Shock anafiláctico versus síndrome de Kounis durante el intraoperatorio de cirugía cardiaca: diagnóstico diferencial / Anaphylactic shock versus Kounis syndrome in cardiac surgery: Differential diagnosis

Pese a que fue descrito hace casi 3 décadas, ha sido en los últimos años cuando se ha producido un incremento notable en la comunicación de casos de síndromes coronarios agudos desarrollados en el contexto de reacciones alérgicas, entidad que es conocida como síndrome de Kounis. En este artículo nos planteamos esta posibilidad diagnóstica ante un fracaso biventricular agudo en el transcurso de una reacción anafiláctica durante el intraoperatorio de una cirugía valvular cardiaca

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery

Anaphylactic shock versus Kounis syndrome in cardiac surgery: Differential diagnosis. / Shock anafiláctico versus síndrome de Kounis durante el intraoperatorio de cirugía cardiaca: diagnóstico diferencial.

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery.

[Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain]. / Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorlo.

OBJECTIVE: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. METHODS: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. RESULTS: Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. CONCLUSIONS: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.

Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorio / Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain

Objetivo: Evaluar la concordancia entre la escala verbal numérica y la escala visual analógica en la valoración del seguimiento del dolor agudo postoperatorio durante 3 días consecutivos. Métodos: Recogida secuencial de datos a los pacientes sometidos a cirugía mayor subsidiaria de pauta de analgesia postoperatoria con opiáceos parenterales o técnicas neuroaxiales en un hospital terciario durante 2 meses consecutivos. Se interrogó a los pacientes durante 3 días consecutivos con intervalos de 24 horas mediante las escalas visual numérica (EVN) y visual analógica (EVA). Para valorar la concordancia entre variables cuantitativas se utilizó el coeficiente de correlación intraclase, y coeficiente de correlación de Spearman, estratificándose los resultados por edad (menos o mayor de 65 años). Resultados: Se analizaron datos de 159 pacientes (105 <= 65 años y 54 > 65 años). La valoración de la EVA no fue posible realizarla en 12 pacientes, mientras que la valoración de la EVN fue posible en todos los pacientes. Los valores del coeficiente de correlación interclase fueron globalmente > 0,70 durante los tres días, siendo más altos los coeficientes en mayores de 65 años. Conclusiones: La concordancia entre las EVA y EVN de dolor se puede considerar como buena o muy buena durante los tres días de seguimiento, siendo mejor en pacientes con edad superior a 65 años. El grado de colaboración para recoger los datos fue mejor para la EVN que para la EVA. En la comparación de las valores numéricos del dolor la EVN mostró repetidamente valores más altos que la EVA(AU)

Objective: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. Methods: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. Results: Data for 159 patients (105 65 years; 54 > 65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. Conclusions: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale(AU)

Comparison of the effectiveness of venlafaxine in peri- and postmenopausal patients with major depressive disorder.

INTRODUCTION: This study examines the difference in the efficacy and tolerability of an antidepressant inhibiting the reuptake of norepinephrine and serotonin--IRNS--on climacteric patients diagnosed of major depressive disorder, comparing the therapeutic response between perimenopausal and postmenopausal patients. METHODS: Observational, prospective, open-label, multicenter study 24 weeks study. The sample consisted of women between 45 and 55 years diagnosed of major depressive disorder. The study drug was venlafaxine extended release at doses according to the investigator's clinical criteria. The efficacy was assessed using repeated measures of the scales: Hamilton Depression Rating Scale and Blatt-Kupperman Menopausal Index. RESULTS: 36 depressed women were included in the study and 35 completed it. The patient's age range was 47 to 55 years old. Throughout the study, a significant clinical improvement in depressive and hormonal symptoms was seen. The comparison of the pattern of improvement, according to the menstrual status of the patients, showed no significant different between pre and postmenopausal patients. Perimenopausal women reported a higher rate of adverse events. CONCLUSION: The Venlafaxine was effective in treating depressive and hormonal symptoms regardless of the menstrual status of climacteric patients with a slightly worse tolerance in perimenopause.

[Evaluation of a protocol for predicting difficult airway in routine practice: interobserver agreement]. / Evaluación de un protocolo de predicción de vía aérea difícil en la práctica habitual: estudio de concordancia.

OBJECTIVES: To evaluate a protocol for routine assessment of potential risk factors for difficult airway intubation in an anesthesia department, by measuring interobserver agreement and the behavior of the factors in a predictive model. MATERIAL AND METHODS: A cross-sectional study group of 320 consecutive patients undergoing major surgery requiring orotracheal intubation was assessed for possible difficult airway. We calculated interrater agreement for recording of the Mallampati score, thyromental distance less than 6 cm, thick neck, kyphosis, small mouth, macroglossia, and dental prosthesis during the preanesthesia examination (by an anesthetist) and on the day of the operation (by an anesthetist and a resident). We constructed a model to predict difficult intubation (requiring 3 or more attempts). RESULTS: The kappa indices of agreement between the anesthetists at the preoperative examination and in the operating room or the resident were all less than 0.6. Factors like thyromental distance, small mouth, and kyphosis had kappa indices less than 0.21. The kappa index between the resident and the anesthetist in the operating room was over 0.55. The only factor that had a different level of agreement was the presence or not of a dental prosthesis. None of the studied individual factors, nor these factors in association with the Mallampati score, achieved significance in a bivariate regression model to predict difficult intubation. CONCLUSIONS: There is poor interobserver agreement on factors for predicting difficult airway in comparisons between preoperative and operating room assessment by an anesthetist or a resident. The individual predictive factors and their association with the Mallampati score did not prove useful for predicting difficult intubation.

[The prevalence of enteropathogens in urban day nurseries]. / Prevalencia de enteropatógenos en guarderías urbanas.

BACKGROUND: Survey on the intestinal pathogens prevalence in a population of preschool children attending to the urban day-nurseries. METHODS: Samples of faeces of 408 children and 31 adults, in their charge, were collected. The children were classified per sex, age and kind of day-nursery they were to; data on their physical condition and the faeces characteristics were obtained. RESULTS: Parasites were the enteropathogens, found with the greatest frequency (21% of children and 19% of adults), next were rotavirus (3% of the children's samples and only one case in adults). The cases of a double parasitization only were 0.74% of the total number of the children surveyed (3 children per each case). CONCLUSIONS: The highest prevalence of enteropathogens in children attending to the urban day-nurseries in our community belongs to the group of parasites; rotavirus are a much smaller group and bacterium are only isolated cases.