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Background: Perioperative anaphylaxis can be life-threatening. The global incidence is estimated to be 1 in 10,000-20,000 procedures. The most common agents are neuromuscular blockers, latex, and antibiotics. There are very few reports of allergies to inhaled anesthetics such as sevoflurane, which is considered relatively safe in patients with drug allergies. Case report: 12-year-old patient, admitted to oncology, diagnosed with acute lymphoblastic leukemia. History of two perioperative hypersensitivity reactions. In the first event, lidocaine and rupivacaine were administered, he presented urticaria, managed with an antihistamine. On the second occasion, he received only sevoflurane and presented anaphylaxis, treated with intramuscular adrenaline. Later during intrathecal therapy, he received sevoflurane, he presented rash and arterial hypotension, managed again with adrenaline, with total remission of symptoms. Retrospectively Brighton criteria level I of certainty, classified as serious by Brown. Hypersensitivity to sevoflurane was suspected, ruling out other anesthetics such as lidocaine and rupivacaine with negative intradermal skin tests. Molecular components for latex were requested with negative results for Hev b 1, Hev b 3, Hev b 6. Due to the above and associated with the characteristics of the drug, a basophil activation test for sevoflurane was performed with an activation percentage of 50% (positive). Perioperative anaphylaxis due to sevoflurane is confirmed. Conclusion: All drugs involved in perioperative hypersensitivity reactions should be considered to establish adequate and safe treatment alternatives for this small group of patients.

Antecedentes: La anafilaxia perioperatoria puede amenazar la vida del paciente. La incidencia global se estima 1 entre 10.000-20.000 procedimientos. Los agen- tes más frecuentes son bloqueadores neuromusculares, látex y antibióticos. Hay muy pocos reportes de alergia a anestésicos inhalados como el sevoflurano, el cual se considera relativamente seguro en pacientes con alergia a fármacos. Reporte de caso: Paciente de 12 años, ingresó en oncología, diagnóstico de leucemia linfoblástica aguda. Antecedente de dos reacciones de hipersensibilidad perioperatorias. En primer evento se administró lidocaína y rupivacaína, presentó urticaria, manejado con antihistamínico. Segunda ocasión recibió sólo sevo- fluorano y presentó anafilaxia, tratado con adrenalina intramuscular. Posteriormente durante terapia intratecal, recibió sevoflurano, presentó rash e hipotensión arterial, manejo nuevamente con adrenalina, con remisión total de síntomas. Retrospectivamente criterios de Brighton nivel I de certeza, clasificada grave por Brown. Se sospechó hipersensibilidad a sevoflurano, descartando otros anestésicos como lidocaína y rupivacaina con pruebas cutáneas intradérmicas negativas. Se solicitaron componentes moleculares para látex con resultados negativos para Hev b 1, Hev b 3, Hev b 6. Por lo anterior y asociado a las características del fármaco se realiza prueba de activación de basófilos para sevoflurano con un porcentaje de activación del 50% (positivo). Se confirma anafilaxia perioperatoria por sevoflurano. Conclusión: Deben considerarse todos los fármacos involucrados en las reacciones de hipersensibilidad perioperatoria, para establecer alternativas adecuadas y seguras de tratamiento de este pequeño grupo de pacientes.

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Introducción: Es posible deducir la mejoría o empeoramiento del intercambio gaseoso en el paciente con COVID-19 en ventilación mecánica invasiva mediante el índice PaO2/FiO2 tras el uso de la posición prono. Objetivos: Identificar los cambios en el índice PaO2/FiO2 tras el uso de tres ciclos de prono, y detallar las características sociodemográficas de los pacientes. Material y métodos: En este estudio descriptivo y retrospectivo se analizaron los expedientes clínicos de 60 pacientes con COVID-19, se tomaron en cuenta valores de PaO2/FiO2, saturación de oxígeno y datos sociodemográficos. Resultados: Con el uso de tres ciclos de posición prono de 24 horas cada uno, en promedio la PaO2/FiO2 aumentó 26.38 mmHg (20%) y la saturación de oxígeno aumentó un 6.3%. 66.7% de la población eran hombres, y el promedio de edad fue de 67.10 años. Limitación: Hubo limitaciones de carácter retrospectivo debido al contexto de la pandemia de COVID-19 y la alta carga de trabajo que imposibilitó la adecuada recolección de información relevante, como los tipos de tratamiento farmacológico y de soporte vital empleados. Conclusiones: El uso de la posición prono en el paciente orointubado con COVID-19 constituye una estrategia de primera línea, pues ha demostrado un aumento en la PaO2/FiO2, que resulta en una mejoría en la oxigenación/perfusión.

Introduction: The improvement or worsening of gas exchange in patients with COVID-19 on invasive mechanical ventilation can be determined through the PaO2/FiO2 index after using the prone position. Objectives: To identify changes in the PaO2/FiO2 index after three prone cycles, and to describe the sociodemographic characteristics of the patients. Material and methods: In this descriptive and retrospective study, the clinical records of 60 patients with COVID-19 were analyzed, PaO2/FiO2 oxygen saturation values and sociodemographic data were considered. Results: With the use of three prone position cycles of 24 hours each, on average, the PaO2/FiO2increased by 26.38 mmHg (20.09%) and oxygen saturation increased by 6.3%. Male population represented 66.7%, and the average age was 67.10 years. Limitation: There was retrospective limitations due to the COVID-19 pandemic context and high workload, which made difficult to adequately record relevant information, including types of pharmacological and life support treatments used. Conclusions: The prone position used on orointubated patient with COVID-19 constitutes a first-line strategy; it has shown an increase in PaO2/FiO2 values, which leads to an improvement in oxygenation/perfusion.

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Neosartorya fischeri, an Aspergillaceae fungus, was evaluated in its capacity to transform high molecular weight polycyclic aromatics hydrocarbons (HMW-PAHs) and the recalcitrant fraction of petroleum, the asphaltenes. N. fischeri was able to grow in these compounds as sole carbon source. Coronene, benzo(g,h,i)perylene, and indeno(1,2,3-c,d)pyrene, together with the asphaltenes, were assayed for fungal biotransformation. The transformation of the asphaltenes and HMW-PAHs was confirmed by reverse-phase high-performance liquid chromatography (HPLC), nano-LC mass spectrometry, and IR spectrometry. The formation of hydroxy and ketones groups on the PAH molecules suggest a biotransformation mediated by monooxygenases such as cytochrome P450 system (CYP). A comparative microarray with the complete genome from N. fischeri showed three CYP monooxygenases and one flavin monooxygenase genes upregulated. These findings, together with the internalization of aromatic substrates into fungal cells and the microsomal transformation of HMW-PAHs, strongly support the role of CYPs in the oxidation of these recalcitrant compounds.

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Malondialdehyde (MDA), a marker of lipid peroxidation, was measured in the plasma of patients with congestive heart failure (CHF) having varying degrees of clinical symptoms and in control subjects. The 53 patients studied were divided in two groups based on their left ventricular ejection fraction (LVEF). Group A consisted of 30 symptomatic patients with chronic CHF (NYHA classes II and III) and LVEF < 40%. Group B consisted of 23 asymptomatic patients with LVEF > 40%. Patients in group A (mean LVEF = 28) has a significantly greater history of myocardial infarction (88% vs 48%; p = 0.002) than those in group B. Group B patients and the controls had similar LVEFs (58.0 vs 62.1; p = 0.14). Neither patients in the CHF group nor group B patients showed correlation between MDA values and LVEF, unless control were included. Mean MDA concentrations in groups A (2.65 +/- 1.03 mumol/L) and B (2.1 +/- 0.7 mumol/L) were significantly higher than those in the control group (1.45 +/- 0.77 mumol/L; p < 0.05), supporting the hypothesis that the CHF state and underlying risk conditions appear to be associate with abnormal oxidative stress. Moreover, a significant correlation (r = 0.74; p = 0.0001) was found in group A patients between the MDA values and the duration in years (chronicity) of the CHF state.

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The data herein presented provides persuasive evidence that in addition to diuretics, and probably digitalis (since all studies have included subjects taking this drug) patients with congestive heart failure should also be placed on a vasodilator regimen to slow the progression of the syndrome and to reduce its mortality. Firm recommendations for the choice of drug and the selection of patients likely to benefit from this treatment must await the results of further studies. At present, ACE inhibitors are preferred because they are usually better tolerated than conventional vasodilators and are clinically more effective. In regard to the question of when to begin vasodilator it is noteworthy that neurohormonal activation may occur early in the course of the disease, even before symptoms appear. If so, perhaps vasodilators should be initiated even in the asymptomatic stage of left ventricular dysfunction to prevent the progressive dilatation and deterioration that lead to clinical heart failure. The just published study of the efficacy of captopril in preventing the progression of left ventricular dilatation in patients with a recent anterior, transmural myocardial infarction supports this view. Further, ongoing studies, will help place these issues in their proper perspective.

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La respuesta hemodinamica obtenida de la administracion de agentes vasodilatadores a pacientes con fallo congestivo cardiaco va a depender de su efecto relativo en las arteriolas y venas. Aquellos vasodilatadores que predominantemente causan dilatacion arteriolar, aumentan el debito cardiaco sin cambios significativos en la presion de cuna pulmonar. Aquellos que son vasodilatadores venosos disminuyen la presion de cuna pulmonar sin causar cambios significativos en el debito cardiaco. Los efectos hemodinamicos en pacientes con infarto agudo del miocardio y decompensacion cardiaca van a depender del valor o nivel inicial de la presion telediastolica del ventriculo izquierdo. El rastreo hemodinamico es indispensable en situaciones agudas, para determinar los efectos hemodinamicos de este tipo de terapia

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