Un mecanismo nefrogénico subyace a la poliuria inducida por dexmedetomidina: informe de un caso / Nephrogenic mechanism underlies dexmedetomidine-induced polyuria: A case report

La dexmedetomidina, agonista del adrenorreceptor α, se utiliza cada vez más como agente sedativo-hipnótico y analgésico, aunque su popularidad suscita preocupación acerca de los efectos secundarios de dicho fármaco.La bradicardia y la hipotensión son efectos adversos comunes, pero también existen diversos informes de gasto urinario excesivo, posiblemente debido a la secreción de vasopresina y a la permeabilidad de los conductos colectores.La poliuria se resuelve normalmente con la discontinuación del fármaco, no habiéndose reportado morbilidad significativa. La identificación temprana, la eliminación del agente y el tratamiento son imperativos para minimizar las complicaciones, principalmente natremia y síntomas neurológicos.Este informe de caso describe la poliuria relacionada con dexmedetomidina durante la anestesia general libre de opioides para cirugía mayor de cabeza y cuello. Nuestra hipótesis de etiología nefrogénica se ve reforzada por los datos analíticos obtenidos. También describimos cómo abordar la poliuria intraoperatoria. (AU)

Dexmedetomidine's α-adrenoreceptor agonism has been gaining popularity in the anesthetic room as a sedative-hypnotic and analgesic agent, and with extensive perioperative use rising concern about side effects is necessary.Bradycardia and hypotension are common but excessive urine output is increasingly reported, suggested mechanisms being vasopressin secretion and increasing permeability of the collecting ducts.Polyuria usually resolves with discontinuation of the drug and significant morbidity has not been reported. Early identification, removal of agent and treatment are imperative to minimize complications, mainly associated with natremia levels and neurological symptoms.This case report describes a dexmedetomidine-related polyuric syndrome during opioid-free general anesthesia for major head and neck surgery. A nephrogenic mechanism for the clinical effect is proposed and reinforced by analytical data obtained. An intra-operative polyuria approach is also delineated. (AU)

Lumbosacral pain in a patient with psoriatic arthritis: when the rheumatic disease is innocent.

Lumbar pain is a very common symptom that derives from benign musculoskeletal conditions, rheumatic inflammatory diseases, neoplasms, and referred and/or nociplastic pain. A 70-year-old man with psoriatic arthritis presented with early-onset lumbosacral pain without evident red flags. Symptomatic treatment was unhelpful. Radiographic imaging showed subtle signs of a disease that could easily be missed. Magnetic resonance imaging revealed a massive prostatic malignancy with bone (sacral and iliopubic) metastasis. Awareness must be given not to disregard every lumbar pain as part of the preexisting rheumatic inflammatory disease (spondyloarthropathy in this case) or a common muscle/ligament/articular disarrangement. Persistence of pain, albeit not inflam-matory nor sharp in nature, despite adequate treatment might be just as important as an acute red flag and requires proper follow-up.

A nephrogenic mechanism underlies dexmedetomidine-induced polyuria. A case report.

Dexmedetomidine's α-adrenoreceptor agonism has been gaining popularity in the anesthetic room as a sedative-hypnotic and analgesic agent, and with extensive perioperative use rising concern about side effects is necessary. Bradycardia and hypotension are common adverse effects, but there are also several reports of excessive urine output, possibly due to vasopressin secretion and permeability of collecting ducts. Polyuria usually resolves with discontinuation of the drug, and significant morbidity has not been reported. Early identification, removal of the agent, and treatment are imperative to minimize complications - mainly natremia and neurological symptoms. This case report describes a dexmedetomidine-related polyuric syndrome during opioid-free general anesthesia for major head and neck surgery. A nephrogenic mechanism for the clinical effect is proposed and reinforced by analytical data obtained. An intra-operative polyuria approach is also delineated.

S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anaesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anaesthesia with a serratus plane block (SPB) and transversus thoracic muscle plane block (TTPB) with administration of Mepivacaine and Ropivacaine. S-ICD placement was achieved under regional anaesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anaesthetic risk. In this case, the association of SPB and TTPB was an effective anaesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico / S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case

Introducción: El desarrollo de un desfibrilador-cardioversor implantable subcutáneo (DCI-S), combinado con las comorbilidades normales del paciente crea nuevos retos en anestesia. Caso clínico: Varón joven, ASA II, propuesto para implantación de DCI-S, tras recuperarse de un episodio de parada cardiaca súbita. Realizamos anestesia regional con bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso con administración de mepivacaína y ropivacaína. La implantación de DCI-S se logró bajo anestesia regional. En el periodo perioperatorio el paciente permaneció hemodinámicamente estable, sin complicaciones ni dolor. Discusión: La implantación de DCI se produce en pacientes frágiles, con alto riesgo anestésico. En este caso, la asociación de bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso fue una técnica anestésica/analgésica efectiva, con ventajas en comparación con otras técnicas, y uso potencial en otros procedimientos.(AU)

Introduction: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. Clinical case: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. Discussion: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.(AU)

S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case. / Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Antimicrosporidian activity of sulphated polysaccharides from algae and their potential to control honeybee nosemosis.

Nosemosis is one of the most common and widespread diseases of adult honeybees. The causative agents, Nosema apis and Nosema ceranae, belong to microsporidia some obligate intracellular eukaryotic parasites. In this study, 10 sulphated polysaccharides from algae were evaluated for their antimicrosporidian activity. They were first shown to inhibit the in vitro growth of the mammal microsporidian model, Encephalitozoon cuniculi. The most efficient polysaccharides were then tested for their ability to inhibit the growth of Nosema ceranae in experimentally-infected adult honeybees. Two polysaccharides extracted from Porphyridium spp. did not show any toxicity in honeybees and one of them allowed a decrease of both parasite load and mortality rate due to N. ceranae infection. A decrease in parasite abundance but not in mortality rate was also observed with an iota carrageenan. Our results are promising and suggest that algal sulphated polysaccharides could be used to prevent and/or control bee nosemosis.

Axenic cultures of Nitrosomonas europaea and Nitrobacter winogradskyi in autotrophic conditions: a new protocol for kinetic studies.

As a part of a natural biological N-cycle, nitrification is one of the steps included in the conception of artificial ecosystems designed for extraterrestrial life support systems (LSS) such as Micro-Ecological Life Support System Alternative (MELiSSA) project, which is the LSS project of the European Space Agency. Nitrification in aerobic environments is carried out by two groups of bacteria in a two-step process. The ammonia-oxidizing bacteria (Nitrosomonas europaea) realize the oxidation of ammonia to nitrite, and the nitrite-oxidizing bacteria (Nitrobacter winogradskyi), the oxidation of nitrite to nitrate. In both cases, the bacteria achieve these oxidations to obtain an energy and reductant source for their growth and maintenance. Furthermore, both groups also use CO2 predominantly as their carbon source. They are typically found together in ecosystems, and consequently, nitrite accumulation is rare. Due to the necessity of modeling accurately conversion yields and transformation rates to achieve a complete modeling of MELiSSA, the present study focuses on the experimental determination of nitrogen to biomass conversion yields. Kinetic and mass balance studies for axenic cultures of Nitrosomonas europaea and Nitrobacter winogradskyi in autotrophic conditions are performed. The follow-up of these cultures is done using flow cytometry for assessing biomass concentrations and ionic chromatography for ammonium, nitrite, and nitrate concentrations. A linear correlation is observed between cell count and optical density (OD) measurement (within a 10 % accuracy) validating OD measurements for an on-line estimation of biomass quantity even at very low biomass concentrations. The conversion between cell count and biomass concentration has been determined: 7.1 × 10¹² cells g dry matter (DM)⁻¹ for Nitrobacter and 6.3 × 10¹² cells g DM⁻¹ for Nitrosomonas. Nitrogen substrates and products are assessed redundantly showing excellent agreement for mass balance purposes and conversion yields determination. Although the dominant phenomena are the oxidation of NH4⁺ into nitrite (0.95 mol mol N⁻¹ for Nitrosomonas europaea within an accuracy of 3 %) and nitrite into nitrate (0.975 mol mol N⁻¹ for Nitrobacter winogradskyi within an accuracy of 2 %), the Nitrosomonas europaea conversion yield is estimated to be 0.42 g DM mol N⁻¹, and Nitrobacter winogradskyi conversion yield is estimated to be 0.27 g DM mol N⁻¹. The growth rates of both strains appear to be dominated by the oxygen transfer into the experimental setups.