The physiologic effects of indomethacin test on CPP and ICP in severe traumatic brain injury (sTBI).

BACKGROUND: Refractory intracranial hypertension (RICH) is associated with high mortality in severe traumatic brain injury (sTBI). Indomethacin (INDO) can decrease intracranial cerebral pressure (ICP) improving cerebral pressure perfusion (CPP). Our aim was to determine modifications in ICP and CPP following INDO in RICH secondary to sTBI. METHODS: INDO was administered in a loading dose (0.8 mg/kg/15 min), followed by continuous 2-h infusion period (0.5 mg/kg/h). Clinical outcome was assessed at 30 days according to Glasgow Outcome Scale (GOS). Differences in ICP and CPP values were assessed using repeated-measures ANOVA. Receiver operating characteristic curve (AUC) was used for discrimination in predicting 30-day survival and good functional outcome (GOS 4 or 5). Analysis of INDO safety profile was also conducted. RESULTS: Thirty-two patients were included. Median GCS score was 6 (interquartile range: 4-7). The most frequent CT finding was the evacuated mass lesion (EML) according to Marshall classification (28.1 %). Mortality rate was 34.4 %. Within 15 min of INDO infusion, ICP decreased (Δ%: -54.6 %; P < 0.0001), CPP increased (Δ%: +44.0 %; P < 0.0001), and the remaining was stable during the entire infusion period. Patients with good outcome (n = 12) showed a greater increase of CPP during INDO test (P = 0.028). CPP response to INDO test discriminated moderately well surviving patients (AUC = 0.751; P = 0.0098) and those with good functional recovery (AUC = 0.763; P = 0.0035) from those who died and from those with worse functional outcome, respectively. No adverse events were observed. CONCLUSIONS: INDO appears effective in reducing ICP and improving CPP in RICH. INDO test could be a useful tool in identifying RICH patients with favorable outcome. Future studies are needed.

[POTENTIALLY FATAL LYELL SYNDROME]. / SINDROME DE LYELL POTENCIALMENTE FATAL.

Toxic epidermal necrolysis or Lyell's syndrome is a rare entity with strong compromise of immune system. It is a hypersensitivity reaction secondary to the use of specific drugs and other triggers. Erythematous lesions of bullous aspect characterize the clinical picture affecting all layers of the skin, scaly and widespread in distribution and progression. Sometimes life threatening, generate a severe inflammatory and systemic reaction with multiple organ dysfunction. Treatment encompasses three objectives: identification and suspension of triggers, general clinical support and therapy to the skin lesions. Immune therapy is controversial and not supported by solid scientific evidence. We report a case that summarizes all aspects of this potentially lethal disease.

[Diagnosis and therapy of polyuric states in patients with acute cerebral injury]. / Enfoque práctico para el diagnóstico y tratamiento de los estados poliúricos en pacientes con injuria cerebral aguda.

In patients with acute cerebral injury, polyuric states can potentially trigger, maintain and aggravate the primary neurological damage, due to hypovolemia, arterial hypotension and alterations of osmolarity. The true incidence of the condition in this population is unknown. A widely validated definition of polyuric state is lacking and its etiology is multifactorial. There are two principal classes of polyuria: (a) aqueous polyuria with diabetes insipidus as the main cause; and (b) osmotic polyuria in which sodium, glucose or ureaplay the main role. Polyuric states are in close association with disorders of water and sodium metabolism and with alterations in acid-base balance. A detailed analysis of the history, clinical picture and simple laboratory determinations in blood and urine, are required for an adequate assessment of these polyuric states. The problem must be faced with pathophysiological reasoning and a systematic and sequential approach, because each disorder needs a specific therapy.

Microfluidic-controlled optical router for lab on a chip.

In multiplexed analysis, lab on a chip (LoC) devices are advantageous due to the low sample and reagent volumes required. Although optical detection is preferred for providing high sensitivity in a contactless configuration, multiplexed optical LoCs are limited by the technological complexity for integrating multiple light sources and detectors in a single device. To address this issue, we present a microfluidic-controlled optical router that enables measurement in four individual optical channels using a single light source and detector, and without movable parts. The optofluidic device is entirely fabricated in polydimethylsiloxane (PDMS) by soft-lithography, compatible with standard microfabrication technologies, enabling monolithic integration in LoCs. In the device, in-coupled light from an optical fiber is collimated by a polymeric micro-lens and guided through a set of four sequentially connected micro-chambers. When a micro-chamber is filled with water, light is transmitted to the next one. If it is empty of liquid, however, total internal reflection (TIR) occurs at the PDMS-air interface, re-directing the light to the output optical fiber. The router presents high performance, with low cross-talk (<2%) and high switching frequencies (up to 0.343 ± 0.006 Hz), and provides a stable signal for up to 91% of the switching time. With this miniaturized, low-cost, simple and robust design, we expect the current technology to be integrated in the new generation of multiplexed photonic LoCs for biomarker analysis, even at the point of care.