Impacto de la implementación de la estrategia multimodal de la OMS para mejorar la higiene de manos en una Unidad de Cuidados Intensivos / Impact on implementation of multimodal of World Health Organization strategies to improve hand hygiene in an Intensive Care Unit

INTRODUCCIÓN: La higiene de manos (HM) es la principal medida para disminuir las IAAS, las que en las Unidades de Cuidados Intensivos (UCI) presentan una alta prevalencia. En Chile no existe información sobre el impacto de la estrategia multimodal de la OMS para la HM en adultos. El objetivo fue evaluar el impacto de la implementación de la estrategia en una UPC. METODOLOGÍA: Estudio longitudinal con evaluación pre y post-intervención, entre los años 2018 y 2021, en la UCI del Hospital del Trabajador (HT), Santiago, Chile. La implementación se evaluó con pautas de cumplimiento de HM, consumo de jabón y productos en base alcohólica (PBA). El impacto se midió con las tasas de neumonía asociada a ventilación mecánica (NAVM), infecciones del torrente sanguíneo asociadas a CVC (ITS- CVC) y del tracto urinario por CUP (ITU-CUP), y la incidencia anual de dermatitis. RESULTADOS: El cumplimiento de pautas aumentó de 91 a 96% (p < 0,05). El consumo total de productos para la HM aumentó de 0,17 a 0,31 L/día/cama y de PBA en 10%. Las tasas de IAAS pre y post-intervención fueron para NAVM de 10,3 y 8,4; ITS-CVC de 0,8 y 1,5 e ITU-CUP de 4,2 y 5,3 por 1.000 días de exposición. La incidencia anual de dermatitis disminuyó en 30% (p < 0,05). CONCLUSIONES: La implementación de la estrategia multimodal se asoció a una disminución de las tasas de NAVM y de dermatitis en la UCI del HT.

INTRODUCTION: Hand hygiene is the main measure to decrease infections related to healthcare and the Intensive Care Unit has a high prevalence. In Chile there aren't reports about the impact of the World Health Organization multimodal hand hygiene improvement strategy. AIM: To assess the implementation impact of this strategy at the ICU. METHODOLOGY: Longitudinal study with pre- and postintervention evaluation during the years 2018-2021 at ICU. The implementation was assessed against hand hygiene compliance guidelines, soap consumption and alcohol-based products. The impact was evaluated with the rates of ventilator-associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter associated urinary tract infection (CAUTI) and the annual dermatitis incidence. RESULTS: The guidelines compliance increased from 91% to 96% (p < 0.05). The total product consumption increased from 0.17 to 0.31 Liters/day/bed. The use of alcohol-based products increased by 10%. HAI rates pre- and post-intervention were for VAP 10.3 and 8.4, CRBSI 0.8 and 1.5 and CAUTI 4.2 and 5.3. The annual dermatitis incidence decreased by 30.8% (p < 0.05). CONCLUSIONS: The strategy implementation benefited the decrease of VAP and the dermatitis prevention in ICU.

Apport de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques chez l'adulte à Abidjan / Contribution of multimodal MRI in the management of brain tumors in adults in Abidjan

Dans le monde, le nombre de nouveaux cas de tumeurs encéphaliques était de 14 millions en 2014 avec environ 8 millions de personnes décédées. Objectif: déterminer l'efficacité diagnostique de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques dans notre contexte. Matériels et Méthodes: Etude rétrospective à visée descriptive, multicentrique sur une période de 2 ans allant de février 2017 à mars 2019, dans 2 services de radiologie et 2 services de Neurochirurgie, à Abidjan. Nous nous sommes intéressés àtous les patients ayant réalisé une IRM multimodale pour suspicion d'un processus tumoral encéphalique, et qui ont eu une exérèse chirurgicale suivie d'un examen anatomopathologique de la pièce opératoire. Les examens d'IRM multimodale encéphaliques ont été réalisés selon un protocole standard sur des appareils de 1,5 Tesla, et lus par des radiologues séniors. Nous avons confronté les résultats anatomopathologiques aux diagnostics posés à l'imagerie IRM multimodale.Résultats: Ont été retenu 18 dossiers. On notait une prédominance masculine avec un sex-ratio de 1,57. L'âge moyen était de 42,8 ans avec des extrêmes de 20ans et 61ans et un écart type de 10,75.La corrélation diagnostique entre l'examen anatomopathologique et l'IRM a été de6 sur 7 cas, 4 sur 5 cas, 2 sur 2 cas, 2 sur 2 cas et 1 sur 1 cas respectivement pour le méningiome, le gliome, les métastases, l'adénome hypophysaire, le lymphome cérébral primitif.Conclusion:Les tumeurs encéphaliques dans notre étude, étaient variéeset concernaient la population jeune. Les motifs d'erreur diagnostique étaient essentiellement en rapport avec la variété de présentations des tumeurs à l'IRM et l'expérience récente de nos radiologues sur l'utilisation efficace des séquences avancées.

Worldwide, the number of new cases of brain tumors was 14 million in 2014 with approximately 8 million people dying.Objective: determine the diagnostic effectiveness of multimodal MRI in the management of brain tumors in our context.Methods: Retrospective study with a descriptive aim, multicenter over a period of 2 years from February 2017 to March 2019, in 2 radiology departments and 2 neurosurgery departments, in Abidjan. We were interested in all patients who had a multimodal MRI for suspicion of a brain tumor process, and who had a surgical excision followed by an pathological examination of the surgical specimen. The multimodal brain MRI examinations were carried out according to a standard protocol on 1.5 Tesla devices, and read by seniorradiologists. We compared the pathological results with the diagnoses made on multimodal MRI imaging.Results:18 files were retained. There was a male predominance with a sex ratio of 1.57. The average age was 42.8 years with extremes of 20 and 61 years and a standard deviation of 10.75. The diagnostic correlation between the pathological examination and MRI was 6 out of 7 cases, 4 out of 5 cases, 2 out of 2 cases, 2 out of 2 cases and 1 out of 1 case respectively for meningioma, glioma, metastases, pituitary adenoma, primary cerebral lymphoma.Conclusion: The brain tumors in our study were varied and concerned the young population. The reasons for diagnostic error were mainly related to the variety of tumor presentations on MRI and the recent experience of our radiologists on the effective use of advanced sequences.

Effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical ICU patients / 中国药房

OBJECTIVE To investigate the effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical intensive care unit （ICU） patients. METHODS Forty cases of mechanically ventilated non-surgical patients in the ICU of our hospital from February 1st， 2023 to July 31st， 2023 were selected and randomly divided into control group and esketamine （S-K） group using grouping method with opaque envelopes， with 20 cases in each group. Control group was given sufentanil， and S-K group was infused with Esketamine hydrochloride injection at a constant rate of 0.2 mg/（kg·h）+ sufentanil. The treatment period length， analgesic compliance rate， sedation level， analgesic and sedative consumption， and gastric motility indexes were compared between the two groups. RESULTS There was no statistically significant difference in the treatment period length， analgesic compliance rate， sedation level， or the consumption of propofol and midazolam between the two groups （P＞0.05）. The consumption of sufentanil in the S-K group was significantly less than control group （P＜ 0.05）. Compared with 1 h after randomization， the antral contraction frequency， antral contraction amplitude and antral motility index of patients in the S-K group were significantly higher at 72 h after randomization and were significantly higher than control group （P＜0.05）. CONCLUSIONS Esketamine may reduce opioid consumption and improve gastric motility in mechanically ventilated non-surgical ICU patients while ensuring a level of analgesic sedation.

Logic-gated tumor-microenvironment nanoamplifier enables targeted delivery of CRISPR/Cas9 for multimodal cancer therapy

Recent innovations in nanomaterials inspire abundant novel tumor-targeting CRISPR-based gene therapies. However, the therapeutic efficiency of traditional targeted nanotherapeutic strategies is limited by that the biomarkers vary in a spatiotemporal-dependent manner with tumor progression. Here, we propose a self-amplifying logic-gated gene editing strategy for gene/H2O2-mediated/starvation multimodal cancer therapy. In this approach, a hypoxia-degradable covalent-organic framework (COF) is synthesized to coat a-ZIF-8 in which glucose oxidase (GOx) and CRISPR system are packaged. To intensify intracellular redox dyshomeostasis, DNAzymes which can cleave catalase mRNA are loaded as well. When the nanosystem gets into the tumor, the weakly acidic and hypoxic microenvironment degrades the ZIF-8@COF to activate GOx, which amplifies intracellular H+ and hypoxia, accelerating the nanocarrier degradation to guarantee available CRISPR plasmid and GOx release in target cells. These tandem reactions deplete glucose and oxygen, leading to logic-gated-triggered gene editing as well as synergistic gene/H2O2-mediated/starvation therapy. Overall, this approach highlights the biocomputing-based CRISPR delivery and underscores the great potential of precise cancer therapy.

Anestesia balanceada em gato palheiro (Leopardus braccatus) para realização de gastrotomia e enterotomia ­ relato de caso / Balanced anesthesia in pamps cat (Leopardus braccatus) for gastrotomy and enterotomy ­ case report / Anestesia balanceada en gato palheiro (Leopardus braccatus) para gastrotomía y enterotomía ­ reporte de caso

Foi atendido no Hospital Veterinária da Universidade Federal de Mato Grosso (HOVET-UFMT) - Campus Cuiabá, um gato palheiro (Leopardus braccatus), macho, filhote e pesando 1,8kg. Após avaliação clínica e exames complementares diagnosticou-se presença de corpo estranho solido gástrico e intestinal. Como medicação pré-anestésica optou-se pela associação de cetamina (1mg/kg) e midazolam (0,2mg/kg), seguiu-se com a indução com propofol (à efeito) e manutenção anestésica por meio do fornecimento de isofluorano. Como técnica adicional utilizou-se epidural, com uma associação de lidocaína (4,5mg/kg) e morfina (0,1mg/kg). Durante o procedimento anestésico notou-se estabilidade das variáveis cardiovasculares e respiratórias, além de recuperação satisfatória ao final do procedimento.

Was attended to in the Veterinary Hospital of the Federal University of Mato Grosso (HOVET-UFMT) - Campus Cuiabá, a pantanal cat (Leopardus braccatus), male, puppy and weighing 1.8 kg. After clinical evaluation and complementary exams, the presence of a solid gastric and intestinal foreign body was diagnosed. As pre-anesthetic medication, the association of ketamine (1mg/kg) and midazolam (0.2mg/kg) was chosen, followed by induction with propofol (for effect) and anesthetic maintenance by supplying isoflurane. As an additional technique, an epidural was used, with an association of lidocaine (4.5mg/kg) and morphine (0.1mg/kg). During the anesthetic procedure, stability of cardiovascular and respiratory variables was observed, in addition to satisfactory recovery at the end of the procedure.

Ingresó en el Hospital Veterinario de la Universidad Federal de Mato Grosso (HOVET-UFMT) · Campus Cuiabá, un gato palheiro (Leopardus braccatus), macho, cachorro y con un peso de 1,8 kg. Luego de evaluación clínica y exámenes complementarios se diagnosticó la presencia de cuerpo extraño sólido gástrico e intestinal. Como medicación preanestésica se optó por la asociación de ketamina (1 mg/kg) y midazolam (0,2 mg/kg), seguida de inducción con propofol (por efecto) y mantenimiento anestésico mediante suministro de isoflurano. Como técnica adicional se utilizó epidural, con asociación de lidocaína (4,5 mg/kg) y morfina (0,1 mg/kg). Durante el procedimiento anestésico se observó estabilidad de variables cardiovasculares y respiratorias, además de recuperación satisfactoria al final del procedimiento.

Além das ferramentas tradicionais: explorando redes neurais convolucionais como modelos prognósticos inovadores no adenocarcinoma ductal pancreático / Beyond traditional tools: exploring convolutional neural networks as innovative prognostic models in pancreatic ductal adenocarcinoma

ABSTRACT Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive and lethal form of cancer with limited prognostic accuracy using traditional factors. This has led to the exploration of innovative prognostic models, including convolutional neural networks (CNNs), in PDAC. CNNs, a type of artificial intelligence algorithm, have shown promise in various medical applications, including image analysis and pattern recognition. Their ability to extract complex features from medical images makes them suitable for improving prognostication in PDAC. However, implementing CNNs in clinical practice poses challenges, such as data availability and interpretability. Future research should focus on multi-center studies, integrating multiple data modalities, and combining CNN outputs with biomarker panels. Collaborative efforts and patient autonomy should be considered to ensure the ethical implementation of CNN-based prognostic models. Further validation and optimisation of CNN-based models are necessary to enhance their reliability and clinical utility in PDAC prognostication.

RESUMO Contexto O adenocarcinoma ductal pancreático (ACDP) é uma forma de câncer altamente agressiva e letal com precisão prognóstica limitada usando fatores tradicionais. Isso levou à exploração de modelos prognósticos inovadores, incluindo redes neurais convolucionais (CNNs), no ACDP. As CNNs, um tipo de algoritmo de inteligência artificial, mostraram promessa em várias aplicações médicas, incluindo análise de imagem e reconhecimento de padrões. Sua capacidade de extrair características complexas de imagens médicas as torna adequadas para melhorar o prognóstico no ACDP. No entanto, a implementação de CNNs na prática clínica apresenta desafios, como a disponibilidade de dados e a interpretabilidade. Pesquisas futuras devem se concentrar em estudos multicêntricos, integrando múltiplas modalidades de dados e combinando saídas de CNN com painéis de biomarcadores. Esforços colaborativos e autonomia do paciente devem ser considerados para garantir a implementação ética de modelos prognósticos baseados em CNN. Mais validação e otimização de modelos baseados em CNN são necessárias para aumentar sua confiabilidade e utilidade clínica na prognostico do ACDP.

Use of multimodal anesthesia in the treatment of postoperative pain / Uso da anestesia multimodal no tratamento da dor pós-operatória

ABSTRACT BACKGROUND AND OBJECTIVES: Hippocrates already said 2400 years ago: "relieving pain is a divine work". Postoperative pain is an important symptom, because it affects the patient's recovery and because of the risk of pain chronicity. And as a treatment option, there is multimodal analgesia, mentioned in several studies as the best approach, although opioid therapy is still the main treatment for pain after surgical interventions. The objective of this study was to describe the use of multimodal anesthesia in the treatment of pain, especially in the postoperative period. CONTENTS: A literature review was performed on studies that explained multimodal analgesia, its components, and which analyzed therapeutic drug options. The theme was approached from a consultation of articles published in LILACS, Scielo, Medline and Pubmed, in English and Portuguese, between the years 2012 and 2022. The keywords used for research were: "multimodal analgesia", "multimodal anesthesia", "surgical procedures" "postoperative". In the results, examples of drugs that are part of multimodal analgesia in different procedures were listed. CONCLUSION: In this way, multimodal anesthesia has demonstrated its benefits for the treatment of postoperative pain in various surgical procedures. However, further studies are needed so that this modality can be used more widely.

RESUMO JUSTIFICATIVA E OBJETIVOS: Hipócrates já dizia há 2400 anos: "aliviar a dor é uma obra divina". A dor pós-operatória é um sintoma importante por causar repercussões na recuperação do paciente e devido ao risco de cronicidade da dor. Como opção de tratamento, tem-se a analgesia multimodal, sendo mencionada em diversos estudos como a melhor conduta, embora a terapia com opioides ainda seja o principal tratamento para a dor após intervenções cirúrgicas. O objetivo deste estudo foi descrever o uso da anestesia multimodal no tratamento da dor, em especial no pós-operatório. CONTEÚDO: Foi realizada uma revisão de literatura sobre estudos que explicitaram a analgesia multimodal e seus componentes, ou que analisaram opções terapêuticas de fármacos. O tema foi abordado a partir de uma consulta de artigos publicados nas bases LILACS, Scielo, Medline e Pubmed, na língua inglesa e em português, entre os anos de 2012 e 2022. As palavras-chaves utilizadas para pesquisa foram: "multimodal analgesia", "multimodal anesthesia", "surgical procedures" e "postoperative". Nos resultados, foram listados exemplos de fármacos que fazem parte da analgesia multimodal em diferentes procedimentos. CONCLUSÃO: Nesse sentido, a anestesia multimodal demonstrou seus benefícios para o tratamento da dor no pós-operatório em vários procedimentos cirúrgicos. Contudo, são necessários novos estudos a fim de que esta modalidade seja utilizada de forma mais abrangente.

Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? / A melhora da mobilidade e da força isométrica do tronco se correlacionam com a melhora da dor e da incapacidade após a reabilitação multimodal para dor lombar?

Abstract Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS (p< 0.0001) and ODI (p< 0.0001) scores, mean trunk extension (p< 0.0001), and flexion (p< 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension (p< 0.0001) and flexion (p< 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p= 0.006) and flexion strength (r = -0.28, p= 0.001), as well as between the ODI score and TIS extension (r = -0.30, p= 0.0007) and flexion (r = -0.28, p= 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

Resumo Objetivo Determinar a correlação entre a amplitude de movimento (ADM) do tronco pós-tratamento e a força isométrica do tronco (FIT) e a dor e a incapacidade em pacientes submetidos à reabilitação multimodal para dor lombar (DL). Métodos Neste estudo de coorte prospectiva, 122 pacientes submetidos à reabilitação multimodal para DL foram analisados. Foram comparados os escores de escala numérica de dor pré- e pós-tratamento (END) e do índice de incapacidade Oswestry (Oswestry disability index - ODI), a ADM do tronco e a FIT. A correlação de Pearson foi utilizada para determinar a correlação entre desfechos clínicos e a ADM e a FIT pós-tratamento. Resultados Ao final do tratamento, as médias de ADM (p< 0,0001) e ODI (p< 0,0001), as ADMs médias de extensão (p< 0,0001) e a flexão (p< 0,0001) do tronco melhoraram significativamente. Da mesma forma, a FIT pós-tratamento, as FITs médias de extensão (p< 0,0001) e flexão (p< 0,0001) melhoraram significativamente. Houve uma correlação fraca entre o escore do END e a ADM de extensão (r = -0,24, p= 0,006) e força de flexão (r = -0,28, p= 0,001) pós-tratamento, assim como entre o escore de ODI e FIT de extensão (r = -0,30, p= 0,0007) e flexão (r = -0,28, p= 0,001) pós-tratamento. Conclusão Apesar da melhora significativa da dor, capacidade, ADM do tronco e FIT com tratamento multimodal, houve uma fraca correlação entre dor pós-tratamento e função e ADM e FIT de tronco. A melhora da dor e da função com o tratamento de reabilitação física para DL é um fenômeno complexo e precisa de uma investigação mais aprofundada.

Anestesia multimodal intratecal en cesáreas, cambios que mejoran su eficacia y seguridad: ensayo clínico / Intrathecal multimodal anesthesia in caesarean sections, changes that improve its efficacy and safety: clinical trial

Resumen: Introducción: la concentración y velocidad en la administración de la anestesia multimodal intratecal con fentanilo en cesáreas mejoran la eficacia anestésica manteniendo buen control hemodinámico. Objetivo: evaluar si algunos cambios en la anestesia multimodal intratecal mejoran su eficacia y seguridad en cesáreas. Material y métodos: ensayo clínico, controlado, aleatorizado, doble ciego en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo F6B2: fentanilo 65 μg + bupivacaína hiperbárica 2.5 mg + morfina 10 μg + dexmedetomidina 5 μg; grupo F6B3: fentanilo 60 μg + bupivacaína hiperbárica 3 mg+ morfina 100 μg+ dexmedetomidina 5 μg; y grupo F7B2: fentanilo 70 μg + bupivacaína hiperbárica 2 mg + morfina 100 μg + dexmedetomidina 5 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como los signos vitales. Resultados: los grupos F6B2 y F6B3 resultaron tener mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.02) y el grupo F7B2 el de mayor seguridad con mejor control hemodinámico a los minutos 1 y 10 (p = 0.03 y p = 0.03 respectivamente). Conclusiones: los cambios en la administración de la anestesia multimodal intratecal con fentanilo mejoraron la eficacia anestésica, pero disminuyen la seguridad sobre el control hemodinámico.

Abstract: Introduction: the concentration and speed in the administration of intrathecal multimodal anesthesia with fentanyl in cesareans section improve anesthetic efficacy while maintaining good hemodynamic control. Objective: to evaluate if some changes in intrathecal multimodal anesthesia improve its efficacy and safety in cesareans section. Material and methods: clinical trial, controlled, randomized, double blind; in pregnant women scheduled for cesarean section, divided into 3 groups: group F6B2: fentanyl 65 μg + hyperbaric bupivacaine 2.5 mg+ morphine 100 μg+ dexmedetomidine 5 μg; group F6B3: fentanyl 60 μg + hyperbaric bupivacaine 3 mg + morphine 100 μg + dexmedetomidine 5 μg; and group F7B2: fentanyl 70 μg + hyperbaric bupivacaine 2 mg + morphine 100 μg + dexmedetomidine 5 μg. The anesthetic efficacy was evaluated prior to the incision, during the dissection of the abdominal wall, upon the admission to the abdominal cavity, in the review of paracolic slides and in the immediate postoperative period, as well as the vital signs. Results: the F6B2 and F6B3 groups turned out to have greater anesthetic efficacy in the revision of paracolic slides (p = 0.02) and the F7B2 group had the highest safety with better hemodynamic control at 1 and 10 minutes (p = 0.03 and p = 0.03, respectively). Conclusions: changes in the administration of intrathecal multimodal anesthesia with fentanyl improved anesthetic efficacy, but decreased safety over hemodynamyc control.

Actualización en analgesia preventiva y analgesia multimodal / Update on preventive analgesia and multimodal analgesia

Una deficiente calidad del manejo del dolor post operatorio agudo genera aumento en la morbilidad perioperatoria, disminuye la calidad de vida del paciente, aumenta los reingresos hospitalarios y, finalmente, los costes en salud. La analgesia preventiva y multimodal son dos estrategias que han sido implementadas para tratar de optimizar el manejo del dolor. Si bien en la primera, la evidencia es favorable a su empleo, aún no existe un total consenso en esto. A su vez, la analgesia multimodal, al emplear diferentes fármacos y/o técnicas, ha logrado evidenciar de mejor manera su utilidad y los beneficios al implementarla como terapia. En este artículo, revisamos la evidencia que certifica y avala el uso de éstas. Finalmente, a nuestro parecer, lo más importante en el quehacer del clínico, es lograr individualizar la estrategia que usaremos en el manejo del dolor postoperatorio, adaptándonos a las necesidades y el contexto propio de cada uno de nuestros pacientes.

A poor quality of acute postoperative pain management generates an increase in perioperative morbidity, decreases the quality of life of the patient, increases hospital readmissions and finally, increases health costs. Preventive and multimodal analgesia are two strategies that are implemented to try to optimize pain management. Although in the first, the evidence is favorable to its use, there is still no total consensus. At the same time, multimodal analgesia, by using different drugs and/or techniques, has demonstrated, in a better way, its usefulness and benefits when implemented as a therapy. In this article, we review the evidence that certifies and supports the use of these techniques. Finally, in our opinion, the most important thing in the clinician's task is to be able to individualize the strategy that we will use in postoperative pain management, adapting to the needs and context of each one of our patients.

Desprendimiento de la capa bacilar de la retina asociado a enfermedad inflamatoria ocular

El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico.

Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view.

Eficacia y seguridad de la anestesia multimodal intratecal con fentanilo en cesárea: ensayo clínico / Efficacy and safety of multimodal intrathecal anesthesia with fentanyl in cesarean section: clinical trial

Resumen: Introducción: El fentanilo ofrece buena eficacia anestésica, con menores efectos sobre el sistema nervioso simpático, al mantener un mejor estado hemodinámico, pero su efecto en combinación con otros anestésicos en embarazadas no está del todo descrito. Objetivo: Evaluar la eficacia anestésica y seguridad de la anestesia multimodal con fentanilo en mujeres embarazadas durante la cesárea. Material y métodos: Ensayo clínico, controlado, aleatorizado, doble ciego; en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo FBMD: fentanilo 70 μg + bupivacaína hiperbárica 0.1%, 2 mg, + morfina 100 μg + dexmedetomidina 5 μg; grupo BFM: bupivacaína hiperbárica 0.25%, 5 mg, + fentanilo 25 μg + morfina 100 μg, y el grupo BM: bupivacaína hiperbárica 0.375%, 7.5 mg, + morfina 100 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como, los signos vitales. Resultados: Se analizaron 180 mujeres. El grupo FBMD mostró mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.01) y en el postquirúrgico inmediato (p = 0.0001), así como mayor seguridad con mejor control hemodinámico a los minutos uno y 10 (p = 0.02 y p = 0.03, respectivamente). Conclusiones: La anestesia multimodal con FBMD demuestra mejor eficacia anestésica y seguridad sobre el control hemodinámico.

Abstract: Introduction: Fentanyl offers good anesthetic efficacy and fewer effects on the sympathetic nervous system with better hemodynamic status, but its effect in combination with other anesthetics in pregnant women has not been fully described. Objective: To evaluate the anesthetic efficacy and safety of multimodal anesthesia with fentanyl in pregnant women undergoing caesarean section. Material and methods: Controlled, randomized, double blinded clinical trial; in pregnant women scheduled for cesarean section distributed in 3 groups: FBMD group: fentanyl 70 μg + hyperbaric bupivacaine 0.1%, 2 mg, + morphine 100 μg + dexmedetomidine 5 μg; BFM group: hyperbaric bupivaine 0.25%, 5 mg, + fentanyl 25 μg + morphine 100 μg, and group BM: hyperbaric bupivacaine 0.375%, 7.5 mg, + morphine 100 μg. The anesthetic efficacy was evaluated: prior to the incision, during the dissection of the abdominal wall, upon entry to the abdominal cavity, in the revision of parietocolic slides and in the immediate postoperative period, as well as the vital signs. Results: 180 women were analyzed. The FBMD group showed greater anesthetic efficacy in the revision of parietocolic slides (p = 0.01) and in the immediate postoperative period (p = 0.0001) and greater safety, showing better hemodynamic control at minutes 1 and 10 (p = 0.02 y p = 0.03 respectively). Conclusions: Multimodal anesthesia with FMBD shows better anesthetic efficacy and safety over hemodynamic control.

Physiological and Biological Testing and Assessment of Post-Traumatic Stress Disorder / Physiological and Biological Testing and Assessment of Post-Traumatic Stress Disorder / Testes fisiológicos e biológicos e avaliação do Transtorno de Estresse Pós-Traumático

This review essay investigates the biological and physi- ological consequences of PTSD to deepen its academic understanding, alongside an analysis of psychobiologi- cal testing and assessment procedures. Psychological responses to traumatic events can be acute stress reactions or stress disorders. One among them is post-traumatic stress disorder (PTSD). When people experience a trau- matic event, such as death, terror, or physical injury, they tend to demonstrate fear, helplessness, or hopelessness. Patients displaying other symptoms like re-experiencing the trauma, avoidance, or hyper-arousal also indicate PTSD. Experiencing extended PTSD may cause significant health problems, whether biological, such as the dysfunction of stress-responsive neurobiological sys- tems, or physiological, such as hypertension and heart disease. Previous studies of trauma survivors reported a strong link between physical and mental health. The cumulative literature in psychology shows that traumatic exposure can cause disturbing effects in the short and long term. This review will contribute to developing an understanding of the biological markers of PTSD. This paper specifically deals with biological and physiological testing and assessment of PTSD. It includes widely utilized biological assessments and summarizes a general multi-model assessment to identify PTSD symptoms.

Las respuestas psicológicas a acontecimientos traumáticos pueden dar lugar a estrés agudo, trastornos de estrés o trastornos de estrés postraumático (TEPT). Cuando las personas experimentan un evento traumático, como la muerte de un ser querido, terror o daño físico, tienden a mostrar miedo, impotencia o desesperanza. Mostrar otros síntomas como volver a vivir aquellas experiencias, evasión o hiperexcitación indica TEPT. Sufrir el TEPT a largo plazo puede causar problemas de salud importantes, ya sean biológicos, como la disfunción de los sistemas neurobiológicos sensibles al estrés; o fisiológicos, como la hipertensión y enfermedades cardíacas. Sin embargo, la literatura psicológica deja poco o ningún espacio para tales consecuencias sobre la salud. Para proporcionar información sobre este tema, la presente revisión tiene como objetivo investigar las consecuencias biológicas y fisiológicas del TEPT, y las pruebas y evaluaciones psicobiológicas relacionadas. Esta revisión de la literatura puede contribuir al desarrollo de marcadores biológicos de TEPT.

As respostas psicológicas a eventos traumáticos po- dem levar a estresse agudo, transtornos de estresse ou transtorno de estresse pós-traumático (TEPT). Quando as pessoas vivenciam um evento traumático, como a morte de um ente querido, terror ou danos físicos, elas tendem a demonstrar medo, desamparo ou desesperança. Mostrar outros sintomas, como reviver essas experiências, evitação ou hiperexcitação, indica TEPT. Sofrer de TEPT de longa duração pode causar problemas de saúde significativos, sejam eles biológicos, como disfunção de sistemas neurobiológicos sensíveis ao estresse; ou fisiológicos, como hipertensão e doenças cardíacas. No entanto, a literatura psicológica deixa pouco ou nenhum espaço para a discussão de tais consequências para a saúde. Para fornecer informações sobre esse tópico, a presente revisão tem como objetivo investigar as consequências biológicas e fisiológicas do TEPT, assim como testes e avaliações psicobiológicas relacionados. Esta revisão de literatura pode contribuir para

Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas / Atualização na avaliação por imagens dos sarcomas ósseos e das partes moles

Abstract The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Resumo A evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.

Advances in Shock Management and Fluid Resuscitation in Children

Shock in children is associated with signifcant mortality and morbidity, particularly in resource-limited settings. The principles of management include early recognition, fuid resuscitation, appropriate inotropes, antibiotic therapy in sepsis, supportive therapy for organ dysfunction, and regular hemodynamic monitoring. During the past decade, each step has undergone several changes and evolved as evidence that has been translated into recommendations and practice. There is a paradigm shift from protocolized-based care to personalized management, from liberal strategies to restrictive strategies in terms of fuids, blood transfusion, ventilation, and antibiotics, and from clinical monitoring to multimodal monitoring using bedside technologies. However, uncertainties are still prevailing in terms of the volume of fuids, use of steroids, and use of extracorporeal and newer therapies while managing shock. These changes have been summarized along with evidence in this article with the aim of adopting an evidence-based approach while managing children with shock.

Case of Left Thalamic Hemorrhage and Presumed Presence of Multimodal Agnosia / The Japanese Journal of Rehabilitation Medicine

We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.

Case of Left Thalamic Hemorrhage and Presumed Presence of Multimodal Agnosia / The Japanese Journal of Rehabilitation Medicine

We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.

Review on ultrasonographic diagnosis of thyroid diseases based on deep learning / 生物医学工程学杂志

In recent years, the incidence of thyroid diseases has increased significantly and ultrasound examination is the first choice for the diagnosis of thyroid diseases. At the same time, the level of medical image analysis based on deep learning has been rapidly improved. Ultrasonic image analysis has made a series of milestone breakthroughs, and deep learning algorithms have shown strong performance in the field of medical image segmentation and classification. This article first elaborates on the application of deep learning algorithms in thyroid ultrasound image segmentation, feature extraction, and classification differentiation. Secondly, it summarizes the algorithms for deep learning processing multimodal ultrasound images. Finally, it points out the problems in thyroid ultrasound image diagnosis at the current stage and looks forward to future development directions. This study can promote the application of deep learning in clinical ultrasound image diagnosis of thyroid, and provide reference for doctors to diagnose thyroid disease.

Deep learning method for magnetic resonance imaging fluid-attenuated inversion recovery image synthesis / 生物医学工程学杂志

Magnetic resonance imaging(MRI) can obtain multi-modal images with different contrast, which provides rich information for clinical diagnosis. However, some contrast images are not scanned or the quality of the acquired images cannot meet the diagnostic requirements due to the difficulty of patient's cooperation or the limitation of scanning conditions. Image synthesis techniques have become a method to compensate for such image deficiencies. In recent years, deep learning has been widely used in the field of MRI synthesis. In this paper, a synthesis network based on multi-modal fusion is proposed, which firstly uses a feature encoder to encode the features of multiple unimodal images separately, and then fuses the features of different modal images through a feature fusion module, and finally generates the target modal image. The similarity measure between the target image and the predicted image in the network is improved by introducing a dynamic weighted combined loss function based on the spatial domain and K-space domain. After experimental validation and quantitative comparison, the multi-modal fusion deep learning network proposed in this paper can effectively synthesize high-quality MRI fluid-attenuated inversion recovery (FLAIR) images. In summary, the method proposed in this paper can reduce MRI scanning time of the patient, as well as solve the clinical problem of missing FLAIR images or image quality that is difficult to meet diagnostic requirements.