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Cryogels are novel materials because the manufacturing process known as cryostructuring allows biopolymers to change their properties as a result of repeated controlled freeze-thaw cycles. Hydrogels of xanthan and karaya gums were evaluated after undergoing up to four controlled freeze-thaw cycles in indirect contact with liquid nitrogen (up to -150 °C) to form cryogels. Changes in structural, molecular, rheological, and thermal properties were evaluated and compared to those of their respective hydrogels. Samples were also analyzed by Scanning Electron Microscopy (SEM), Fourier Transform Infrared Spectroscopy with Attenuated Total Reflection (FTIR-ATR), Rotational Rheology (RR), Modulated Differential Scanning Calorimetry (MDSC) and zeta potential (ζ). In general, significant differences (p < 0.05) between the numbers of freeze-thaw cycles were found. Karaya cryogels were not stable to repeated cycles of cryostructuring such as the three-cycle xanthan cryogel, which has the best structural order (95.55%), molecular interactions, and thermal stability, which allows the generation of a novel material with improved thermal and structural properties that can be used as an alternative in food preservation.
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Criogéis/química , Tecnologia de Alimentos/métodos , Hidrogéis/química , Polissacarídeos Bacterianos/química , Sterculia/química , Biofilmes , Varredura Diferencial de Calorimetria , Congelamento , Temperatura Alta , Microscopia Eletrônica de Varredura , Polímeros/química , Álcool de Polivinil/química , Reologia , Espectroscopia de Infravermelho com Transformada de Fourier , XanthomonasRESUMO
BACKGROUND: Acute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery. METHODS: This is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia. INTERVENTION: In the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality. DISCUSSION: This study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05569265. Registered on October 6, 2022.
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Abdome , Injúria Renal Aguda , Hipotensão , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/diagnóstico , Abdome/cirurgia , Hipotensão/prevenção & controle , Hipotensão/etiologia , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Feminino , Idoso , Fatores de Tempo , Hemodinâmica , Masculino , Terapia Precoce Guiada por Metas , Fatores de RiscoRESUMO
AIM: Liver fibrosis results in a disproportion of the hepatic composition and architecture, characterized by a progressive accumulation of fibrillar proteins at the liver parenchyma. Modulated-differential scanning calorimetry (mDSC) is an experimental methodology able to determine the specific thermal signature from any biological substance, based on the variation in heat flow and heat capacity. As these physicochemical properties are directly influenced by compositional and structural changes, we decided to study the thermal behavior of the liver during fibrosis using mDSC. METHODS: Liver fibrosis was induced in rats by bile duct ligation or carbon tetrachloride administration. Degree of liver fibrosis was determined by histological examination using the Masson-trichrome stain, accompanied by hepatic expression of α-smooth muscle actin. The thermal analysis was performed in a modulated-differential scanning calorimeter using 20 mg of fresh liver mass. RESULTS: The liver showed a characteristic thermal signature in control animals, which progressively differed among mild (F1), moderate (F2) and advanced (F3-F4) liver fibrosis. For heat flow, the hepatic thermal signature from F3-F4 rats exhibited significant differences when compared with F1, F2 and controls. In terms of heat capacity, liver specimens provided a specific thermal signature for each stage of disease, characterized by a transition temperature onset at 95°C for controls, whereas in F1, F2 and F3-F4 animals this temperature significantly decreased to 93°C, 84°C and 75°C, respectively. CONCLUSION: Because the liver shows a differential thermal signature according to the degree of fibrosis, mDSC could be a novel tool in the study of liver fibrosis progression.
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The human being has historically consumed fried foods for centuries; however, conventional frying has a disadvantage, immersion in vegetable and/or animal oils, which leads to the search for different options. This is why air frying is a good alternative, which still has a wide field of study. In this work, frozen French fries of a brand marketed in Mexico that were subjected to frying in canola oil and air frying were compared. They were evaluated through the change in the removed moisture content, water activity, color profile, hardness, fracturability, and surface damage by SEM, thermal analysis by MDSC, and chemical by FTIR-ATR spectroscopy. Air-fried French fries were found to contain about 48% less moisture, fewer perceptible color changes, and less surface damage translated into better crunchiness compared with conventionally fried. It was also found that the changes at the chemical level are smaller, mainly attributed to the absence of canola oil and that the thermal transitions are more stable in terms of temperatures and enthalpies, which makes it possible to emphasize that air frying is a good alternative for developing new fried products that allow expanding the variety of these in the market without sacrificing some quality attributes.
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Cryostructured gels, better known as cryogels, are a very important emerging class of biomaterials that have diverse applications in food preservation. This work shows a novel alternative to prepare a cryostructured composite coating made from a blend of xanthan, bovine collagen, and oregano essential oil. The composite coating was suitably applied onto the surface of preservative-free biscuits which were stored for 15 days at 25 ± 2°C and 52% ± 1% relative humidity. The evaluation focused mainly on the changes in the physicochemical, textural, and microbiological characteristics of the biscuits. It was found that the coated samples significantly (p < 0.05) decreased moisture absorption, water activity, and fungal growth. However, the composite coating minimally impacted the quality of biscuits in terms of color, texture profile, and surface microstructure. Overall, the cryostructured composite coating constitutes an advance in technological strategies aimed at the preservation of baked products. This will allow, in the future, the development of novel coatings on bakery products to generate new trends in the conservation of their properties and extension of shelf life. This could be achieved through the implementation of new technologies in the food industry, with the aim of making them more environmentally friendly and contributing to the generation of less plastic waste. PRACTICAL APPLICATION: The study and application of cryogels, as innovative systems in the food industry, allow to expand and diversify the materials that can function as coatings to maintain some quality characteristics, in this case in bakery products, so it is important to analyze their effects and consider them to improve conservation processes.
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Óleos Voláteis , Origanum , Animais , Bovinos , Óleos Voláteis/química , Origanum/química , México , Criogéis , Conservação de AlimentosRESUMO
Both chronic obstructive pulmonary disease and bronchiectasis are highly prevalent diseases. In both cases, inhaled corticosteroids (ICs) are associated with a decrease in exacerbations in patients with a high peripheral blood eosinophil count (BEC), but it is still not known what occurs in bronchiectasis-COPD overlap syndrome (BCOS). The present study aimed to assess the effect of ICs on various outcomes in patients with BCOS, according to BEC values. We undertook a post-hoc analysis of a cohort of 201 GOLD II-IV COPD patients with a long-term follow-up (median 74 [IQR: 40-106] months). All participants underwent computerized tomography and 115 (57.2%) had confirmed BCOS. A standardized clinical protocol was followed and two sputum samples were collected at each medical visit (every 3-6 months), whenever possible. During follow-up, there were 68 deaths (59.1%), and the mean rate of exacerbations and hospitalizations per year was 1.42 (1.2) and 0.57 (0.83), respectively. A total of 44.3% of the patients presented at least one pneumonic episode per year. The mean value of eosinophils was 402 (112) eosinophils/µL, with 27 (23.5%), 63 (54.8%), and 25 patients (21.7%) presenting, respectively, less than 100, 101-300, and more than 300 eosinophils/µL. A total of 84 patients (73.1%) took ICs. The higher the BEC, the higher the annual rate of exacerbations and hospitalizations. Patients with less than 100 eosinophils/µL presented more infectious events (incident exacerbations, pneumonic episodes, and chronic bronchial infection via pathogenic bacteria). Only those patients with eosinophilia (>300 eosinophils/µL) treated with ICs decreased the number (1.77 (1.2) vs. 1.08 (0.6), p < 0.001) and the severity (0.67 (0.8) vs. 0.35 (0.5), p = 0.011) of exacerbations, without any changes in the other infectious outcomes or mortality. In conclusion, ICs treatment in patients with BCOS with increased BEC decreased the number and severity of incident exacerbations without any negative influence on other infectious outcomes (incidence of pneumonia or chronic bronchial infection).
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BACKGROUND: The Centres for Disease Control and Prevention (CDC) broadened the focus of surveillance from ventilator-associated pneumonia to ventilator-associated event (VAE) for quality purposes. No paediatric definition of VAE (PaedVAE) has been accurately validated. We aimed to analyse the incidence and impact on patient outcomes resulting from the application of the adult and two paediatric VAE (PaedVAE) criteria. SECONDARY OBJECTIVE: to evaluate VAE/PaedVAE as factors associated with increased duration of mechanical ventilation (MV) and Paediatric Intensive Care Unit (PICU) stay. METHODS: Multicentre observational prospective cohort study in 15 PICUs in Spain. VAEs were assessed using the 2013/2015 CDC classification. PaedVAE were assessed using the CDC definition based on mean airway pressure (MAP-PaedVAE) versus a paediatric definition based on positive end-expiratory pressure (PEEP-PaedVAE). Children who underwent MV ≥ 48 h were included. RESULTS: A total of 3626 ventilator-days in 391 patients were analysed. The incidence of VAE, MAP-PaedVAE and PEEP-PaedVAE was 8.55, 5.24 and 20.96 per 1000 ventilator-days, respectively. The median time [IQR] for VAE, MAP-PaedVAE and PEEP-PaedVAE development from the MV onset was 4 [3-12.5], 4 [3-14], and 5 [3-7.75] days, respectively. Among survivors, all three were associated with increased MV duration (> 7 days) and PICU stay (> 10 days) at univariate analysis. Multivariate analysis showed that PEEP-PaedVAE was the only definition independently associated with MV above 7 days [OR = 4.86, 95% CI (2.41-10.11)] and PICU stay [OR = 3.49, 95% CI (1.68-7.80)] above ten days, respectively. CONCLUSIONS: A VAE definition based on slight PEEP increases should be preferred for VAE surveillance in children.
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Pneumonia Associada à Ventilação Mecânica , Ventiladores Mecânicos , Adulto , Criança , Humanos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Espanha/epidemiologiaRESUMO
Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals. OBJETIVE: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic. METHODS: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale. RESULTS: 5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items. CONCLUSIONS: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date.
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COVID-19/prevenção & controle , Controle de Infecções/normas , Pandemias , Reumatologia/métodos , Ultrassonografia , COVID-19/transmissão , Desinfecção/métodos , Desinfecção/normas , Contaminação de Equipamentos/prevenção & controle , Géis , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Angioscopia Microscópica/instrumentação , Angioscopia Microscópica/métodos , Óleos , Equipamento de Proteção Individual , Doenças Reumáticas/diagnóstico por imagem , SARS-CoV-2 , Ultrassonografia/instrumentação , Ultrassonografia/métodosRESUMO
Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals. Objetive: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic. Methods: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale. Results: 5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items. Conclusions: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date.
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BACKGROUND: Plasminogen activator inhibitor 1 (PAI-1) attenuates the conversion of plasminogen to plasmin. Polymorphisms of the PAI-1 gene are associated with varying PAI-1 levels and risk of prothrombotic events in nonsurgical patients. The purpose of this study, a secondary analysis of a clinical trial, was to investigate whether PAI-1 genotype affects the efficacy of tranexamic acid (TA) in reducing postoperative chest tube blood loss of patients undergoing cardiopulmonary bypass. METHODS: Fifty patients were classified according to PAI-1 genotype (4G/4G, 4G/5G, or 5G/5G). Twenty-four received 2 g TA before and after cardiopulmonary bypass, whereas 26 received placebo. The authors recorded data related to coagulation, fibrinolysis, and bleeding before surgery, at admission to the intensive care unit (0 h), and 4 and 24 h later. RESULTS: In patients not receiving TA, those with the 5G/5G genotype had significantly higher chest tube blood loss and transfusion requirements compared with patients with the other genotypes at all time points. Patients with the 5G/5G genotype receiving TA showed significantly lower blood loss compared with the placebo group. There were no significant differences in blood loss or transfusion requirements between patients with the 4G/4G genotype when TA was used. CONCLUSIONS: Plasminogen activator inhibitor-1 5G/5G homozygotes who did not receive TA showed significantly greater postoperative bleeding than patients with other PAI-1 genotypes. 5G/5G homozygotes who received TA showed the greatest blood-sparing benefit.
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Ponte Cardiopulmonar/efeitos adversos , Homozigoto , Inibidor 1 de Ativador de Plasminogênio/genética , Polimorfismo Genético/genética , Hemorragia Pós-Operatória/genética , Ácido Tranexâmico/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético/efeitos dos fármacos , Hemorragia Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ácido Tranexâmico/farmacologiaRESUMO
Starch is the major component of cereal, pulses, and root crops. Starch consists of two kinds of glucose polymers, amylose and amylopectin. Waxy starch-with 99â»100% amylopectin-has distinctive properties, which define its functionality in many food applications. In this research, a novel material was prepared through the cryogelification of waxy starch (WS) using four cycles of freezing and thawing in indirect contact with liquid nitrogen at -150 °C. Polyvinyl alcohol (PVA) was used as a reference. The cryogels were characterized using several validation methodologies: modulated differential scanning calorimetry (MDSC), scanning electron microscopy (SEM), rheology, and Fourier transform infrared (FTIR) spectroscopy with diffuse reflectance (DR). Based on the number of freezeâ»thaw cycles, significant changes were found (P < 0.05) showing important structural modifications as well as reorganization of the polymeric matrix. Two cryogelification cycles of the WS were enough to obtain the best structural and functional characteristics, similar to those of PVA, which has already been tested as a cryogel. From these results, it is concluded that WS has potential as a cryogel for application in food processing.
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INTRODUCTION: Extracorporeal circulation induces hemostatic alterations that lead to inflammatory response (IR) and postoperative bleeding. Tranexamic acid (TA) reduces fibrinolysis and blood loss after cardiopulmonary bypass (CPB). However, its effects on IR and vasoplegic shock (VS) are not well known and elucidating these effects was the main objective of this study. METHODS: A case control study was carried out to determine factors associated with IR after CPB. Patients undergoing elective CPB surgery were randomly assigned to receive 2 g of TA or placebo (0.9% saline) before and after intervention. We performed an intention-to-treat analysis, comparing the incidence of IR and VS. We also analyzed several biological parameters related to inflammation, coagulation, and fibrinolysis systems. We used SPSS version 12.2 for statistical purposes. RESULTS: In the case control study, 165 patients were studied, 20.6% fulfilled IR criteria, and the use of TA proved to be an independent protective variable (odds ratio 0.38, 95% confidence interval 0.18 to 0.81; P < 0.01). The clinical trial was interrupted. Fifty patients were randomly assigned to receive TA (24) or placebo (26). Incidence of IR was 17% in the TA group versus 42% in the placebo group (P = 0.047). In the TA group, we observed a significant reduction in the incidence of VS (P = 0.003), the use of norepinephrine (P = 0.029), and time on mechanical ventilation (P = 0.018). These patients showed significantly lower D-dimer, plasminogen activator inhibitor 1, and creatine-kinase levels and a trend toward lower levels of soluble tumor necrosis factor receptor and interleukin-6 within the first 24 hours after CPB. CONCLUSION: The use of TA attenuates the development of IR and VS after CPB.
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Antifibrinolíticos/uso terapêutico , Ponte Cardiopulmonar/efeitos adversos , Fibrinólise/efeitos dos fármacos , Mediadores da Inflamação/sangue , Mediadores da Inflamação/uso terapêutico , Hemorragia Pós-Operatória/patologia , Ácido Tranexâmico/uso terapêutico , Idoso , Antifibrinolíticos/sangue , Antifibrinolíticos/farmacologia , Estudos de Casos e Controles , Método Duplo-Cego , Feminino , Fibrinólise/fisiologia , Humanos , Mediadores da Inflamação/antagonistas & inibidores , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ácido Tranexâmico/farmacologiaRESUMO
Olfactory nerve derived and olfactory bulb derived olfactory ensheathing cells (OECs) have the ability to promote axonal regeneration and remyelination, both of which are essential in a successful cell transplant. Thus, morphological identification of OECs is a key aspect to develop an applicable cell therapy for injuries to the nervous system. However, there is no clear definition regarding which developmental stage or anatomical origin of OECs is more adequate for neural repair. In the present study, an ultrastructural comparison was made between OECs recovered from primary cultures of olfactory nerve and bulb in two developmental stages. The most notorious difference between cells obtained from olfactory nerve and bulb was the presence of indented nuclei in bulb derived OECs, suggesting a greater ability for possible chemotaxis. In neonatal OECs abundant mitochondria, lipid vacuoles, and smooth endoplasmic reticulum were detected, suggesting an active lipid metabolism, probably involved in synthesis of myelin. Our results suggest that neonatal OECs obtained from olfactory bulb have microscopic properties that could make them more suitable for neural repair.
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Neuroglia/ultraestrutura , Bulbo Olfatório/ultraestrutura , Nervo Olfatório/ultraestrutura , Animais , Animais Recém-Nascidos , Células Cultivadas , Cultura Primária de Células , Ratos WistarRESUMO
INTRODUCTION: The risks and benefits of transfusing critically ill patients continue to evoke controversy. Specifically, the critically ill patients with active ischemic cardiac disease continue to represent a "gray area" in the literature. EVIDENCE ACQUISITION: Meta-analysis of the effects of lower versus higher hemoglobin thresholds on mortality in critically ill patients was carried out using PRISMA methodology. A systematic research was performed in PubMed, Embase, and the Cochrane Library (last update, December 2014). INCLUSION CRITERIA: Anemic critically ill adult patients admitted to intensive care units and/or anemic patients with acute coronary syndrome in which a restrictive vs. liberal transfusion therapy was compared. PRIMARY ENDPOINT: mortality. Included studies were subjected to quantifiable analysis, predefined subgroup analysis, trial sequential analysis and predefined sensitivity analysis. EVIDENCE SYNTHESIS: Thirty RCT's were initially identified; 6 fulfilled the inclusion criteria, including 2156. There were no differences in mortality between the restrictive and liberal groups (RR: 0.86, 95% CI 0.70-1.05 P=0.14), neither in patients with chronic cardiovascular disease subgroup (RR: 1.13, 95% IC 0.88-1.46 P=0.34). However, there is a trend towards decreased mortality in the subgroup critically ill (RR: 0.86, 95% CI 0.73-1.01 P=0.06); while in the subgroup of patients with acute myocardial infarct seems like it might be a non-significant trend towards increased mortality (RR: 3.85, 95% CI 0.82-18.0 P=0.09). CONCLUSIONS: Restrictive strategy is at least as effective to liberal strategy in critically ill patients. Nevertheless, there is insufficient evidence to recommend a restrictive strategy for patients with acute coronary syndrome.
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Síndrome Coronariana Aguda/terapia , Anemia/terapia , Estado Terminal , Transfusão de Eritrócitos , Hemoglobinas , Síndrome Coronariana Aguda/mortalidade , Anemia/mortalidade , Transfusão de Eritrócitos/mortalidade , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
La ecografía es una técnica de amplia implantación en reumatología que implica una gran interacción entre paciente y profesional. La pandemia COVID-19 hace necesario un cambio en nuestra práctica clínica, mediante estrategias que permitan la asistencia integral de nuestros pacientes, garantizando la seguridad tanto de los pacientes como de los profesionales sanitarios. Objetivo: Desarrollar unas recomendaciones prácticas, consensuadas entre un panel de expertos, sobre el uso y seguridad de la ecografía reumatológica durante la pandemia COVID-19. Métodos: Analizando la literatura disponible se realizaron unas recomendaciones preliminares, posteriormente consensuadas con un panel de expertos mediante el método Delphi con una escala Likert 1-5. Resultados: Se elaboraron y consensuaron por el panel 5 principios fundamentales y 28 recomendaciones. El consenso del grupo se logró en el 100% de ítems (acuerdo para cada recomendación ≥4 en escala de Likert del 75% de componentes del panel). Conclusiones: El documento proporciona información de utilidad acerca de medidas preventivas en la práctica de ecografía en reumatología en tiempos de pandemia COVID-19 de acuerdo a la experiencia y literatura disponible hasta el momento.(AU)
Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals. Objetive: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic. Methods: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale. Results:5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items. Conclusions: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date.(AU)
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Humanos , Infecções por Coronavirus , Pandemias , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Ultrassonografia , Diagnóstico por Imagem , Reumatologia , Doenças ReumáticasRESUMO
La ecografía es una técnica de amplia implantación en reumatología que implica una gran interacción entre paciente y profesional. La pandemia COVID-19 hace necesario un cambio en nuestra práctica clínica, mediante estrategias que permitan la asistencia integral de nuestros pacientes, garantizando la seguridad tanto de los pacientes como de los profesionales sanitarios. OBJETIVO: Desarrollar unas recomendaciones prácticas, consensuadas entre un panel de expertos, sobre el uso y seguridad de la ecografía reumatológica durante la pandemia COVID-19. MÉTODOS: Analizando la literatura disponible se realizaron unas recomendaciones preliminares, posteriormente consensuadas con un panel de expertos mediante el método Delphi con una escala Likert 1-5. RESULTADOS: Se elaboraron y consensuaron por el panel 5 principios fundamentales y 28 recomendaciones. El consenso del grupo se logró en el 100% de ítems (acuerdo para cada recomendación ≥4 en escala de Likert del 75% de componentes del panel). CONCLUSIONES: El documento proporciona información de utilidad acerca de medidas preventivas en la práctica de ecografía en reumatología en tiempos de pandemia COVID-19 de acuerdo a la experiencia y literatura disponible hasta el momento
Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals. OBJECTIVE: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic. METHODS: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale. RESULTS: 5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items. CONCLUSIONS: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date
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Humanos , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Sociedades Médicas , Doenças Reumáticas/diagnóstico por imagem , Ultrassonografia/normas , EspanhaAssuntos
Antibacterianos/uso terapêutico , Estado Terminal/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Sepse/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Estado Terminal/mortalidade , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Sepse/diagnóstico , Sepse/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade , Fatores de TempoRESUMO
BACKGROUND: In cardiopulmonary bypass (CPB) patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA) reduced CPB-mediated inflammatory response (IR). METHODS: We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB) or the double-dose group (40 mg/Kg TA before and after CPB). RESULTS: 160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; P = 0.030). After adjusting for hypertension, total protamine dose and temperature after CPB, TA2 showed a lower risk of IR compared with TA1 [OR: 0.29 (95% CI: 0.10-0.83), (P = 0.013)]. Relative risk for IR was 2.5 for TA1 (95% CI: 1.02 to 6.12). The double-dose group had significantly lower chest tube bleeding at 24 hours [671 (95% CI 549-793 vs. 826 (95% CI 704-949) mL; P = 0.01 corrected-P significant] and lower D-dimer levels at 24 hours [489 (95% CI 437-540) vs. 621(95% CI: 563-679) ng/mL; P = 0.01 corrected-P significant]. TA2 required lower levels of norepinephrine at 24 h [0.06 (95% CI: 0.03-0.09) vs. 0.20(95 CI: 0.05-0.35) after adjusting for dobutamine [F = 6.6; P = 0.014 corrected-P significant]. We found a significant direct relationship between IL-6 and temperature (rho = 0.26; P < 0.01), D-dimer (rho = 0.24; P < 0.01), norepinephrine (rho = 0.33; P < 0.01), troponin I (rho = 0.37; P < 0.01), Creatine-Kinase (rho = 0.37; P < 0.01), Creatine Kinase-MB (rho = 0.33; P < 0.01) and lactic acid (rho = 0.46; P < 0.01) at ICU arrival. Two patients (1.3%) had seizure, 3 patients (1.9%) had stroke, 14 (8.8%) had acute kidney failure, 7 (4.4%) needed dialysis, 3 (1.9%) suffered myocardial infarction and 9 (5.6%) patients died. We found no significant differences between groups regarding these events. CONCLUSIONS: Prolonged inhibition of fibrinolysis, using an additional postoperative dose of tranexamic acid reduces inflammatory response and postoperative bleeding (but not transfusion requirements) in CPB patients. A question which remains unanswered is whether the dose used was ideal in terms of safety, but not in terms of effectiveness.
Assuntos
Antifibrinolíticos/uso terapêutico , Ponte Cardiopulmonar , Mediadores da Inflamação/uso terapêutico , Ácido Tranexâmico/uso terapêutico , Idoso , Análise de Variância , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/farmacologia , Temperatura Corporal , Creatina Quinase/sangue , Creatina Quinase Forma MB/sangue , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinólise/efeitos dos fármacos , Humanos , Mediadores da Inflamação/administração & dosagem , Mediadores da Inflamação/farmacologia , Interleucina-6/sangue , Ácido Láctico/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Placebos , Estatísticas não Paramétricas , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/farmacologia , Resultado do TratamentoRESUMO
Ocular manifestations in Systemic Lupus Erythematosus (SLE) are relatively frequent, with a major prevalence of the Keratoconjunctivitis sicca. Nevertheless, the appearance of unilateral exophthalmos secondary to orbital pseudotumor in patients with SLE is extremely rare(1-7), and on occasion it can be refractory to conventional pharmacological treatment (glucocorticoids and immunosuppressants). We present the case of a patient with SLE and orbital pseudotumor refractory to treatment with Cyclophosphamide (CF) and an excellent clinical response, with disappearance of the ophthalmological condition after the beginning of therapy with Rituximab (1g×2), continuing after the infusion of two complete cycles without incidents.