Comparative evaluation of propofol in nanoemulsion with solutol and soy lecithin for general anesthesia / Avaliação comparativa do propofol em nanoemulsão com solutol e com lecitina de soja para anestesia geral

ABSTRACT INTRODUCTION: The vehicle for propofol in 1 and 2% solutions is soybean oil emulsion 10%, which may cause pain on injection, instability of the solution and bacterial contamination. Formulations have been proposed aiming to change the vehicle and reduce these adverse reactions. OBJECTIVES: To compare the incidence of pain caused by the injection of propofol, with a hypothesis of reduction associated with nanoemulsion and the occurrence of local and systemic adverse effects with both formulations. METHOD: After approval by the CEP, patients undergoing gynecological procedures were included in this prospective study: control (n = 25) and nanoemulsion (n = 25) groups. Heart rate, noninvasive blood pressure and peripheral oxygen saturation were monitored. Demographics and physical condition were analyzed; surgical time and total volume used of propofol; local or systemic adverse effects; changes in variables monitored. A value of p < 0.05 was considered significant. RESULTS: There was no difference between groups regarding demographic data, surgical times, total volume of propofol used, arm withdrawal, pain during injection and variables monitored. There was a statistically significant difference in pain intensity at the time of induction of anesthesia, with less pain intensity in the nanoemulsion group. CONCLUSIONS: Both lipid and nanoemulsion formulations of propofol elicited pain on intravenous injection; however, the nanoemulsion solution elicited a less intense pain. Lipid and nanoemulsion propofol formulations showed neither hemodynamic changes nor adverse effects of clinical relevance.

RESUMO INTRODUÇÃO: O veículo do propofol em soluções a 1 e 2% é a emulsão de óleo de soja a 10%, que pode provocar dor à injeção, instabilidade da solução e contaminação bacteriana. Formulações foram propostas com o objetivo de alterar o veículo e reduzir essas reações adversas. OBJETIVOS: Comparar a incidência de dor à injeção do propofol com a hipótese de redução associada à nanoemulsão e a ocorrência de efeitos adversos locais e sistêmicos com as duas formulações. MÉTODO: Após aprovação pelo Conselho de Ética em Pesquisa, foram incluídos neste estudo prospectivo pacientes submetidas a procedimentos cirúrgicos ginecológicos: grupos controle (n = 25) e nanoemulsão (n = 25). Foram monitorados frequência cardíaca, pressão arterial não invasiva e saturação periférica de oxigênio. Foram analisados dados demográficos e estado físico; tempo cirúrgico e volume total usado de propofol; efeitos adversos locais ou sistêmicos; alterações nas variáveis de monitoramento. Considerou-se significativo valor de p < 0,05. RESULTADOS: Não houve diferença entre os grupos em relação a: dados demográficos, tempos cirúrgicos, volume total usado de propofol, retirada do braço, presença de dor durante a injeção e variáveis de monitoramento. Verificou-se diferença estatística significativa na intensidade da dor no momento da indução da anestesia, com menor intensidade no grupo nanoemulsão. CONCLUSÕES: Ambas as formulações de propofol, lipídica e em nanoemulsão, elicitaram dor à injeção venosa, porém a solução de nanoemulsão promoveu dor em menor intensidade. O propofol lipídico e o propofol em nanoemulsão não apresentaram alterações hemodinâmicas e efeitos adversos de relevância clínica.

Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy

PURPOSE: To evaluate the pain on injection of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy. METHODS: Total 439 patients were randomly allocated into 6 groups. Propofol & fentanil (PF) group received 1 μg/kg fentanyl, propofol & sufentanil (PS) group received 0.1 μg/kg sufentanil and propofol & remifentanyl (PR) group received 1 μg/kg remifentanyl prior to administration of 1-2 mg/kg of propofol. The propofol & half-fentanil (Pf) group, propofol & half-sufentanil (Ps) group and propofol & half-remifentanyl (Pr) group were given 0.5 μg/kg fentanyl, 0.05 μg/kg sufentanil and 0.5 μg/kg remifentanyl, respectively and later administrated 1-2 mg/kg propofol. All patients were monitored for the blood pressure (MAP), heart rate (HR), and oxygen saturation (SpO2). Additionally, the pain intensity was assessed using a 4-point verbal rating scale (VRS) by professional doctors. RESULTS: The incidence of pain due to propofol injection in Ps group (33.8%) was significantly lower than other 5 groups. The heart rate (HR) and mean arterial pressure (MAP) were maintained within the normal limits in all six groups and there was no hypotension or bradycardia encountered during the study period. CONCLUSION: Propofol and sufentanil group was the most suitable program for painless gastroscopy. .

Embolia gaseosa orbitaria y paraselar: reporte de un caso / Orbitary and parasellar gas embolism: case report

Se presenta el caso de una paciente de 39 años, de sexo femenino con antecedentes de rinitis alérgica y depresión en tratamiento, que consulta al servicio de urgencia por un episodio vertiginoso, el cual es tratado con tietilperazina endovenosa en forma exitosa. Posteriormente, como control, se realiza una tomografía computarizada de cerebro que evidencia gas a nivel selar, paraselar, hacia senos cavernosos y canales ópticos, lo cual se interpreta como una complicación atribuible a la punción venosa de urgencia. La paciente es manejada en forma conservadora manteniéndose siempre asintomática en los controles, con una resolución completa a la vez del cuadro vertiginoso. Este caso ejemplifica una complicación de difícil diagnóstico y potencialmente grave en el manejo de un paciente de urgencia mediante medicamentos endovenosos.

We describe the case of a 39 years old female patient, with history of allergic rhinitis and depression who came to the emergency room with a vertiginous episode, which was treated with intravenous thiethylperazine. Computed tomography of the brain showed evidence of sellar, parasellar, cavernous sinus and orbitary gas, with the interpretation of this being a complication from the emergency room intravenous treatment. The patient was managed by conservative means and remained asymptomatic in controls, with a complete resolution of the vertiginous episode as well. This case illustrates a difficult to diagnose and potentially serious complication, in the management of a patient with any intravenous drugs.

Intravenous device associated blood stream staphylococcal infection in paediatric patients.

Background & objectives: Intravenous device (IVD) associated nosocomial blood stream infections due to staphylococci are major cause of morbidity and mortality. The present study was carried out to assess the frequency of staphylococcal IVD associated infections in a paediatric ward of a tertiary case hospital. Prevalence of resistance to commonly used antimicrobials in hospital acquired staphylococcal isolates was also tested. Methods: Children admitted in paediatric wards with IVD for more than 48 h were enrolled. Blood, IVD tip at the time of removal, skin swab at the site of insertion of IVD and nasal swab were collected and cultured by standard protocol. All staphylococcal isolates from any source were analyzed for antimicrobial susceptibility by disk diffusion method. Genotyping matching of those staphylococcal isolates was done which were isolated from different sites of the same patient, but were phonotypically similar. Genotype of blood isolate was compared with genotype of isolate from nose/IVD/skin. Results: Staphylococcus aureus was the most frequent blood isolate (8.7%) followed by Candida (2.9%), coagulase negative staphylococci (CoNS 2.6%), Pseudomonas spp. (0.4%), Klebsiella spp. (0.3%) and Escherichia coli (0.1%). Isolation of microorganisms from blood was significantly higher in patients whose skin, IVD and nose were colonized by same microorganism (P<0.001). None of the staphylococcal isolate was found to be resistant to glycopeptides (vancomycin and teicoplanin). High penicillin and oxacillin resistance was present in both S. aureus (penicillin resistance; 76.8%, oxacillin resistance; 66.7%) and CoNS (penicillin resistance; 73.3%, oxacillin resistance; 60.0%). Among CoNS biotypes, S. haemolyticus was commonest blood isolate while S. epidermidis was commonest isolate from Skin/nose. Only 33.3 per cent of S. aureus blood stream infections and most of S. epidermidis and S. haemolyticus blood infections were IVD associated. Interpretation & conclusions: Staphylococci were the major causative agent of nosocomial blood stream infections. All episodes of septicaemia due to S. epidermidis and S. haemolyticus were IVD associated while only 1/3 of S. aureus septicaemia was IVD associated.

Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine

Propofol has the disadvantage of causing pain or discomfort on injection. The aim of the study was to assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain. One hundred American Society of Anesthesiology [ASA] I and II adults, scheduled for various elective surgical procedures under general anesthesia [GA], were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous [i.v.] magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0-3 which corresponds to no, mild, moderate and severe pain was recorded. All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control. Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection

Trombosis venosa profunda de la vena humeral / Deep venous thrombosis of the humeral vein

La trombosis venosa profunda de la vena humeral es una patología poco frecuente y no suele presentarse como complicación de la inyección endovenosa de contraste yodado. Se reporta el caso de una paciente con esta asociación inusual, en la que el Doppler fue determinante para el diagnóstico y control de su resolución.

Effect of vegetation size on the outcome of infective endocarditis in intravenous drug users

Infective endocarditis is one of the most important complications of injection drug use, which is associated with significant mortality and morbidity. The aim of this study was to evaluate the influence of vegetation size and localization on outcome and in-hospital mortality of infective endocarditis. A total of 34 patients were admitted to a university hospital in a four-year period and analyzed prospectively. Injection drug users were defined as patients who had injected drugs intravenously within the past 3 months before admission. The diagnosis of infective endocarditis was made on the basis of modified Duke's criteria. Totally, 38 episodes of endocarditis in 34 patients were identified. Patients were all male with the mean [ +/- standard deviation] age of 30.4 +/- 7.1 years. The affected valves were as follow: tricuspid valve in 26 cases [74.3%], mitral valve in 4 [11.4%], mitral and tricuspid valve in 4 [11.4%], and mitral and aortic valve in 1 [2.9%]. The vegetation size was 10mm or less in 12 cases [34.29%], and more than 10mm in the remaining 23 cases [65.71%]. Eight patients [21.1%] underwent surgery, however, unfortunately, nine [23.7%] died. Vegetations sized more than 10mm [p<0.033], involvement of the left-sided valves [p<0.012], and presence of more than one vegetation on TTE or TEE [p<0.05] were associated with higher probability of death. In contrast to some earlier studies which concluded that vegetations larger than 20mm are associated with higher mortality, our results revealed that the mortality rate increases even with smaller vegetations. In addition, the number and the location of vegetations also could affect the prognosis. Therefore, lower threshold for surgical interventions should be applied in patients with vegetations larger than 10mm

Hepatitis C among former athletes: association with the use of injectable stimulants in the past

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5 percent), reaching 50.8 percent in the professionals. The overall prevalence for hepatitis C was 7.2 percent, with values of 11 percent among professionals and 5.5 percent among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36 percent and 0.8 percent among amateurs; 21.9 percent and 0 percent among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.

Remifentanil Prevents Withdrawal Movements Caused by Intravenous Injection of Rocuronium

PURPOSE: The incidence of pain induced withdrawal movement following intravenous injection of rocuronium is high. This randomized, double-blind, placebo-controlled study was designed to evaluate the effect of pretreatment of remifentanil on the withdrawal movements due to intravenous injection of rocuronium during anesthetic induction. MATERIALS AND METHODS: Ninety adult female patients undergoing thyroidectomy were randomly allocated to three groups. Each patient intravenously received one of three solutions of equal volume (4 mL): normal saline (Group I, n=30), 0.5 microgram/kg remifentanil (Group II, n=30) or 1 microgram/kg remifentanil (Group III, n=30). Thirty seconds after remifentanil administration, anesthesia was induced with 5 mg/kg IV thiopental. Twenty seconds after thiopental injection, 0.6 mg/kg IV rocuronium was administered (injection rate of 0.5 mL/sec) and patients' withdrawal movements were assessed. Mean arterial pressure (MAP) and heart rate were assessed on arrival in the operation room, before the tracheal intubation and immediately, 1 and 2 min after the tracheal intubation. RESULTS: The incidence of withdrawal movements was significantly lower in both of the remifentanil groups (3 and 0% in Group II and III, respectively) than in the saline group (70%). Remifentanil attenuated the increase of heart rate and MAP immediately and 1 min after the tracheal intubation. CONCLUSION: The pretreatment with 0.5 and 1.0 microgram/kg remifentanil of bolus doses prevented the withdrawal movements caused by rocuronium injection, and effectively blunted cardiovascular activation following tracheal intubation.

Social harms in injecting drug users participating in the first phase III HIV vaccine trial in Thailand.

OBJECTIVE: To study related social harms due to identification with a group of participants in an HIV-1 vaccine trial who are potentially high risk for HIV/AIDS. MATERIAL AND METHOD: Two thousand five hundred forty six injecting drug users (IDU) were enrolled in a 36-month vaccine trial. Volunteers received education and risk reduction counseling at every six-month study visit. Social harms were not actively solicited, but volunteers were encouraged to report any during the process of counseling at every six-month visit. If a social harm was reported, a questionnaire was administered and the harm was tracked If necessary, clinic staff assisted in resolving the social harm. RESULTS: Thirty-nine social harms were reported by 37 participants; 33 (84.6%) were disturbances in personal relationships, three (7.7%) in employment, one (2.6%) was medically related, one (2.6%) was related to admission in the military and one (2.6%) was related with misbelieve about the vaccine. The most common reason for disturbances in personal relationships was suspicion of HIV infection (n=20). The impact of these harms on quality of life was characterized as minimal by 31 (79.5%) participants, as moderate by seven (17.9%), and as major by one (2.6%). All social harms were documented to be resolved by the end of the study. CONCLUSION: A few participants reported study-related social harms during the course of the trial. Most harm had minimal impact and all could be resolved by the end of the present study.

Pain on injection of propofol: propofol LCT vs propofol MCT/LCT with or without lidocaine pretreatment.

BACKGROUND: Pain on injection was a disadvantage of propofol long-chain triglyceride (LCT) and reduces patient satisfaction. Based on a systematic review, the recommended method to attenuate this pain was a previous administration of lidocaine under tourniquet for 30-120 seconds before injection of propofol (pretreatment of lidocaine). Recently, propofol medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion was proposed for its ability to decrease pain on injection. The authors conducted a double-blind randomized controlled trial to compare the incidence and severity of pain on injection between the new propofol MCT/LCT and the propofol LCT with and without lidocaine pretreatment. MATERIAL AND METHOD: 360 adult patients with ASA physical status I-III who underwent general anesthesia were assigned into 4 groups by computer-generated randomization; Group I - pretreatment of lidocaine 1% and propofol LCT Group I - pretreatment oflidocaine 1% and propofol MCT/LCT Group III - pretreatment of saline and propofol MCT/LCT and Group IV- pretreatment of saline and propofol LCT mixed with lidocaine 1%. All groups received pretreatment under tourniquet for 60 seconds. Evaluators who were blinded to the injected drugs recorded pain intensity (none, mild, moderate and severe) after the first 30% of total induction dose ofpropofol was injected at a rate of 1 ml/s by questioning patients. Data was analyzed by using Kruskal-Wallis testfor ordinal data. Post hoc analysis was performed by using the Mann-Whitney U-test with Bonferroni's correction on pairwise comparisons and was considered significant with p value of less than 0.05. RESULTS: Patients in an individual group had insignificant differences in their demographic data. The incidences of pain in Group I, II, III and IV were 61.1%, 46.7%, 62.2% and 55.6% respectively with an average incidence of 56% (p = 0.006). There were 15.6%, 5.6%, 23.3% and 24.4% of patients in Group I, II, III and IV who rated pain intensity as severe. Pain on injection of propofol MCT/LCT with lidocaine pretreatment was less than propofol MCT/LCT alone (p = 0.001). CONCLUSION: The incidence of pain on injection of propofol MCT/LCT was not different from that caused by propofol LCT with pretreatment of lidocaine and the intensity of pain on propofol MCT/LCT injection decreased significantly when using lidocaine pretreatment. Therefore, the authors could conclude that an injection of new propofol MCT/LCT solution was an alternative in reducing pain sensation to propofol LCT with pretreatment of lidocaine. Additionally, pain of propofol MCT/LCT injection could be alleviated by pretreatment of lidocaine with a 60 seconds tourniquet time before the injection ofpropofol.

[ comparison of distraction and EMLA Cream effects on pain intensity due to intravenus Catheters in 5-12 years old thalassemic children]

Intravenous [IV] insertion is a common painful procedure in pediatric care and it is a source of distress in children. Many children especially those suffering from chronic diseases such as thalassemia experince treatment procedures without any pain relief. This study was performed to compare the effect of distraction and eutectic mixture of local anesthetic [EMLA] cream on pain intensity of IV catheterizing in children with thalasemia. In this study a clinical trial was performed on 32 thalassemic children aged 5-12 years selected by convenient sampling method. The methods of distraction, EMLA cream and control [routine intervention] were used for each case in three stages with 14 days intervals. Data was collected by Ocher scales and CMFS questionnaire and was analyzed using t- and Wilcoxon test. There was a significant difference between mean pain intensity [numeral and photographic] of distraction and EMLA cream methods compared to the control, but not between distraction and EMLA cream Our findings showed that both distraction and EMLA cream procedures decreased pain of IV catheter with the same level of efficacy. However, since distraction method is more economical than EMLA ointment, it is recommended

comparative study between lidocaine iontophoresis, intravenous lidocaine, and magnesium sulfate pretreatment for reduction of pain during propofol injection

Propofol produces anesthcsia with rapid recovery[1]- It has become the induction agent of choice for elective surgery in many countries. However, it causes pain or discomfort on intravenous injection in 28 - 90% of patients, which is a recognized complication that is recalled post operatively by 52-62% of those who experience it, and several methods have been advocated to reduce its incidence and severity [2]. The aim of the study is to compare the efficacy of three different techniques in attenuating pain induced propofol injection, which are magnesium sulfate pretreatment prior to propofol administration, in comparison to iontophoretically applied lidocaine, which is a transdermal anesthesia technique and i.v. injection of 2% lidocaine prior to propofol injection. A prospective, randomized double blind clinical study was conducted in 90 ASA I and II adults undergoing elective surgery. After obtaining a written informed consent, they were divided into 3 groups 30 patients in each. Group I [lidocaine group] pretreated with 2 ml. 2% lidocaine [40 mg], the pretreatment injection given over 30 seconds, 1 minute before the start of propofol infusion. This is accompanied by venous occlusion for 1 min.In group II [lontophoresis group], the negative electrode containing 4% lidocaine in a hydrogel was placed on the test area on the dorsum of the hand while, the positive electrode was placed 10 cm proximally, and both electrodes were connected to the iontophoresis unit [lomed Phoresor 11, Croydon, UK]. Electric current was set at 0.0 mA and was increased gradually to a maximum 4.0 mA. lontophoresis was discontinued when 40 mA min-1 dose was delivered and the time required was recorded, since, drug delivery is proportional to the total electrical charge, measured as a product of the current strength and duration of application [units: miliampere x minutes, [mA.min-[1]][3]. In group III was pretreated with 2ml 50% magnesium sulfate [1 g] the pretreatment solutions were given over 30 seconds. 1 minute before the start of propofol infusion-This is accompanied by venous occlusion for 1 min. followed by propofol infusion. The infusion was stopped when the patient lost consciousness as detected by loss of eye lash reflex. Pain was assessed on a four point scale 0 = no pain, 1 = mild pain, 2 = moderate pain, 3= severe pain, at the start of propofol infusion and at 20 seconds intervals for 1 minute. The incidence of pain following i.v injection of propofol after pretreatment with lidocaine 2% was 17%in group I [lidocaine] compared to 39% and 46% in group II [lontophoresis] and group III [magnesium] respectively [P < 0.05]. Intravenous lidocaine pretreatment was more effective in attenuating pain during propofol administration than iontophoretically applied lidocaine and magnesium sulfate pretreatment. There was no statistically significant difference between group II and group Ill as regard pain reduction during propofol injection. intravenous lidocaine pretreatment is more effective in attenuating pain induced by propofol injection than topically applied lidocaine and magnesium sulfate pretreatment

Reduction of pain following propofol injection using blood aspiration

A randomized, controlled, single-blinded study was carried out to see the effect of blood aspiration on reduction of propofol injection pain. Seventy-five patients were studied. They were divided into three categories, comparing the aspiration of 2ml of the patients' blood into the propofol syringe immediately before injection, and the addition of either normal saline 2ml, or lignocaine 20mg to the propofol before injection. The addition of blood was as effective as the addition of lignocaine in reducing the pain of injection, but significantly more effective than the addition of saline [P<0.001] in reducing propofol injection pain. Blood as well as lignocaine are more effective than saline in reducing pain of propofol injection

Immediate and delayed reactions to contrast media during intravenous urography

To highlight the incidence of both immediate and delayed reactions to the intravenous administration of urografin 70% [meglumine and NA diatrizoate] and niopam 300 [iopamidol] for urographic examination. Twelve hundred patients, over 18 years of age, who were referred to the radiology department at Queen Alia Military Hospital for non-emergency of urograph from 1st October 1996 until 30th September 1998 were examined. A specially designed questionnaire investigating reactions or side effects noticed by patients after the injection was distributed. Data were collected and analyzed. A total of 1699 patients received single injections of either urografin or niopam. Eight hundred and forty four patients received urografin 70% and 855 patients received niopam 300. Significant differences were found in the incidence of both types of reactions to the two media with respect to nausea and vomiting, arm pain, and taste in the mouth, which was commoner in patients receiving urografin 70%, whereas the incidence of delayed skin rashes and parotid swelling was commoner with niopam 300. The occurrence of a flu-like illness, so-called "iodism ", was found to be equal in the two contrast media groups. Conclusion:1. Patients seem to prefer non-ionic media, which give them a more comfortable examination. 2. Intermediate and sensitivity reactions are commoner with urografin. 3. Delayed reactions are very common with both types of media, particularly arm pain, a flu-like illness and rashes. Delayed rashes and perhaps parotitis are commoner with non-ionic media. 4. Routine use of non-ionic contrast media for urography does not appear justified

Tamizaje de marcadores para hepatitis B pre y post-vacunación en el hospital de C. del Uruguay, Argentina / Screening of the hepatitis B markers before and after vaccination at the C. del Uruguay's hospital, Argentina

Se estudió entre 1993 y 1995 la prevalencia para tres marcadores de hapatitis B (antiHBs, AgHBs y antiHBc) en 382 de 402 (95 por ciento) empleados del hospital público de C. del Uruguay, por presunción de unaincidencia elevada y la necesidad de identificar subgrupos de mayor riesgo, con un muestreo único transversal. Se utilizó la prueba de inmunosorción enzimática (ELISA), y se siguió la respuesta inmune a la vacuna por DNA-recombinante para un mínimo de tres y hasta cuatro dosis, mediante el dosaje de anti HBs. Los resultados muestran una prevalencia general prevacunación para al menos algún marcador de 5,6 por ciento (de 2,9 a 16,7 por ciento según profesiones) y para sólo el anti HBc de 4,2 por ciento. La seroprevalencia positiva del personal fue significativamente mayor en los servicios de odontología, laboratorio, pediatría, cirugía y guardia, en ese orden, que entre el personal de los servicios (p < 0,05). No se encontró asociación con el sexo, edad, antigüedad en el servicio, condición familiar, intervenciones quirúrgicas, transfusiones ni enfermedades crónicas, pero sí con las aplicaciones endovenosas de medicamentos recibidas. El 70 por ciento de los seropositivos eran médicos, personal de enfermería, de laboratorio e instrumentadores, y el resto personal administrativo de servicios y auxiliares. La asociación con la frecuencia de contacto sanguíneo o de mucosas expuestas resultó significativa (p < 0,05). Con respecto a la respuesta inmune frente a la vacunación, el 93,4 por ciento respondieron satisfactoriamente luego de la tercera dosis, y el 100 por ciento luego de la cuarta. El 80 por ciento del personal que requiriera una cuarta dosis, tenían una antigüedad media de 15,5 ñ 2,3 años en el servicio de radiología, en ausencia de otros factores, lo que sugiere la posibilidad de un grupo con depresión inmunológica. En la población estudiada la magnitud de la respuesta inmune o el retardo en la misma no aparece asociada con la edad, el sexo, los otros lugares de desempeño, el hábito de fumar, enfermedades crónicas o la obesidad

Acute pulmonary edema following use of intravenous naloxone

We report the case of a 21-year old male, who developed acute pulmonary edema in immediate post-operative period following intravenous injection of a small dose of naloxone, which was managed in Operation Theater [OT] and Intensive Care Unit [ICU] successfully and discharged without any complication