Síndrome de DRESS asociado a alopurinol con fracaso renal agudo: a propósito de un caso / DRESS syndrome associated with alopurinol with acute kidney injury: a case report

Introducción: El síndrome de DRESS es una reacción mucocutánea y visceral grave provocada por fármacos que puede llegar a provocar la muerte por la afectación de hígado y riñón.Caso Clínico: Varón de 46 años que presentó un exantema generalizado no pruriginoso, junto con fiebre, síntomas digestivos, adenopatías cervicales y sudoración nocturna coincidiendo con la toma previa de alopurinol. Tras el ingreso en el hospital se le diagnostica hepatitis aguda y deterioro de la función renal con oliguria, necesitando realización de hemodiálisis urgente. Tras un tratamiento multidisciplinar entre los servicios de nefrología, digestivo y hematología, el paciente es dado de alta con mejora de su función renal, pero continúa en seguimiento ambulatorio.Conclusiones: El alopurinol, fármaco muy utilizado en la práctica clínica, puede tener reacciones adversas muy graves, poniendo en riesgo la vida del paciente.El síndrome de DRESS, al ser muy poco frecuente, no tiene un tratamiento estandarizado. En el caso concreto de nuestro paciente, una detección temprana, junto a un tratamiento efectivo, con recambios plasmáticos con albúmina, hemodiálisis y corticoides, propiciaron una evolución favorable del paciente, con recuperación de la función renal. (AU)

Introduction: DRESS syndrome is a severe drug-induced mucocutaneous and visceral reaction that can be fatal due to liver and kidney damage. Case report: A 46-year-old man developed a generalised, non-pruritic rash, together with fever, digestive symptoms, cervical lymphadenopathy and night sweats coinciding with the previous intake of allopurinol. On hospital admission, he was diagnosed with acute hepatitis and deterioration of renal function including oliguria, requiring urgent hemodialysis. After a multidisciplinary treatment by the nephrology, digestive and haematology departments, the patient was discharged with an improvement in renal function, although he continued to be monitored on an ambulatory service. Conclusions: Allopurinol, a widely used drug in clinical prac-tice, can cause severe and life-threatening adverse reactions.DRESS syndrome, being very rare, has no standardised treat-ment. Specifically in the case of the patient, early detection, combined with effective treatment, including plasma replace-ment with albumin, hemodialysis and corticosteroids, favou-rably influenced the patient’s evolution, with recovery of renal function. (AU)

Biomechanical Analysis of Cervical Motion With a Pediatric Immobilization and Extrication Device.

OBJECTIVE: To determine the motions produced during pediatric extrication when using a system of motion estriction and extrication. METHODS: Simulation-based biomechanical analysis study conducted with inertial sensors to measure motion produced in the cervical spine of a pediatric simulator during extrication from a vehicle. RESULTS: The mean of the movements was 3.5° (SD ±1.35°). The mean time was 4 minutes 1 second (SD, ±45.09 seconds). The mean rotation toward the right was 3.34° (SD ±3.52°) and toward the left 2.62° (SD ±2.26°). The mean for lateralization was 6.24° (SD ±3.20°) toward the right and 2.50° (DE ±2.76°) toward the left. The mean for flexion was 2.36° (SD ±2.10°) and for extension 4.21° (SD ±2.15°). CONCLUSIONS: The device analyzed allows for the extrication of the pediatric patient with high levels of motion restriction of the spinal column with the Pediatric Immobilization and Extrication System.

Comparación biomecánica de la autoextracción con y sin collarín cervical: estudio de simulación / Self-extraction with and without a cervical collar: a biomechanical simulation study

Objetivos: Comparar la autoextracción (AE) frente a la AE con collarines en sujetos con bajo riesgo de lesión cervical. Método: Estudio de simulación mediante análisis biomecánico con sensores inerciales, determinando la desalineación de la columna cervical durante la AE con y sin collarines cervicales. Resultados: El desequilibrio fue 3,12 (DE 34,62) grados mayor con el collarín STIFNECK (SN) (IC al 95% de -15,33 a 21,57; p =0,7234) que con AE y también 5,95 (DE 31,76) grados mayor con collarín X-COLLAR (XC) (IC al 95% de -10,98 a 22,87; p = 0,4654) que con AE. Cuando comparamos la AE con los diferentes tipos de collarines, observamos que con el collarín XC se produjeron 2,83 (DE 12,10) grados de desalineación más que con el collarín SN (IC al 95% de -3,62 a 9,27; p = 0,3650). Conclusiones: La desalineación de la columna cervical mediante la AE es similar a la provocada cuando se aplican collarines cervicales

Objective: To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries. Methods: Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar. Results: Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650). Conclusion: Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place

Self-extraction with and without a cervical collar: a biomechanical simulation study. / Comparación biomecánica de la autoextracción con y sin collarín cervical: estudio de simulación.

OBJECTIVES: To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries. MATERIAL AND METHODS: Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar. RESULTS: Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650). CONCLUSION: Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place.

OBJETIVO: Comparar la autoextracción (AE) frente a la AE con collarines en sujetos con bajo riesgo de lesión cervical. METODO: Estudio de simulación mediante análisis biomecánico con sensores inerciales, determinando la desalineación de la columna cervical durante la AE con y sin collarines cervicales. RESULTADOS: El desequilibrio fue 3,12 (DE 34,62) grados mayor con el collarín STIFNECK (SN) (IC al 95% de ­15,33 a 21,57; p =0,7234) que con AE y también 5,95 (DE 31,76) grados mayor con collarín X-COLLAR (XC) (IC al 95% de ­10,98 a 22,87; p = 0,4654) que con AE. Cuando comparamos la AE con los diferentes tipos de collarines, observamos que con el collarín XC se produjeron 2,83 (DE 12,10) grados de desalineación más que con el collarín SN (IC al 95% de ­3,62 a 9,27; p = 0,3650). CONCLUSIONES: La desalineación de la columna cervical mediante la AE es similar a la provocada cuando se aplican collarines cervicales.

[Kinematic analysis of the spine during placement on 2 transfer devices: a spinal backboard and a scoop stretcher]. / Análisis cinemático de la columna vertebral durante la colocación de dos dispositivos de transferencia: tablero espinal frente a camilla de cuchara.

OBJECTIVES: To analyze and compare measurements of spine kinematics during prehospital emergency responders' placement of a patient on a spinal backboard or a scoop stretcher. MATERIAL AND METHODS: Cross sectional, quasi-experimental clinical simulation to compare misalignment (main endpoint) by means of data from a 3-dimensional motion capture system. RESULTS: Mean (SD) misalignment during placement on the 2 devices was 37.53° (14.15°). By device, mean misalignment was 31.08° (6.38°) for the scoop stretcher and 43.97° (7.97°) for the backboard (P=.048). CONCLUSION: Less misalignment occurs during placement on the scoop stretcher than on the spinal backboard.

OBJETIVO: Analizar y comparar la cinemática de la columna vertebral durante la colocación del tablero espinal (TE) y de la camilla de cuchara (CC) en una situación simulada realizada por expertos en emergencias prehospitalarias. METODO: Estudio transversal, cuasiexperimental, de simulación clínica para comparar la desalineación (variable principal), mediante un sistema de captura de movimiento en 3 dimensiones. RESULTADOS: Los resultados obtenidos en la desalineación media durante la colocación de los dispositivos fueron de 37,53°: 31,08° (6,38) para la CC y de 43,97° (7,97) para el TE (p = 0,048). CONCLUSIONES: La colocación de la camilla de cuchara provoca menos desalineación que el tablero espinal.

[Biomechanical analysis of cervical spine movement on removal of motorcycle helmets]. / Análisis biomecánico del movimiento cervical en la extracción del casco en motoristas.

OBJECTIVES: To measure cervical spine movement during removal of a motorcycle helmet by health care professionals. MATERIAL AND METHODS: Observational study using biomechanical inertial sensors to detect movement in the spinal column during removal of helmets. RESULTS: Thirty-four emergency medicine specialists and nurses participated. The mean (SD) rotation was 1.14° (0.82°) to the left and 3.30° (1.69°) to the right (P<.001). Mean flexion was 9.82° (7.46°) and mean extension was 6.23° (6.86°) (P<.001). Mean lateral displacement was 5.73° (2.97°) to the left and 5.62° (8.22°) to the right (P=.678). The removal maneuvers took a mean of 70 seconds (4 seconds). CONCLUSION: Helmet removal was completed in an average of 70 seconds with flexion and rotation mainly toward the side where the professional supporting the head was positioned.

OBJETIVO: Determinar el movimiento cervical durante la extracción de un casco realizada por profesionales sanitarios. METODO: Estudio observacional mediante análisis biomecánico con sensores inerciales de los movimientos producidos en la columna durante la extracción de un casco. RESULTADOS: La muestra final la componen 34 profesionales de servicios de urgencias y emergencias. La rotación fue de 1,14 (DE 0,82)° hacia el lado izquierdo y de 3,30 (1,69)° hacia el lado derecho (p < 0,001). La flexoextensión fue de 9,82 (7,46)° para la flexión y de 6,23 (6,86)° para la extensión (p < 0,001). La lateralización fue de 5,73 (2,97)° para el lado izquierdo y de 5,62 (8,22)° para el lado derecho (p = 0,678). El tiempo medio de realización de la extracción fue 70 (4) seg. CONCLUSIONES: La extracción del casco se realizó en 70 segundos con flexión y rotación hacia el lado donde se encuentra colocado el profesional que sujeta la cabeza.

Análisis biomecánico del movimiento cervical en la extracción del casco en motoristas / Biomechanical analysis of cervical spine movement on removal of motorcycle helmets

Objetivo. Determinar el movimiento cervical durante la extracción de un casco realizada por profesionales sanitarios. Métodos. Estudio observacional mediante análisis biomecánico con sensores inerciales de los movimientos producidos en la columna durante la extracción de un casco. Resultados. La muestra final la componen 34 profesionales de servicios de urgencias y emergencias. La rotación fue de 1,14 (DE 0,82)° hacia el lado izquierdo y de 3,30 (1,69)° hacia el lado derecho (p < 0,001). La flexoextensión fue de 9,82 (7,46)° para la flexión y de 6,23 (6,86)° para la extensión (p < 0,001). La lateralización fue de 5,73 (2,97)° para el lado izquierdo y de 5,62 (8,22)° para el lado derecho (p = 0,678). El tiempo medio de realización de la extracción fue 70 (4) seg. Conclusión. La extracción del casco se realizó en 70 segundos con flexión y rotación hacia el lado donde se encuentra colocado el profesional que sujeta la cabeza (AU)

Objective. To measure cervical spine movement during removal of a motorcycle helmet by health care professionals. Methods. Observational study using biomechanical inertial sensors to detect movement in the spinal column during removal of helmets. Results. Thirty-four emergency medicine specialists and nurses participated. The mean (SD) rotation was 1.14° (0.82°) to the left and 3.30° (1.69°) to the right (P<.001). Mean flexion was 9.82° (7.46°) and mean extension was 6.23° (6.86°) (P<.001). Mean lateral displacement was 5.73° (2.97°) to the left and 5.62° (8.22°) to the right (P=.678). The removal maneuvers took a mean of 70 seconds (4 seconds). Conclusion. Helmet removal was completed in an average of 70 seconds with flexion and rotation mainly toward the side where the professional supporting the head was positioned (AU)

Análisis cinemático de la columna vertebral durante la colocación de dos dispositivos de transferencia: tablero espinal frente a camilla de cuchara / Kinematic analysis of the spine during placement on 2 transfer devices: a spinal backboard and a scoop stretcher

Objetivos: Analizar y comparar la cinemática de la columna vertebral durante la colocación del tablero espinal (TE) y de la camilla de cuchara (CC) en una situación simulada realizada por expertos en emergencias prehospitalarias. Método: Estudio transversal, cuasiexperimental, de simulación clínica para comparar la desalineación (variable principal), mediante un sistema de captura de movimiento en 3 dimensiones. Resultados: Los resultados obtenidos en la desalineación media durante la colocación de los dispositivos fueron de 37,53°: 31,08° (6,38) para la CC y de 43,97° (7,97) para el TE (p = 0,048). Conclusiones: La colocación de la camilla de cuchara provoca menos desalineación que el tablero espinal (AU)

Objective: To analyze and compare measurements of spine kinematics during prehospital emergency responders’ placement of a patient on a spinal backboard or a scoop stretcher. Methods: Cross sectional, quasi-experimental clinical simulation to compare misalignment (main endpoint) by means of data from a 3 dimensional motion capture system. Results: Mean (SD) misalignment during placement on the 2 devices was 37.53° (14.15°). By device, mean misalignment was 31.08° (6.38°) for the scoop stretcher and 43.97° (7.97°) for the backboard (P=.048). Conclusion: Less misalignment occurs during placement on the scoop stretcher than on the spinal backboard (AU)

Effect of training in advanced trauma life support on the kinematics of the spine: A simulation study.

More than 7.5 million people in the world are affected by spinal cord injury (SCI). In this study, we aimed to analyze the effect of training in advanced trauma life support (ATLS) on the kinematics of the spine when performing different mobilization and immobilization techniques on patients with suspected SCI. A quasi-experimental study, clinical simulation, was carried out to determine the effect of training in ATLS on 32 students enrolled in the Master's program of Emergency and Special Care Nursing. The evaluation was performed through 2 maneuvers: placing of the scoop stretcher (SS) and spinal board (SB), with an actor who simulated a clinical situation of suspected spinal injury. The misalignment of the spine was measured with the use of a Vicon 3D motion capture system, before (pre-test) and after (post-test) the training. In the overall misalignment of both maneuvers, statistically significant differences were found between the pre-test misalignment of 62.1°â€Š±â€Š25.9°, and the post-test misalignment of 32.3°â€Š±â€Š10.0°, with a difference between means of 29.7° [(95% confidence interval, 95% CI 22.8-36.6°), (P = .001)]. The results obtained for the placing of the SS showed that there was a pre-test misalignment of 65.1°â€Š±â€Š28.7°, and a post-test misalignment of 33.2°â€Š±â€Š10.1°, with a difference of means of 33.9° [(95% CI, 23.1-44.6°), (P = .001)]. During the placing of the SB, a pre-test misalignment of 59.0°â€Š±â€Š28.7° and a post-test misalignment of 33.4°â€Š±â€Š10.0° were obtained, as well as a difference of means of 25.6° [(95% CI 16.6-34.6°), (P = .001)]. The main conclusion of this study is that training in ATLS decreases the misalignment provoked during the utilization of the SS and SB, regardless of the device used.

A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis.

UNLABELLED: ♦ BACKGROUND: Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. ♦ METHODS: We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). ♦ RESULTS: Ultrafiltration averaged 653 ± 363 mL/4 h - twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload (p < 0.01) and inversely proportional to final peritoneal glucose concentration (p < 0.05). ♦ CONCLUSION: This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.