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Resumen: Introducción: el dolor agudo postoperatorio demora la recuperación funcional del paciente. Objetivo: evaluar utilidad de la ketamina asociada a morfina administrados en bolos intravenosos en el control del dolor agudo postoperatorio de pacientes sometidos a cirugía renal electiva. Material y métodos: realizamos estudio doble ciego en pacientes con dolor postoperatorio moderado-severo sometidos a cirugía renal electiva. Se conformaron dos grupos: grupo MK administramos morfina 0.05 mg/kg más ketamina 0.2 mg/kg y grupo M morfina 0.05 mg/kg más solución salina a 0.9%. Pacientes con dolor de intensidad moderada-severa según escala analógica visual recibieron dosis de morfina cada 20 minutos hasta lograr dolor ligero, registrándose el consumo total de morfina por paciente. La tensión arterial, frecuencia cardíaca y respiratoria, saturación de oxígeno y efectos adversos fueron evaluados con la misma periodicidad. Resultados: el grupo MK mostró menor intensidad del dolor con disminución significativa del consumo de morfina. Ambos grupos resultaron ser similares en cuanto a cifras de tensión arterial, frecuencia cardíaca, frecuencia respiratoria y saturación de oxígeno. Las náuseas y vómitos fueron los efectos adversos de mayor prevalencia, siendo superiores en el grupo morfina. Conclusiones: la asociación morfina-ketamina resultó útil en el control del dolor moderado-severo en pacientes sometidos a cirugía renal electiva.
Abstract: Introduction: acute postoperative pain delays the patient's functional recovery. Objective: to evaluate the utility of ketamine associated with morphine administered in intravenous boluses in the control of acute postoperative pain in patients undergoing elective renal surgery. Material and methods: we conducted a double-blind study in patients with moderate-severe postoperative pain undergoing elective renal surgery. Two groups were formed: group MK administered 0.05 mg/kg morphine plus 0.2 mg/kg ketamine and group M 0.05 mg/kg morphine plus 0.9% saline solution. Patients with pain of moderate-severe intensity according to the visual analogue scale received doses of morphine every 20 minutes until achieving light pain, recording the total consumption of morphine per patient. Blood pressure, heart and respiratory rates, oxygen saturation, and adverse effects were evaluated with the same periodicity. Results: MK group showed lower pain intensity with a significant decrease in morphine consumption. Both groups turned out to be similar in terms of blood pressure, heart rate, respiratory rate and oxygen saturation Figures. Nausea and vomiting were the most prevalent adverse effects, being higher in the morphine group. Conclusions: the morphine-ketamine association was useful in the control of moderate-severe pain in patients undergoing elective renal surgery.
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Filamentous fungi are an important source of natural products. The mold Penicillium roqueforti, which is well-known for being responsible for the characteristic texture, blue-green spots, and aroma of the so-called blue-veined cheeses (French Bleu, Roquefort, Gorgonzola, Stilton, Cabrales, and Valdeón, among others), is able to synthesize different secondary metabolites, including andrastins and mycophenolic acid, as well as several mycotoxins, such as Roquefortines C and D, PR-toxin and eremofortins, Isofumigaclavines A and B, festuclavine, and Annullatins D and F. This review provides a detailed description of the biosynthetic gene clusters and pathways of the main secondary metabolites produced by P. roqueforti, as well as an overview of the regulatory mechanisms controlling secondary metabolism in this filamentous fungus.
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Resumen: Objetivo: Evaluar el comportamiento de las presiones intrapulmonares con la inversión del índice inspiración espiración durante la colecistectomía electiva videolaparoscópica. Material y métodos: Se realizó un ensayo clínico controlado fase tres acerca de tales presiones intrapulmonares, durante operaciones de colecistectomía laparoscópica, en el Hospital Universitario «Manuel Ascunce Domenech¼, en el período de septiembre del 2016 a febrero del 2020. El universo estuvo constituido por los pacientes que cumplieron con los criterios de inclusión, y una muestra de 106 de ellos, los cuales se dividieron en dos conjuntos de 53 personas cada uno, por método aleatorio simple. La fuente primaria de obtención de datos la constituyeron las historias clínicas y el resultado de una encuesta. Los datos se recogieron en un modelo diseñado en correspondencia con la bibliografía. Resultados: Se presentó aumentos de la presión inspiratoria pico y presión meseta luego del neumoperitoneo, con descenso de ambas tras la transposición del índice I:E, además de hipertensión arterial, arritmias e hipotensión arterial, sin guardar relación con la aplicación del indicador I:E invertido. Conclusiones: La inversión de la inspiración espiración contribuyó a mejorar los efectos del neumoperitoneo sobre dichas presiones intrapulmonares, manteniendo una oxigenación adecuada y nulos efectos cardiovasculares.
Abstract: Objective: Evaluating the behavior of intrapulmonary pressures with the inversion of the inspiration expiration index, during elective videolaparoscopic cholecystectomy. Material and methods: A phase three controlled clinical trial was conducted on intrapulmonary pressures during laparoscopic cholecystectomies at the «Manuel Ascunce Domenech¼ University Hospital, from September 2016 to February 2020, the universe consisted of patients who met the inclusion criteria, from which a sample of 106 patients was selected, by a simple randomizing method. The primary source of data collection was the medical records and the result of a survey. These data were collected in a model designed in correspondence with the bibliography reviewed. Results: Measured by variation in peak inspiratory pressure and plateau pressure after pneumoperitoneum, with significant decrease of both after inversion of I:E index. More than half of the patients presented arterial hypertension, arrhythmias and arterial hypotension, without them being related to the application of the inverted I:E index. Conclusions: The inversion of inspiratory expiration contributed to improve the effects of pneumoperitoneum on intrapulmonary pressures, with adequate oxygenation and no cardiovascular effects.
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Introduction: Patient Blood Management (PBM) programs improve patient care and reduce health costs. It includes detection of presurgical anemia, reduction of blood loss and improvement of patient-specific anemic reserve. The aim of this study is to assess the effect of a PBM program on transfusion rate, length of stay (LOS) and adverse events. Methods: We developed a retrospective observational study. We included patients who underwent total hip (THR) o knee replacement (TKR). Our PBM involved preoperative assessment, administration of 2 doses of tranexamic acid, application of restrictive transfusion criteria and use of IV iron. We compared results between the group of patients before and the one after the PBM implementation. Results: We included 179 patients (80 TKR and 99 THR) who underwent surgery before PBM implementation from January to December 2014 (Group A), and 187 patients (103 TKR and 84 THR) who underwent arthroplasty after PBM application from January to November 2016 (Group B). In Group A, hemoglobin drop was larger than in Group B, for TKR (5.1±1.2 vs. 4.2±1.2 g/dl; p<0,05) and for THR (4.7±1.3 vs. 3.8±1.3 g/dl; p<0,05). In group A, more patients were transfused (31.8% vs. 2.7%; p<0.001). LOS was longer for patients in group A, in both surgeries (for TKA, 3.98±1.4days vs. 2.99±0.95 days; p<0.0001; for THA 3.68±1.06days vs. 2.88±0.75days; p<0.0001). No significant differences were found regarding adverse events. Conclusion: Our PBM program saved transfusions after primary TKR and THR and lowered LOS, without risking patients to higher number of complications or death.
Introducción: Los protocolos de manejo de anemia perioperatoria mejoran el cuidado del paciente y disminuyen los costos en salud. El objetivo de este estudio fue identificar el efecto de dicho programa en pacientes sometidos a reemplazo total de cadera (RTC) o rodilla (RTR), en la tasa de transfusiones, tiempo de estadía hospitalaria y eventos adversos. Métodos: Se realizó un estudio observacional retrospectivo, incluyendo pacientes sometidos a RTC o RTR primarios. El programa abarcó la valoración preoperatoria, el uso de 2 dosis de ácido tranexámico, la aplicación de transfusiones restringidas, y el uso de hierro suplementario. Se compararon los resultados entre pacientes pre y post implementación del protocolo. Resultados: Se incluyeron 179 pacientes (80 RTR y 99 RTC) pre protocolo entre enero y diciembre 2014 (grupo A) y 187 casos (103 RTR y 84 RTC) post protocolo entre enero y noviembre 2016 (grupo B). En el grupo A, la caida de hemoglobina fue mayor que en el grupo B en RTR (5,1±1,2 vs. 4,2±1,2 g/dl; p<0,05) y en RTC (4,7±1.3 vs. 3,8±1.3 g/dl; p<0,05). Hubo mayor requerimiento transfusional en el grupo A (31,8% vs. 2,7%; p<0,001). El tiempo de estadía hospitalaria (TEH) fue mayor en el grupo A para ambas cirugías (en RTR 3,98±1,4días vs. 2,99±0,95 días; p<0,0001; en RTC 3,68±1,06días vs. 2,88±0,75días; p<0,0001). No se encontraron diferencias significativas respecto a eventos adversos. Conclusión: En ambas artroplastias, nuestro programa disminuyó la cantidad de transfusiones, la caída de hemoglobina y la estadía hospitalaria, sin aumentar el número de complicaciones.
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Transfusão de Sangue , Humanos , Estudos RetrospectivosRESUMO
El documento consta de una breve introducción, Madre de Dios y mercurio, Madre de Dios: Salud y minería informal e ilegal, algunas reflexiones finales.
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Saúde Pública , Poluição Ambiental , Mercúrio , MineraçãoRESUMO
Resumen: Objetivos: Evaluar las modalidades analgésicas subaracnoideas fentanyl-bupivacaína y bupivacaína en intervenciones quirúrgicas del hemiabdomen inferior. Material y métodos: Se realizó un estudio prospectivo longitudinal analítico en el Hospital Universitario «Manuel Ascunce Domenech¼ desde enero de 2015 a diciembre de 2017. El universo estuvo compuesto por 180 pacientes. Se seleccionó una muestra de 60 pacientes mediante muestreo probabilístico aleatorio simple distribuidos en dos grupos: A (fentanyl-bupivacaína) y B (bupivacaína) que cumplieron los criterios de inclusión. Los datos fueron recogidos en formulario a propósito de la investigación que permitió la confección de una base de datos en Statistical Package for Social Sciences. Se emplearon en el análisis técnicas univariadas y multivariadas. Resultados: Las complicaciones y reacciones adversas y su probabilidad de presentación en el grupo fentanyl-bupivacaína, que resultó mayor, fueron somnolencia (3.5 veces), hipotensión arterial (2.8 veces), prurito (2.1 veces) y bradicardia (2.1 veces), corroborado por el intervalo de confianza. Este grupo tuvo 10 veces más probabilidades de tener molestia tolerable o nada de dolor (OR = 10.2) que los tratados con bupivacaína que presentaron dolor moderado; 10 veces más probabilidades de analgesia superior a tres horas (OR = 10.7) frente a bupivacaína con analgesia de treinta minutos a tres horas y ocho veces más probabilidades de percibir satisfacción buena (OR = 7.8). Conclusiones: La evaluación del dolor postoperatorio y el tiempo de analgesia fueron mejores en los pacientes tratados con fentanyl-bupivacaína, lo que resultó en analgesia de mayor calidad aunque predominó la somnolencia, la hipotensión arterial, el prurito y la bradicardia como reacciones adversas.
Abstract. Objective: To evaluate subarachnoid analgesic modes fentanyl-bupivacaine and bupivacaine in surgery procedures of low abdomen. Material and methods: An analytic longitudinal prospective study was performed at the «Manuel Ascunce Domenech¼ University Hospital in Camagüey, from January 2015 to December 2017. The universe was compound by 180 patients. Sample was selected about 60 patients by probabilistic simple random sampling distributed in two groups: A (fentanyl-bupivacaine) and B (bupivacaine) according to inclusion criteria. The data were collected in questionnaire properly to investigation with baseline data in Statistical Package for Social Sciences. A univariate and multivariate analysis were conducted. Results: Complications and adverse reactions and their probability of presentation in the fentanyl-bupivacaine group was greater, drowsiness (3.5 times), arterial hypotension (2.8 times), pruritus (2.1 times) and bradycardia (2.1 times) corroborated by confidence intervals. This group had ten times more probability to have tolerable trouble or no pain (OR = 10.2) that bupivacaine group, all of which showed moderate pain; 10 times more probability of analgesia higher to 3 hours (OR = 10.7) versus bupivacaine with analgesia from 30 minutes to 3 hours and 8 times more probability to perceive good satisfaction (OR = 7.8). Conclusions: Evaluation of pain postoperative and analgesic time were better in patients managed with fentanyl-bupivacaine that resulted in analgesic of the greatest quality although prevailed drowsiness, arterial hypotension, pruritus and bradycardia like adverse reactions.
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El síndrome de Beckwith-Wiedemann es caracterizado por presentar onfalocele, macroglosia, visceromegalias e hipoglucemia neonatal además de una gran diversidad de anomalías clínicas y de laboratorio. Esta enfermedad también se conoce como síndrome de onfalocele, macroglosia y gigantismo. Los problemas más significativos relacionados con la anestesia son hipoglicemia y macroglosia. Es imperativo realizar una evaluación preanestésica que incluya el sistema cardiovascular, sistema urinario, así como la vía aérea. Los niños con este síndrome pueden requerir diferentes procedimientos quirúrgicos. Se debe pronosticar un abordaje difícil de la vía respiratoria debido al crecimiento de la lengua que puede causar dificultad durante la ventilación y/o intubación endotraqueal. S debe monitorizar la glicemia perioperatoria para evitar secuelas neurológicas secundarias a hipoglicemia no diagnosticada. Se reporta el tratamiento perianestesiológico de un niño de cuatro años de edad con síndrome de Beckwith-Wiedemann que requirió tratamiento quirúrgico de un tumor de Wilms. Después de una evaluación minuciosa, se realizó intubación orotraqueal con un tubo 5.0 el cual se introdujo con facilidad bajo inducción con ketamina-vecuronio. La anestesia se mantuvo sin incidentes con isoflurano y fentanilo(AU)
Beckwith-Wiedemann syndrome is characterized by omphalocele, macroglossia, visceromegaly and neonatal hypoglycaemia, as well as a great diversity of clinical and laboratory abnormalities. This disease is also known as omphalocele, macroglossia and gigantism syndrome. The most significant problems related to anesthesia are hypoglycemia and macroglossia. It is imperative to perform a pre-anesthetic evaluation that includes the cardiovascular system, the urinary system, as well as the airway. Children with this syndrome may require different surgical procedures. A difficult approach to the airway should be predicted due to the growth of the tongue which can cause difficulty during ventilation and/or endotracheal intubation. Perioperative glycemia should be monitored in order to avoid neurological sequelae secondary to undiagnosed hypoglycemia. We report the perianesthesiological treatment of a four-year-old boy with Beckwith-Wiedemann syndrome who required surgical treatment for Wilms' tumor. After a thorough evaluation, orotracheal intubation was performed with a 5.0 tube, which was easily introduced with ketamine-vecuronium induction. Anesthesia was maintained without incident with isoflurane and fentanyl(AU)
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Humanos , Masculino , Pré-Escolar , Síndrome de Beckwith-Wiedemann/diagnóstico , Síndrome de Beckwith-Wiedemann/epidemiologia , Tumor de Wilms/cirurgia , Intubação Intratraqueal/métodosRESUMO
To obtain further insight into geographic distribution of Leishmania species in Peru, a countrywide survey, including central to southern rainforest areas where information on causative parasite species is limited, was performed based on cytochrome b (cyt b) and mannose phosphate isomerase (mpi) gene analyses. A total of 262 clinical samples were collected from patients suspected of cutaneous leishmaniasis (CL) in 28 provinces of 13 departments, of which 99 samples were impregnated on FTA (Flinders Technology Associates) cards and 163 samples were Giemsa-stained smears. Leishmania species were successfully identified in 83 (83.8%) of FTA-spotted samples and 59 (36.2%) of Giemsa-stained smear samples. Among the 142 samples identified, the most dominant species was Leishmania (Viannia) braziliensis (47.2%), followed by L. (V.) peruviana (26.1%), and others were L. (V.) guyanensis, L. (V.) lainsoni, L. (V.) shawi, a hybrid of L. (V.) braziliensis and L. (V.) peruviana, and Leishmania (Leishmania) amazonensis. Besides the present epidemiological observations, the current study provided the following findings: 1) A hybrid of L. (V.) braziliensis and L. (V.) peruviana is present outside the Department of Huanuco, the only place reported, 2) Many cases of CL due to L. (V.) lainsoni, an uncommon causative species in Peru, were observed, and 3) L. (V.) shawi is widely circulating in southern Amazonian areas in Peru.
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Citocromos b/genética , Leishmania/classificação , Leishmania/genética , Leishmaniose Cutânea/epidemiologia , Manose-6-Fosfato Isomerase/genética , Filogeografia , Proteínas de Protozoários/genética , Humanos , Leishmania/isolamento & purificação , Peru/epidemiologiaRESUMO
Reservoir sediment can work as both sink and source for contaminants. Once released into the water column, contaminants can be toxic to biota and humans. We investigate potential ecological risk to benthic organisms by metals contamination in six reservoirs in Southeast Brazil. Results of the bioavailable fraction of copper (Cu), chromium (Cr), cadmium (Cd), lead (Pb), zinc (Zn), and iron (Fe) in sediment samples are presented. Considering Cu, Cd, and Zn concentrations, about 6% of the samples exceeded the threshold effect levels of sediment quality guidelines. The comparison to sediment quality guidelines is conservative because we used a moderate metal extraction. Control of contaminant sources in these reservoirs is key because they are sources of water and food. The mixture toxicity assessment showed an increased incidence of toxicity to aquatic organisms showing that mixture toxicity should be taken into account in sediment assessment criteria.