Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

COVID-19: Measures to prevent hospital contagion. what do urologists need to know?

ABSTRACT A new outbreak of respiratory infection caused by the novel coronavirus in late December 2019 in China caused standards of medical care to change not only for related areas but for the entire healthcare system, and when the WHO declared COVID-19 a pandemic new strategies of patient care had to be defined initially to optimize resources to confront the pandemic and then to protect healthcare personnel. As urologists, we must be involved in these new standards, since without an effective vaccine the risk of contagion is high; thus, the purpose of this review is to have orientation on the measures urologists should take in their everyday clinical practice.

Effect of dietary supplementation with olive and sunflower oils on lipid profile and liver histology in rats fed high cholesterol diet

OBJECTIVE@#To compare the effects of high-monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) against the metabolic disorders elicited by a high-cholesterol diet (HC) in rats.@*METHODS@#Using in vivo dietary manipulation, rats were fed with different diets containing 4% soybean oil (cholesterol free diet) and 1% HC containing 12% olive oil (HC + OO) enriched with MUFA and 12% sunflower oil (HC + SO) enriched with PUFA for 60 d. Serum lipid levels and hepatic steatosis were evaluated after the treatment period.@*RESULTS@#Comparatively, rats treated with HC + OO diet experienced a decrease in the serum LDL-C, VLDL-C and CT levels compared to those fed with HC + SO diet (P < 0.05). Otherwise, HC + OO provoked significant microvesicular steatosis situated in the hepatic acinar zone 1.@*CONCLUSIONS@#HC + OO diet has high absorption velocity in the acinar zone 1 of liver compared to the HC + SO diet. Based on this, the reduction of the LDL-C, VLDL-C and CT serum levels in the animals treated with HC + OO diet may have been caused by the delay in the FA release to the blood.

Effect of dietary supplementation with olive and sunflower oils on lipid profile and liver histology in rats fed high cholesterol diet

Objective To compare the effects of high-monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) against the metabolic disorders elicited by a high-cholesterol diet (HC) in rats. Methods Using in vivo dietary manipulation, rats were fed with different diets containing 4% soybean oil (cholesterol free diet) and 1% HC containing 12% olive oil (HC + OO) enriched with MUFA and 12% sunflower oil (HC + SO) enriched with PUFA for 60 d. Serum lipid levels and hepatic steatosis were evaluated after the treatment period. Results Comparatively, rats treated with HC + OO diet experienced a decrease in the serum LDL-C, VLDL-C and CT levels compared to those fed with HC + SO diet (P < 0.05). Otherwise, HC + OO provoked significant microvesicular steatosis situated in the hepatic acinar zone 1. Conclusions HC + OO diet has high absorption velocity in the acinar zone 1 of liver compared to the HC + SO diet. Based on this, the reduction of the LDL-C, VLDL-C and CT serum levels in the animals treated with HC + OO diet may have been caused by the delay in the FA release to the blood.

Tick-borne rickettsial pathogens in questing ticks, removed from humans and animals in Mexico

Tick-borne rickettsial diseases (TBRD) are commonly encountered in medical and veterinary clinical settings. The control of these diseases is difficult, requiring disruption of a complex transmission chain involving a vertebrate host and ticks. The geographical distribution of the diseases is related to distribution of the vector, which is an indicator of risk for the population. A total of 1,107 ticks were collected by tick dragging from forests, ecotourism parks and hosts at 101 sites in 22 of the 32 states of Mexico. Collected ticks were placed in 1.5 mL cryovials containing 70% ethanol and were identified to species. Ticks were pooled according to location/host of collection, date of collection, sex, and stage of development. A total of 51 ticks were assayed by polymerase chain reaction (PCR) to confirm species identification using morphological methods. A total of 477 pools of ticks were assayed using PCR techniques for selected tick-borne pathogens. Anaplasma phagocytophilum was the most commonly detected pathogen (45 pools), followed by, Ehrlichia (E.) canis (42), Rickettsia (R.) rickettsii (11), E. chaffeensis (8), and R. amblyommii (1). Rhipicephalus sanguineus was the tick most frequently positive for selected pathogens. Overall, our results indicate that potential tick vectors positive for rickettsial pathogens are distributed throughout the area surveyed in Mexico.

Terapia endovascular en el tratamiento del ACV isquémico agudo. Perspectiva en Colombia / Endovascular therapy for acute ischemic stroke treatment. A Colombian perspective

La aparición en este año de siete estudios que demuestran la superioridad de la terapia endovascular (TEV)sobre el tratamiento convencional de la trombólisis IV con t-PA en las primeras 4,5 horas posteriores al iniciodel ataque cerebrovascular (ACV) isquémico agudo en pacientes con una obstrucción arterial proximal, estableceun reto terapéutico para los neurólogos colombianos por el costo social que ocasiona la enfermedad y por lasfalencias que presenta nuestro sistema de salud para la atención óptima al respecto.Esta revisión crítica de los estudio MR Clean, Escape, Extend IA, Swift Prime, Revascat, Thrace y Therapy,así como de las guías 2015 de la American Heart Association (AHA), analizan la factibilidad e implementaciónde esta información en Colombia.La administración rápida de la terapia intravenosa con t-PA en estos estudios fortalece su implementaciónen el país e invita a generar protocolos que incluyan imágenes diagnósticas no invasivas como la angiografíacerebral por escanografía cerebral (CTA) o por resonancia magnética (MRA) que seleccionen a los pacientescon obstrucción proximal para brindarles lo más rápido posible el recurso de una TEV a través de una redhospitalaria del ACV.Los principales retos establecidos son los de allanar las diferencias entre el sector público y privado en la atenciónde pacientes con ACV isquémico agudo, dotar hospitales públicos con la tecnología y el talento humanoque la TEV exige, e integrar una red nacional del ACV.

During the last few months, seven pivotal papers have been published in renowned medical journals that have demonstrated the superiority of endovascular therapy added to intravenous tPA in patients with acute ischemic stroke and proximal vessel occlusion. This evidence poses a therapeutic challenge for Colombian neurologists and their patients, given the already suboptimal care for acute stroke patients in Colombia. This critical review comprises the studies MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE and THERAPY. Also, the current 2015 AHA/ASA guidelines on endovascular therapy for acute ischemic stroke were included. Their results reinforce the need to provide IV tPA to all eligible patients while, at the same time, adding diagnostic tools such as CTA (CT angiography) and/or MRA (MR angiography) to present hyperacute treatment protocols in order to confirm or rule out the presence of proximal vessel occlusion. The main challenges ahead lie in closing the existent gaps in stroke care between public and private hospitals, providing public hospitals with modern technologies and trained medical personnel as required for the optimal performance of neuroendovascular therapy, all of them comprised within a national stroke network.