Uso de vasopresina en el postoperatorio de cirugía de Fontan: inferencias sobre morbimortalidad / Vasopressin use in postoperative Fontan surgery: implications for morbidity and mortality

Introducción: Se ha postulado que el uso de vasopresina tendría efectos beneficiosos en el postoperatorio de cirugía cardiovascular. Objetivo: Evaluar la respuesta a la vasopresina en el postoperatorio (POP) de cirugía de Fontan de nuestra población. Métodos: Estudio de casos y controles anidados en una cohorte retrospectiva. Se incluyeron pacientes con cirugía de Fontan entre 2014 y 2019. Se registraron variables demográficas, datos del cateterismo pre-Fontan, días de asistencia respiratoria mecánica (ARM), necesidad de inotrópicos, diuréticos, diálisis, dieta hipograsa, octreotide, sildenafil y nutrición parenteral total (NPT); balance de fluidos al primer y segundo día POP, necesidad de cateterismo en el POP, días de permanencia de tubo pleural, días de internación, necesidad de reinternación y mortalidad. Se compararon los grupos con y sin vasopresina utilizando la prueba de Mann- Whitney-Wilcoxon test. Se consideró significativa una p < 0.05. Resultados: Del total analizado, 35 pacientes recibieron vasopresina. En el grupo control fueron 58 pacientes con características similares de gravedad sin vasopresina. No se encontraron diferencias en la evolución postoperatoria entre ambos grupos. El grupo con vasopresina recibió en mayor proporción dieta hipograsa. Conclusiones: En nuestra serie el uso de vasopresina no marcó diferencias significativas en términos de morbimortalidad con relación al grupo control (AU)

Introduction: The use of vasopressin has been suggested to have beneficial effects in the postoperative period after cardiovascular surgery. Objective: To evaluate the response to vasopressin in the postoperative period (POP) of Fontan surgery in our population. Methods: Nested case-control study in a retrospective cohort. Patients who underwent Fontan surgery between 2014 and 2019 were included. Demographic variables, pre-Fontan catheterization data, days of mechanical ventilation (MRA), need for inotropics, diuretics, dialysis, low-fat diet, octreotide, sildenafil and total parenteral nutrition (TPN); fluid balance at first and second day POP, need for catheterization at POP, duration of chest tube drainage, days of hospitalization, need for readmission, and mortality were recorded. Groups with and without vasopressin were compared using the Mann-Whitney- Wilcoxon test. A p < 0.05 was considered significant. Results: Of all patients analyzed, 35 received vasopressin. The control group consisted of 58 patients with similar severity characteristics who did not receive vasopressin. No differences were found in the postoperative outcome between the two groups. The vasopressin group received a higher proportion of low-fat diet. Conclusions: In our series the use of vasopressin did not show significant differences in terms of morbidity and mortality compared to the control group (AU)

Nonlinear regression analysis of length growth in cultured rainbow trout / [Análise não linear do crescimento em comprimento de truta-arco-íris de aquicultura ]

Length growth as a function of time has a non-linear relationship, so nonlinear equations are recommended to represent this kind of curve. We used six nonlinear models to calculate the length gain of rainbow trout (Oncorhynchus mykiss) during the final grow-out phase of 98 days under three different feed types in triplicate groups. We fitted the von Bertalanffy, Gompertz, Logistic, Brody, Power Function, and Exponential equations to individual length-at-age data of 900 fish. Equations were fitted to the data based on the least square method using the Marquardt iterative algorithm. Accuracy of the fitted models was evaluated using a model performance metrics combining mean squared residuals (MSR), mean absolute error (MAE) and Akaike's Information Criterion corrected for small sample sizes (AICc). All models converged in all cases tested. Evaluation criteria for the Logistic model indicated the best overall fit (0.67 of combined metric MSR, MAE and AICc) under all different feeding types, followed by the Exponential model (0.185), and the von Bertalanffy and Brody model (0.074, respectively). Additionally, ∆AICc results identify the Logistic and Gompertz models as being substantially supported by the data in 100% of cases. The logistic model can be suggested for length growth prediction in aquaculture of rainbow trout.(AU)

O crescimento em comprimento em função do tempo tem uma relação não linear; por isso, funções não lineares são recomendáveis para descrever essa relação. Seis modelos não lineares foram usados para calcular o ganho em comprimento de truta-arco-íris (Oncorhynchus mykiss) durante 98 dias, na fase final da engorda, submetidas a três dietas diferentes em grupos triplicados. Foram ajustadas as equações de von Bertalanffy, Gompertz, logístico, Brody, função potencial e exponencial a dados individuais de comprimento-idade de 900 peixes. O ajuste foi feito pelo método dos mínimos quadrados, usando-se o algoritmo iterativo de Marquardt. A precisão do ajuste foi avaliada pelo uso de critérios combinados de ajuste: quadrado médio do resíduo (QMR), erro médio absoluto (EMA) e o critério de informação de Akaike corrigido para tamanhos amostrais pequenos (AICc). Todos os modelos atingiram a convergência para cada caso avaliado. Os critérios de avaliação do modelo logístico indicaram o melhor ajuste geral (0,67 vez dos critérios combinados MSR, MAE e AICc) para cada grupo de peixe avaliado, seguido pelo modelo exponencial (0,185) e os modelos von Bertalanffy e Brody, com 0,074, respectivamente. Similarmente, os resultados de ΔAICc identificaram-se ao modelo logístico e ao de Gompertz, com grande suporte das informações em 100% dos casos. Por fim, o modelo logístico pode ser sugerido na predição do crescimento em comprimento de truta-arco-íris cultivada.(AU)

Aspergilosis pulmonar crónica cavitada / Chronic cavitary pulmonary aspergillosis

Resumen: La aspergilosis pulmonar es una infección fúngica causada por el hongo Aspergillus, en la mayoría de los casos de la especie fumigatus, un hongo ubicuo que se adquiere al inhalar sus esporas. El pulmón es el principal órgano afectado por Aspergillus. La aspergilosis crónica cavitada (anteriormente denominada aspergiloma complicado) afecta a pacientes inmunocompetentes que padecen una o más cavidades durante varios meses, habitualmente en los lóbulos superiores y si progresan pueden llegar a padecer formas crónicas fibrosantes. Se comunica el caso de una paciente de 67 años de edad, residente de la Ciudad de México, con antecedentes personales de exposición a tabaquismo pasivo durante 30 años, hipertensión arterial en tratamiento con losartán y amlodipino, sin otros antecedentes de importancia. Inició su padecimiento cuatro meses previos a su ingreso con tos seca alternada ocasionalmente con expectoración hemoptoica, así como fiebre intermitente. La aspergilosis pulmonar es poco común en pacientes sin factores de riesgo e inmunocompetentes, como ocurrió en este caso, por lo que su diagnóstico no es fácil de sospechar y, por tanto, el abordaje debe ser minucioso. Es esencial que los clínicos estén familiarizados con la manifestación clínica de la aspergilosis pulmonar crónica cavitada.

Abstract: Pulmonary aspergillosis is a fungal infection caused by the fungus Aspergillus. In most cases, it comes from the fumigatus species, a ubiquitous fungus that is acquired by inhaling its spores. The lung is the main organ affected by Aspergillus. Chronic cavitary aspergillosis (previously referred to as complicated aspergilloma) affects immunocompetent patients who develop one or more cavities for several months, usually in the upper lobes, and if they progress they may develop chronic fibrosing forms. This paper reports the case of a female, 67 year-old patient, resident of Mexico City, with a personal history of exposure to passive smoking for 30 years, hypertension under treatment with losartan and amlodipine, without other antecedents of importance. She started her picture 4 months prior to admission with alternating dry cough occasionally with hemoptysis expectoration, as well as intermittent fever. Pulmonary aspergillosis is little common un patients without risk factors and immunocompetent, as in this case, thus, its diagnosis is not easy to suspect and, therefore, the approach must be careful. It is essential that clinicians become familiar with the clinical presentation and diagnostic approach of chronic cavitary pulmonary aspergillosis.

Problemas actuales respecto del diagnóstico y tratamiento del Trastorno Bipolar en nuestro medio: experiencia y opinión de los usuarios / Experience and opinion related to the diagnosis and treatment of patients with bipolar disorders

El objetivo de este estudio fue investigar la experiencia y la opinión de los pacientes afectados por Trastorno Bipolar en cuanto al diagnóstico y tratamiento de su enfermedad. Se relevó una encuesta anónima entre personas con diagnóstico de Trastorno Bipolar.... involucró a 100 pacientes.78 reportaron haber sido diagnosticados de otra manera a lo largo de su tratamiento. El error diagnóstico más frecuente fue el de Esquizofrenia. Este diagnóstico incorrecto se correlacionó positivamente con la presencia de síntomas psicóticos, los cuales fueron verificados en el 83 por ciento de la muestra...La mayoría de los encuestados calificaron como positivo el haber sido informados de su diagnóstico