RESUMO
Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).
Assuntos
Anemia Hemolítica , Síndrome Hemolítico-Urêmica Atípica , Púrpura Trombocitopênica Trombótica , Microangiopatias Trombóticas , Algoritmos , Síndrome Hemolítico-Urêmica Atípica/terapia , Feminino , Humanos , Masculino , Púrpura Trombocitopênica Trombótica/complicações , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/terapia , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/etiologia , Microangiopatias Trombóticas/terapiaRESUMO
Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).
RESUMO
Candida auris is a multi-resistant emerging fungus. OBJECTIVES: To analyze the relationship between colonization by C. auris and the appearance of invasive candidiasis. Description of the sample of colonized patients, risk factors for colonization and/or infection, and calculation of mortality rates. METHODOLOGY: Longitudinal observational study in an anesthesia intensive care unit in 2018. RESULTS: 2130 patients were admitted. Surveillance studies were positive in 124 patients; 118 cases involved skin colonization and 52 were pharyngeal. Patients with a positive blood culture were identified. A statistically significant association was found between pharyngeal colonization and the appearance of a positive blood culture. There were significant differences between patients with a high Candida Score as a risk factor for candidemia. In total, 67% of pharyngeal carriers negativized at 1 month compared to 21% of cutaneous carriers, who negativized after 3-4 months. Of the patients with positive blood cultures, 70% of non-survivors received only monotherapy, although this difference was not statistically significant due to the small sample size. CONCLUSIONS: The incidence of C. auris, a multi-resistant pathogen that is difficult to diagnose, treat and eradicate, is steadily increasing among critically ill patients. Its status as an emerging threat to global health calls for the urgent implementation of early in-hospital detection systems.
Assuntos
Candidemia , Candidíase Invasiva , Candida , Candidemia/diagnóstico , Humanos , Unidades de Terapia Intensiva , Centros de Atenção TerciáriaRESUMO
OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P=.014) and ID (P=.040) but more fresh frozen plasma than group ID (P=.0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.
RESUMO
OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12â¯h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12 h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (Pâ¯=â¯.014) and ID (Pâ¯=â¯.040) but more fresh frozen plasma than group ID (Pâ¯=â¯.0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.
Assuntos
Antifibrinolíticos , Procedimentos Cirúrgicos Cardíacos , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Humanos , Hemorragia Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ácido Tranexâmico/uso terapêuticoRESUMO
Las microangiopatías trombóticas (MAT) son un conjunto de síndromes clínicos que asocian anemia hemolítica, trombocitopenia y disfunción orgánica, principalmente renal o neurológica. Están asociados a una morbimortalidad significativa, por lo que su diagnóstico y tratamiento precoz son esenciales. En este artículo detallamos 2 casos de MAT; una paciente con una púrpura trombocitopénica trombótica (PTT) y otra paciente con un síndrome hemolítico urémico atípico (SHUa).(AU)
Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).(AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Microangiopatias Trombóticas/congênito , Microangiopatias Trombóticas/tratamento farmacológico , Microangiopatias Trombóticas/terapia , Anemia Hemolítica , Trombocitopenia , Síndrome Hemolítico-Urêmica Atípica , Púrpura Trombocitopênica Trombótica , Proteína ADAMTS13 , Anestesiologia , Reanimação Cardiopulmonar , Indicadores de MorbimortalidadeRESUMO
INTRODUCTION: This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery. MATERIAL AND METHODS: Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend. RESULTS: The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique. CONCLUSION: Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgesia , Hallux Valgus/cirurgia , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Nervo Tibial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos ProspectivosRESUMO
The association of repeated sinus-bronchial-pulmonary infection and male infertility is well known in the literature in conditions such as cystic fibrosis, immotile cilia syndrome and Young's syndrome. Outside the context of these clinical entities, however, the association is unusual. We report the case of a 36-year-old man with sinusitis, bronchiectasis and sterility due to Sertoli-cell-only syndrome, an association that has not been described to date. Testicular biopsy showed absence of spermatogones and other germ cells, and non specific alterations were found in nasal cilia axonemes, in the presence of DNA branches. A sweat test was negative. Given that recent studies have shown an increase in the prevalence os Sertoli-cell-only syndrome, other cases might be described and this association may correspond to a specific entity.
Assuntos
Infecções/complicações , Infertilidade Masculina/complicações , Pneumopatias/complicações , Sinusite Maxilar/complicações , Adulto , Bronquiectasia/complicações , Humanos , Infertilidade Masculina/patologia , Masculino , Recidiva , Células de Sertoli/patologia , EspermatogêneseRESUMO
We report a case of chronic calcifying pancreatitis and exocrine pancreatic deficiency in a patient with chronic renal failure under hemodialysis. We analyze the possible relationship between these two entities with special reference to the role of secondary hyperparathyroidism and extraosseous or metastatic calcification.
Assuntos
Calcinose/complicações , Falência Renal Crônica/complicações , Pancreatite/complicações , Adulto , Doença Crônica , Feminino , Humanos , Pancreatopatias/complicaçõesAssuntos
Golpe de Calor/complicações , Falência Hepática/etiologia , Doença Aguda , Hemorragia Cerebral/diagnóstico , Terapia Combinada , Cuidados Críticos/métodos , Crioterapia , Diagnóstico Diferencial , Dopamina/uso terapêutico , Emergências , Fígado Gorduroso/complicações , Hidratação , Golpe de Calor/diagnóstico , Golpe de Calor/terapia , Humanos , Falência Hepática/terapia , Fígado Artificial , Masculino , Manitol/uso terapêutico , Abuso de Maconha/complicações , Meningoencefalite/diagnóstico , Pessoa de Meia-Idade , Plasma , Inconsciência/diagnóstico , Inconsciência/etiologiaRESUMO
OBJECTIVE: To compare the analgesic efficacy of epidural administration of 0.2% ropivacaine alone to that of 0.1% ropivacaine plus 0.0002% fentanyl during childbirth. PATIENTS AND METHODS: We performed a prospective, randomized single-blind study of 84 women in labor (aged 16 to 40 y, ASA I-II, weight over 110 kg, height over 150 cm, gestational age 37 to 42 weeks). The women were randomly assigned to two groups: group I consisted of 42 patients who received an initial bolus of 10 ml of ropivacaine 0.2% followed by continuous perfusion of ropivacaine 0.2% at a rate of 6 to 10 ml/h; group II was composed of 42 women who received an initial bolus of ropivacaine 0.2% with 50 micrograms of fentanyl followed by continuous infusion of ropivacaine 0.1% and fentanyl 2 micrograms/ml at a rate of 6 to 10 ml/h. Data recorded were parity and type of delivery, blood pressure, heart rate (HR), time to onset of pain relief, motor blockade on a modified Bromage scale, pain on a visual analog scale (VAS) and fetal HR, Apgar score and arterial and venous pH of umbilical blood. RESULTS: We found no significant differences in demographic or hemodynamic data in mothers or fetuses, in type of delivery or motor block, although the latter tended to be slightly lower in group II. In group II, the total anesthetic dose used was significantly lower (p = 0.003); time until onset of pain relief was significantly shorter (p = 0.044); and VAS scores were significantly lower at 15 min (p = 0.005), 30 min (p = 0.029), 60 min (p = 0.017) and 90 min (p = 0.002). The number of top-up boluses needed for deliveries involving instruments was significantly greater in group II (p = 0.37). CONCLUSION: The protocol of ropivacaine 0.1% with 2 micrograms/ml of fentanyl provides satisfactory analgesia throughout labor, allowing lower doses of local anesthetic to be used, with shorter onset of pain relief and reduced motor blockade; however the analgesia provided is insufficient for deliveries assisted by instruments.
Assuntos
Amidas/administração & dosagem , Analgesia Epidural , Anestésicos Locais/administração & dosagem , Fentanila/administração & dosagem , Adolescente , Adulto , Amidas/farmacologia , Índice de Apgar , Sinergismo Farmacológico , Feminino , Fentanila/farmacologia , Feto/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Recém-Nascido , Medição da Dor , Paridade , Gravidez , Estudos Prospectivos , Ropivacaina , Método Simples-Cego , Contração Uterina/efeitos dos fármacosRESUMO
Ropivacaine is a local anesthetic frequently used to provide regional blocks because its toxicity threshold is favorable and it is highly selective for sensory nerve fibers. Few reports of adverse events and complications related to use of ropivacaine have been published. We report 2 cases of central nervous system toxicity. Each occurred after a brachial plexus block with 0.75% ropivacaine, one performed by an axillary approach and one by an infraclavicular approach with nerve stimulation.