Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

A Brief Report: Comparative Evaluation of Online Spanish and English Content on Pancreatic Cancer Treatment.

The Internet is a major source of patient information on medical subjects. Several studies have evaluated the content of English medical material for patient use. However, few have focused on evaluating other languages, an important gap in a growing Spanish-speaking population. The aim of this study is to evaluate and compare English and Spanish online content related to pancreatic cancer treatment. We conducted a Google web search in English and Spanish using the following terms "pancreatic cancer treatment" and "tratamiento cancer de pancreas." The first 15 educational patient-directed websites for each language were included. Two independent reviewers assessed materials for quality and understandability using the DISCERN and the Patient Education Materials Assessment Tool (PEMAT)-validated tools. Readability was measured using two standardized tests. Wilcoxon rank sum test and unpaired Student's T-test were used for comparisons. Overall, websites in Spanish and English were understandable and had moderate to high quality. There were no significant differences in quality (p = 0.712) and understandability (p = 0.069) between languages. Readability level was significantly higher in English (p < 0.001) with content being at the university level, while Spanish was at the 12th grade level. Patient-directed online content on pancreatic cancer treatments exceeds the recommended reading level in both languages. Material is understandable with reasonable quality. Health content creators should acknowledge readability for information to be easily comprehended by those with lower health literacy.

Clinical and Radiological Characteristics to Differentiate Between EGFR Exon 21 and Exon 19 Mutations in Patients With Lung Adenocarcinoma: A Systematic Literature Review and Meta-Analysis.

Epidermal Growth Factor Receptor (EGFR) mutations in lung adenocarcinoma have been previously associated with specific clinical characteristics and Computed Tomography (CT) patterns. However, associations among individual EGFR mutations have not been evaluated. We aim to differentiate if the most common EGFR mutations (exon 21 and 19) are related to specific clinical characteristics or CT patterns. A systematic review and meta-analysis of 5 databases were conducted with literature from January 2002 to July 2021. Eligible studies were of an experimental or observational design that included lung adenocarcinoma patients with confirmed EGFR exon mutations (21 and 19) and associated clinical characteristics and CT imaging patterns. Quality was assessed using the QUADAS-2 tool. The association between clinical and CT patterns and EGFR exon mutations 21 and 19 was evaluated using odds ratios (OR) and then pooled and analyzed with a fixed or random-effects model. This study follows the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A total of 12 retrospective diagnostic accuracy studies were included. Pooled analysis showed that characteristics such as absence of smoking status (OR 1.29 [95% CI 0.97 - 1.70]), and female sex (OR 1.23 [95% CI 0.83 - 1.82]); and CT patterns such as Ground Glass Opacities (GGO) (OR 1.03 [95% CI 0.78 -1.34]), air bronchogram (OR 0.78 [95% CI 0.44 -1.39]), pleural retraction (OR 0.83 [95% CI 0.53 - 1.28]), and spiculation (OR 0.80 [95% CI 0.48 - 1.31]) were not significantly associated to a specific mutation. Specific EGFR exon 21 and 19 mutations cannot be differentiated through characteristics (absence of smoking status and female sex) or radiological patterns (GGO, air bronchogram, pleural retraction, and speculation). There is limited data to assess if early disease stage or vascular convergence aids in differentiating exon 21 from 19 mutations in patients with lung adenocarcinoma.

Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP) / Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

La vía clínica de recuperación intensificada en cirugía cardiaca (RICC) pretende identificar, difundir y favorecer la implementación de las mejores actuaciones basadas en la evidencia científica para disminuir la variabilidad en la práctica clínica. La puesta en marcha de estas prácticas en el proceso clínico global favorecerá la obtención de mejores resultados, acortamiento de estancias hospitalarias y en la Unidad de Cuidados Críticos, lo que permitirá una reducción de costes y una mayor eficiencia. Tras realizar una revisión sistemática en cada uno de los puntos del proceso perioperatorio en cirugía cardiaca, se han redactado recomendaciones basadas en la mejor evidencia científica disponible en la actualidad con el consenso de las sociedades científicas implicadas.(AU)

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.(AU)

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). / Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP).

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Prevalence, molecular typing and antimicrobial susceptibility of Campylobacter spp. isolates in northern Spain.

AIM: To analyse the prevalence, genetic diversity and antimicrobial susceptibility of Campylobacter spp. in northern Spain. METHODS AND RESULTS: Campylobacter was isolated from 139 samples of broiler meat and faecal dropping of broiler and swine with a prevalence of 35·4, 62 and 42·8%, respectively. Campylobacter jejuni (n = 55) and Campylobacter coli (n = 31) were identified by multiplex-PCR in meat, faeces and human clinical samples while Campylobacter fetus (n = 3) was exclusively detected in the latter. Fingerprinting by flaA-RFLP and PFGE revealed 68 different genotypes from the 89 isolates with a Biodiversity Simpson's index of 0·98. The 86·5% of the isolates were resistant to ciprofloxacin, 85·4% to tetracycline and 49·4% to erythromycin; only three genotypes were susceptible to the three antimicrobial drugs. Multidrug resistance was detected in the 40·7% of the isolates. CONCLUSIONS: Campylobacter remains prevalent in northern Spain with a high biodiversity degree. About 93·3% of the isolates were resistant to one or more drugs. SIGNIFICANCE AND IMPACT OF THE STUDY: Although different measures are taken to control Campylobacter, the detection of isolates resistant to the drugs used in the treatment of campylobacteriosis is still high, including different species and genotypes. This evidences the need of additional strategies against this pathogen.

Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve / Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain

La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables. Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation

Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain. / Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve.

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.

Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) / Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE)

La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions

Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). / Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE).

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.

Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

Ecografía clínica en la enfermedad tromboembólica venosa / Clinical ultrasonography in venous thromboembolism disease

La ecografía clínica se ha desarrollado exponencialmente en la última década en distintos ámbitos de la medicina. De igual manera que ha ocurrido en otros campos de actuación de la medicina interna, su uso se ha implantado en la enfermedad tromboembólica venosa, tanto en la trombosis venosa profunda como en la embolia pulmonar. En esta revisión se repasan las técnicas para el diagnóstico, tanto de la trombosis venosa profunda a través de la ultrasonografía por compresión, como de la ecografía multiórgano que incluye la ultrasonografía por compresión, la ecografía pulmonar en busca de infartos pulmonares y la ecocardioscopia para la detección de dilatación y/o disfunción del ventrículo derecho, para el diagnóstico de la embolia pulmonar. Además, se plantean los escenarios clínicos más frecuentes en los que puede ser de ayuda la ecografía clínica en la vida real, así como sus limitaciones y la evidencia existente

The use of clinical ultrasonography has grown exponentially in the past decade in various medical settings. As with other areas of activity in the field of internal medicine, clinical ultrasonography has been implemented in venous thromboembolism disease, both in deep vein thrombosis and pulmonary embolism. In this review, we cover the diagnostic techniques, both for deep vein thrombosis through compression ultrasonography and for multiorgan ultrasonography, which include compression ultrasonography, pulmonary ultrasonography in the search for pulmonary infarctions and echocardiography for detecting dilation and right ventricular dysfunction for the diagnosis of pulmonary embolism. We also establish the most common clinical scenarios in which clinical ultrasonography can be of assistance in actual clinical practice, as well as its limitations and current evidence

Clinical ultrasonography in venous thromboembolism disease. / Ecografía clínica en la enfermedad tromboembólica venosa.

The use of clinical ultrasonography has grown exponentially in the past decade in various medical settings. As with other areas of activity in the field of internal medicine, clinical ultrasonography has been implemented in venous thromboembolism disease, both in deep vein thrombosis and pulmonary embolism. In this review, we cover the diagnostic techniques, both for deep vein thrombosis through compression ultrasonography and for multiorgan ultrasonography, which include compression ultrasonography, pulmonary ultrasonography in the search for pulmonary infarctions and echocardiography for detecting dilation and right ventricular dysfunction for the diagnosis of pulmonary embolism. We also establish the most common clinical scenarios in which clinical ultrasonography can be of assistance in actual clinical practice, as well as its limitations and current evidence.

¿Puede la saturación regional de oxígeno cerebral guiar la transfusión de hematíes en cirugía cardiaca en pacientes de alto riesgo? Estudio prospectivo observacional / Can regional cerebral oxygen saturation guide red blood cell transfusion in high risk cardiac surgery?

Introducción: La cirugía cardíaca se asocia a un uso significativo de hemoderivados. El objetivo de este estudio fue evaluar el efecto de la transfusión sobre la saturación regional de oxígeno cerebral (SrO2) en pacientes tratados mediante cirugía cardiaca con EuroSCORE I aditivo > 6. Material y métodos: Estudio prospectivo observacional. Se incluyó en el estudio a los pacientes con EuroSCORE I aditivo > 6 tratados mediante cirugía cardiaca con circulación extracorpórea. Se recogieron los valores demográficos, complicaciones perioperatorias, estancias hospitalarias, así como el valor de SrO2 basal preinducción, el valor más bajo de hemoglobina (Hb) registrado durante la cirugía, el valor de la Hb y la SrO2 pre y postransfusional, así como la existencia de una caída significativa de más del 20% del valor basal de la SrO2 o por debajo del 50%. Consideramos como respondedores a la transfusión aquellos que presentaron un aumento de la SrO2 postransfusión de al menos el 20% del valor previo, un aumento de la desviación estándar (DE) (7,9) o un aumento hasta el nivel basal. Resultados: Se recogieron los datos de 57 pacientes. El EuroSCORE I aditivo medio +/- DE fue de 7,4 +/- DE 2,6 y el EuroSCORE II fue de 6,1 +/- DE 7,4. El 52% fueron varones. Se trasfundió al menos un concentrado de hematíes al 35,1% de la muestra (20 pacientes). La SrO2 pretransfusional fue 59 +/- DE 8,6 y aumentó de forma no significativa tras la transfusión del primer CH (61,19 +/- 7,9; p = 0,1). Un 29,8% de los pacientes presentaron durante la cirugía una disminución de la SrO2 del 20% con respecto a su basal o un valor inferior al 50%. Los pacientes con una disminución significativa de la SrO2 presentaron un mayor tasa de complicaciones perioperatorias (p = 0,04). La estancia en la Unidad de Cuidados Intensivos (UCI) fue mayor en los pacientes con una disminución significativa de la SrO2 respecto a los que la no presentaron (6,8 +/- 8,2 días vs. 4,3 +/- 3,6; p = 0,01) al igual que la estancia hospitalaria (14,2 +/- 9,4 días vs. 10,1 +/- 3,1; p = 0,01). En nuestra muestra, 6 de los 21 pacientes fueron respondedores. No hubo diferencias significativas en la morbilidad o la mortalidad entre los respondedores y los no respondedores. Discusión: En nuestra población, se observó un aumento no significativo en la SrO2 tras la transfusión. Cuando se analizaron los respondedores a la transfusión por incrementos de SrO2, pocos pacientes fueron identificados como respondedores. En conclusión, la SrO2 podría no ser una herramienta que guíe la transfusión en pacientes tratados mediante cirugía cardiaca con EuroSCORE I aditivo > 6

Introduction: Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6. Material and methods: This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2. Results: Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders. Discussion: In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion

Can regional cerebral oxygen saturation guide red blood cell transfusion in high risk cardiac surgery? / ¿Puede la saturación regional de oxígeno cerebral guiar la transfusión de hematíes en cirugía cardiaca en pacientes de alto riesgo? Estudio prospectivo observacional.

INTRODUCTION: Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6. MATERIAL AND METHODS: This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2. RESULTS: Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders. DISCUSSION: In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion.

Therapeutic tools for oral candidiasis: Current and new antifungal drugs.

BACKGROUND: Candidiasis is one of the most common opportunistic oral infections that presents different acute and chronic clinical presentations with diverse diagnostic and therapeutic approaches. The present study carries out a bibliographic review on the therapeutic tools available against oral candidiasis and their usefulness in each clinical situation. MATERIAL AND METHODS: Recent studies on treatment of oral candidiasis were retrieved from PubMed and Cochrane Library. RESULTS: Nystatin and miconazole are the most commonly used topical antifungal drugs. Both antifungal drugs are very effective but need a long time of use to eradicate the infection. The pharmacological presentations of miconazole are more comfortable for patients but this drug may interact with other drugs and this fact should be assessed before use. Other topical alternatives for oral candidiasis, such as amphotericin B or clotrimazole, are not available in many countries. Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment. Other systemic treatment alternatives, oral or intravenous, less used are itraconazole, voriconazole or posaconazole. Available novelties include echinocandins (anidulafungin, caspofungin) and isavuconazole. Echinocandins can only be used intravenously. Isavuconazole is available for oral and intravenous use. Other hopeful alternatives are new drugs, such as ibrexafungerp, or the use of antibodies, cytokines and antimicrobial peptides. CONCLUSIONS: Nystatin, miconazole, and fluconazole are very effective for treating oral candidiasis. There are systemic alternatives for treating recalcitrant infections, such as the new triazoles, echinocandins, or lipidic presentations of amphotericin B.