden, with information on tobacco use collected prior to the pandemic. Adjusted relative risks (RR) of COVID-19 and 95% confidence intervals (CI) were calculated, contrasting current smokers and snus users to non-users of tobacco. Results: Compared with non-users of tobacco, current smokers had a lower risk of COVID-19 (RR 0.78, 95% CI = 0.75-0.81) and of hospitalisation for the disease. Current snus users had a higher risk of COVID-19. Heavy smokers and snus users had longer hospital stays than non-users of tobacco. Conclusion: Tobacco use may have a different impact on the risk of being infected with SARS-CoV-2 and the risk of developing severe clinical manifestations. Further research is needed to determine the underlying mechanisms.

Application of participatory design and open source to a sustainable proposal for sorption reactor design.

An implementation proposal that seeks to globalize the scope of the sustainable technologies developed in the University laboratories is presented. This approach uses the generation of triple-impact projects placing people at the center of technological development to bring technical and scientific knowledge into a service design oriented to global sustainable solutions. This research is an approach to what a hub for scientific research, technological implementation, and human needs would look like by designing common environments in which to interact and expand knowledge in an iterated way through the experience of all the actors involved in technological implementation. As a control case, a new technology developed at the Universidad de Buenos Aires, consisting of using sustainable materials as tubular reactor fillers for water treatment was chosen. Based on data obtained within the framework of a University extension project, in which the water quality diagnosis for human consumption was carried out and cross-examined with the mathematical analysis of sorption, design parameters of the reactor, participatory design, and open source concepts application, different virtual environments were generated with distinct objectives: i) open design environment: publishing and mapping of installed sorption reactors, reactor model plans, and useful information related to drinking water quality (aimed at contributors of the open source design environment); ii) platform for academic actors linking: connecting data between prototyping lab for participatory design of sorption reactors (aimed at university research users); iii) information disclosure page: space where the implemented technology impact is displayed and shows options to contact researchers and request a reactor design diagnosis for another community (aimed at beneficiary users). A technological service designed to link the University with the community was proposed, by resolving one of the main gaps related to the possibility for communities to access public financing for self-managed improvement projects, increasing the appropriation of the adopted technology and democratizing public investment, making it sustainable over time.

Establishment of a desirable dose using neutral argon plasma to eradicate miliary peritoneal implants: A phase I/II controlled trial.

INTRODUCTION: Neutral argon plasma (NAP) system could meet the requirements to achieve oncological cytoreduction of peritoneal carcinomatosis with miliary lesions, minimizing the associated morbidity. This phase I/II trial aims to establish the desirable dose that is safe and effective in eliminating tumor cells with lower penetration. METHODS: Patients diagnosed with different origins for peritoneal carcinomatosis and miliary implants were selected for the study. The safe and potentially effective dose (desirability) of NAP was evaluated according to three factors: distance (mm), application time (s) and power (%), to evaluate the response variables such as the presence of tumor cells (Y/N) and the depth of penetration. RESULTS: Ten patients and 120 samples were evaluated and treated with NAP. There was no vascular or organ injury intraoperative using a pre-established dose of 100% (coagulation mode) at a distance of 2-3 cm. The distance was found to be correlated with the presence of the tumor cells in ex-vivo analysis, with an OR of 15.4 (4.0-111.4). The time and energy used were protective factors to eliminate tumor cells with an OR of 0.4 (0.1-0.9) and 0.8 (0.8-0.9), respectively. The safest and most effective desirability results were as follows i) energy 80% during 2-4 s with a distance of 2 cm (0.89), and ii) energy 100% during 2-4 s with a distance of 3 cm (0.90). CONCLUSIONS: The use of NAP during a CRS and HIPEC is safe and effective for eradicating tumor cells on the peritoneal surface at suggested doses of energy, distance and duration. TRIAL IDENTIFICATION: ClinicalTrials.gov Identifier: NCT04904042.

Participation of leukaemia inhibitory factor in follicular development and steroidogenesis in rat ovaries.

Leukaemia inhibitory factor (LIF) is a cytokine belonging to the interleukin-6 family that is important at the reproductive level in the uterine implantation process. However, there is very little evidence regarding its effect at the ovarian level. The aim of this work was to study the local involvement of the LIF/LIFRß system in follicular development and steroidogenesis in rat ovaries. To carry out this research, LIF/LIFR/GP130 transcript and protein levels were measured in fertile and sub-fertile rat ovaries, and in vitro experiments were performed to assess STAT3 activation. Then, in in vivo experiments, LIF was administered chronically and locally for 28 days to the ovaries of rats by means of an osmotic minipump to enable us to evaluate the effect on folliculogenesis and steroidogenesis. It was determined by quantitative polymerase chain reaction and western blot that LIF and its receptors are present in fertile and sub-fertile ovaries and that LIF varies during the oestrous cycle, being higher during the oestrus and meta/dioestrus stages. In addition to this, it was found that LIF can activate STAT3 pathways and cause pSTAT3 formation. It was also observed that LIF decreases the number and size of preantral and antral follicles without altering the number of atretic antral follicles and can increase the number of corpora lutea, with a notable increase in the levels of progesterone (P4). It is therefore possible to infer that LIF exerts an important effect in vivo on folliculogenesis, ovulation and steroidogenesis, specifically the synthesis of P4.

[Differences between Spain's autonomous communities in the availability of semi-automatic external defibrillators outside the healthcare setting]. / Diferencias entre comunidades autónomas de España en la dotación de desfibriladores externos semiautomáticos fuera del ámbito sanitario.

BACKGROUND: Early defibrillation is one of the interventions that can most influence the prognosis of cardiac arrest. The objectives of this study were to determine the number of automatic external defibrillators outside the healthcare setting in each autonomous community in Spain and to compare the legislation of each autonomous community on the mandatory installation of defibrillators outside the healthcare setting. METHODS: A cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities. RESULTS: Complete data on the number of registered defibrillators were obtained from 15 autonomous communities. The number of defibrillators ranged from 35 to 126 per 100,000 inhabitants. At the global level, differences were observed between communities with mandatory defibrillator installation and those without (92.1 vs. 57.8 defibrillators/100,000 inhabitants). CONCLUSIONS: There is heterogeneity in the provision of defibrillators outside the health care setting, which seems to be related to the diversity of legislation on the mandatory installation of defibrillators.

Current tobacco use and COVID-19 diagnoses in a cohort of adult clients of public dental clinics in Sweden.

Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99-1.21 among men and 1.15; 95%CI = 1.00-1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61-0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47-0.76) and intensive care (aRR = 0.43; 95% CI = 0.21-0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.

Déficit de glucosa-6-fosfato deshidrogenasa asociado a rasgo falciforme: importancia de una buena historia clínica / Glucose-6-phosphate dehydrogenase deficiency associated with sickle cell trait: importance of a good medical history

Introducción: El déficit de glucosa-6-fosfato deshidrogenasa es la alteración enzimática más frecuente a nivel eritrocitario. El debut característico lo constituye un paciente previamente sano en el que se desencadena una crisis hemolítica por determinados fármacos, infecciones o alimentos. En este último contexto es conocido como favismo el cuadro clínico secundario a la ingesta de habas. Caso clínico. Varón de 23 meses que consulta por fiebre, ictericia, palidez y coluria. Como antecedente personal de interés destaca la determinación de un rasgo falciforme en el cribado neonatal. Los resultados de la analítica sanguínea son compatibles con una crisis hemolítica no inmune, por lo que se establece como hipótesis diagnóstica una anemia hemolítica desencadenada por proceso infeccioso en paciente con rasgo falciforme. Puesto que el rasgo falciforme es asintomático, durante el ingreso se amplíó la anamnesis detectándose al menos un episodio de similares características, pero más leve, y al incidir en la dieta familiar se confirmó la ingesta intermitente de habas. Ante la posibilidad de favismo se solicitó análisis genético que confirmó el diagnóstico. Conclusiones. Las complicaciones de las enfermedades de base de cada paciente frecuentemente causan sus patologías, pero no siempre es así. Es fundamental realizar una anamnesis exhaustiva, dado que esta puede ofrecer claves diagnósticas inesperadas.(AU)

Introduction. Glucose-6-phosphate dehydrogenase deficiency is the most common enzymatic alteration at the erythrocyte level. The characteristic onset is a previously healthy patient in whom a hemolytic crisis is triggered by certain drugs, infections or foods. In this latter context, the clinical condition secondary to the ingestion of broad beans is known as favism. Clinical case. A 23-month-old male presented with fever, jaundice and choluria. As a personal history of interest, the determination of a sickle cell trait in neonatal screening stands out. The blood test results are compatible with a non-immune hemolytic crisis, so the diagnostic hypothesis is established as a hemolytic anemia triggered by an infectious process in a patient with sickle cell trait. During their stay in the ward, the anamnesis is expanded, detecting at least one episode with similar but milder characteristics and by influencing the family diet, the intermittent intake of beans at least once a month is confirmed. Given the possibility of favism, genetic analysis is requested to confirm the diagnosis. Conclusions. The complications of each patient’s underlying diseases often cause their pathologies, but this is not always the case. It is essential to carry out an exhaustive anamnesis, since this can offer unexpected.(AU)

Identification of potentially irritating intravenous medications.

AIMS: To identify commonly used intravenous drugs that may produce endothelial damage. METHODS: An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low. RESULTS: Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100 ml of saline. CONCLUSIONS: Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.

Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation.

AIM: To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). METHODS: An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. RESULTS: Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR = 3.03; 95% CI 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI .87-.99) and grip strength (OR: .94; 95% CI .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. CONCLUSIONS: The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.

Tratamiento quirúrgico de los leiomiosarcomas de vena cava. Serie de casos en un hospital de tercer nivel y revisión de la literatura / Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review

Introducción Los tumores primarios de vena cava inferior son tumores raros de origen mesenquimal que surgen de la musculatura lisa de la pared. Debido a su escasa prevalencia, existen pocos datos definitivos sobre su tratamiento y pronóstico. Su tratamiento se basa en principios oncológicos generales. Métodos Se ha analizado una serie de 6 casos intervenidos desde 2010 a 2020, evaluando distintos parámetros relacionados con las características demográficas del tumor, del tratamiento recibido y de los resultados obtenidos en supervivencia y morbilidad. Además, se ha llevado a cabo una revisión bibliográfica de la evidencia disponible actualmente. Resultados En todos los pacientes se llevó a cabo una resección quirúrgica óptima con R0 en 4/6 y R1 en 2/6. La mayor morbilidad sucedió en un paciente fallecido en periodo intraoperatorio. Se realizó cavorrafia en un paciente y cavoplastia en 5/6 utilizando injerto criopreservado en 3/6 y prótesis en 2/6. Al final del seguimiento de nuestra serie (con una media de seguimiento de 10,7 meses), el 50% de los pacientes continúan vivos. La media de supervivencia fue de 11,3±9,07 meses. De los 6 pacientes, 3 presentaron recidivas hematógenas con un intervalo libre de enfermedad de 9±2 meses. Conclusión El diagnóstico y tratamiento del leiomiosarcoma de vena cava inferior continúa siendo un reto. Debido a su baja prevalencia, resultará difícil establecer un tratamiento totalmente estandarizado, y se recomienda su abordaje en centros especializados. Por otra parte, se deberían intentar aunar los casos intervenidos de cara a avanzar en el conocimiento del abordaje de esta enfermedad (AU)

Introduction Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. Methods A series of six cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. Results Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavography was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3±9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9±2 months. Conclusion The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease (AU)

[Unnecessary peripheral venous catheters in ambulatory emergency care].

The aim of this study was to estimate the frequency of unnecessary peripheral venous catheter (PVC) cannulation in adult patients attended in Ambulatory Emergency Care, and to analyse potential associated factors. An exploratory cross-sectional study was conducted in a tertiary hospital for two consecutive months. The proportion of canulated and unused PVC was calculated and related to patient variables. A PVC was cannulated in 701 patients. In 103 cases (14.7%; 95%CI: 12.1-17.3) the catheter was not used, and the patients were discharged directly home. Age over 64 was associated with a higher proportion of unsuitability (19.3% vs. 10.8%; p=0.002). There seems to be a certain proportion of catheters cannulated unnecessarily in Ambulatory Emergency Care, which would justify the implementation of good practice programmes in the assessment and selection of vascular accesses.

Características de los reanimadores asociadas a la correcta compresión torácica durante la reanimación cardiopulmonar / Rescuers’ characteristics associated with the correct chest compression during cardiopulmonary resuscitation

Objetivos: Analizar las características físicas, antropométricas y formativas de los reanimadores asociadas a la correcta compresión y reexpansión torácica durante la reanimación cardiopulmonar. Metodología: Estudio observacional prospectivo. Profesionales y estudiantes sanitarios de urgencias y cuidados críticos realizaron 2min de compresiones torácicas sobre un maniquí. Se evaluó la profundidad y la presión residual tras las compresiones, y se estudió su asociación a diferentes variables (físicas, antropométricas y formativas) mediante la creación de modelos de regresión logística. Resultados: Participaron 238 voluntarios. Que el reanimador tuviese una experiencia previa en menos de 6 reanimaciones cardiopulmonares (OR: 3,03; IC 95%: 1,2-7,63) se asoció a una mayor probabilidad de no lograr una profundidad adecuada en las compresiones. Una mayor estatura (OR: 0,93; IC 95%: 0,87-0,99) y fuerza de aprehensión (OR: 0,94; IC 95%: 0,89-0,99) fueron condiciones que actuaron como factores predisponentes a la ejecución de una técnica correcta. Ninguna característica se asoció a la adecuación de la reexpansión torácica. Conclusiones: La experiencia previa del reanimador es el factor más fuertemente asociado a la correcta ejecución de las compresiones torácicas. En menor medida, también influye la estatura y la fuerza del tren superior del profesional. No se han identificado factores asociados a la adecuación de la reexpansión torácica tras las compresiones.(AU)

Aim: To analyse the caregivers’ physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). Methods: An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. Results: Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. Conclusions: The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.(AU)

Identificación de medicamentos intravenosos potencialmente irritantes / Identification of potentially irritating intravenous medications

Objetivos: Identificar los medicamentos intravenosos de uso común en el ámbito hospitalario con capacidad de producir daño endotelial. Método: Estudio experimental in vitro. La muestra estuvo formada por 62 medicamentos de uso común en los servicios de urgencias y hospitalización. Las variables estudiadas fueron la osmolaridad y el pH. Posteriormente, en base a esos valores, se determinó la capacidad teórica para provocar daño endotelial, clasificándola en alta, moderada y baja. Resultados: Se analizaron 19 medicamentos para fluidoterapia, 21 antibióticos y 22 medicamentos intravenosos. Las soluciones de glucosa, el bicarbonato 1M y el manitol 10% presentaron una capacidad elevada para provocar irritación venosa. Vancomicina, ciprofloxacino, amiodarona, haloperidol y labetalol mostraron una capacidad irritativa elevada derivada de su pH marcadamente ácido. Los antibióticos, dexketoprofeno, diazepam, digoxina, etomidato, fenitoína, levetiracetam y metamizol presentaron valores extremos de osmolaridad en su presentación reconstituida o sin diluir, y mantuvieron sus valores de tonicidad elevados después de diluirlos en 100ml de suero salino el diazepam, la digoxina y la fenitoína. Conclusiones: Conocer el pH y la osmolaridad de los medicamentos intravenosos permite evaluar su capacidad para provocar daño endotelial. La creación de tablas comprensivas en base a las propiedades químicas de los medicamentos puede constituir una herramienta útil que contribuya a prevenir la flebitis químicamente inducida.(AU)

Aims: To identify commonly used intravenous drugs that may produce endothelial damage. Methods: An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low. Results: Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100mL of saline. Conclusions: Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.(AU)

Catéteres venosos periféricos innecesarios en la zona ambulatoria de un servicio de urgencias / Unnecessary peripheral venous catheters in ambulatory emergency care

El objetivo de este estudio fue estimar la frecuencia de canalización innecesaria de catéteres venosos periféricos (CVP) en pacientes adultos atendidos en la zona ambulatoria del servicio de urgencias, y analizar potenciales factores asociados.Se realizó un estudio transversal exploratorio en un hospital de tercer nivel durante dos meses consecutivos. Se calculó la proporción de CVP insertados y no utilizados, y se relacionó con variables del paciente.A 701 pacientes se les insertó un CVP, en 103 (14,7%; IC95%: 12,1-17,3) el catéter no llegó a ser utilizado, siendo dados de alta directamente a domicilio. La edad superior a 64 años se asoció a una mayor tasa de inadecuación (19,3 vs 10,8%; p=0,002).Parece existir cierta proporción de catéteres canalizados de forma innecesaria en el área ambulatoria urgencias, lo que justificaría la implantación de programas de buenas prácticas en la valoración y selección de accesos vasculares.(AU)

The aim of this study was to estimate the frequency of unnecessary peripheral venous catheter (PVC) cannulation in adult patients attended in Ambulatory Emergency Care, and to analyse potential associated factors. An exploratory cross-sectional study was conducted in a tertiary hospital for two consecutive months. The proportion of canulated and unused PVC was calculated and related to patient variables. A PVC was cannulated in 701 patients. In 103 cases (14.7%; 95%CI: 12.1-17.3) the catheter was not used, and the patients were discharged directly home. Age over 64 was associated with a higher proportion of unsuitability (19.3% vs. 10.8%; p=0.002). There seems to be a certain proportion of catheters cannulated unnecessarily in Ambulatory Emergency Care, which would justify the implementation of good practice programmes in the assessment and selection of vascular accesses.(AU)

Benefits and costs of immune memory in Rhodnius prolixus against Trypanosoma cruzi.

There is increasing evidence supporting the immune memory in invertebrates, but the studies are relatively neglected in insect vectors other than mosquitoes. Therefore, we tested two hypotheses: 1) Rhodnius prolixus insects possess immune memory against Trypanosoma cruzi, and 2) their immune memory is costly. The Dm28c and Y strains of T. cruzi were used, the former being more infective than the latter. On the one hand, the triatomines subjected to dual challenges with the Dm28c strain did not show significant differences in survival than those of the heterologous challenge groups control-Dm28c and Y-Dm28c. On the other hand, the insects survived longer after a dual Y-Y challenge than after the corresponding heterologous challenge (control-Y). The Y-Y, Dm28c-Y, and naïve groups showed similar survival. There was more prolonged survival following the Y-Y versus Dm28c-Dm28c dual challenge. The Dm28c-Dm28c group exhibited moulting sooner than the control-Dm28c or naïve group. In contrast, there were no differences in the probability of moulting between the Y-Y and naïve groups. The results suggest that triatomines have immune memory against the Y but not the Dm28c strain. Further investigation on triatomine and T. cruzi interaction is needed to determine if infectivity accelerates or delay growth due to innate immune memory.

Impact of aging on mitochondrial respiration in various organs.

Mitochondria are considered central regulator of the aging process; however, majority of studies dealing with the impact of age on mitochondrial oxygen consumption focused on skeletal muscle concluding (although not uniformly) a general declining trend with advancing age. In addition, gender related differences in mitochondrial respiration have not been satisfactorily described yet. The aim of the present study was to evaluate mitochondrial oxygen consumption in various organs of aging male and female Fischer 344 rats at the ages of 6, 12 and 24 months. Mitochondrial respiration of homogenized (skeletal muscle, left and right heart ventricle, hippocampus, cerebellum, kidney cortex), gently mechanically permeabilized (liver) tissue or intact cells (platelets) was determined using high-resolution respirometry (oxygraphs O2k, Oroboros, Austria). The pattern of age-related changes differed in each tissue: in the skeletal muscle and kidney cortex of both sexes and in female heart, parameters of mitochondrial respiration significantly declined with age. Resting respiration of intact platelets displayed an increasing trend and it did not correlate with skeletal muscle respiratory states. In the heart of male rats and brain tissues of both sexes, respiratory states remained relatively stable over analyzed age categories with few exceptions of lower mitochondrial oxygen consumption at the age of 24 months. In the liver, OXPHOS capacity was higher in females than in males with either no difference between the ages of 6 and 24 months or even significant increase at the age of 24 months in the male rats. In conclusion, the results of our study indicate that the concept of general pattern of age-dependent decline in mitochondrial oxygen consumption across different organs and tissues could be misleading. Also, the statement of higher mitochondrial respiration in females seems to be conflicting, since the gender-related differences may vary with the tissue studied, combination of substrates used and might be better detectable at younger ages than in old animals.