Drenaje percutáneo con catéter del neumotórax en pacientes con COVID­19 / Percutaneous catheter drainage of pneumothorax in patients with COVID-19

Introducción. La transmisión del SARS-CoV-2 principalmente se da por gotas y contacto cercano con las per-sonas infectadas, pero los aerosoles parecen ser también una fuente de infección. El neumotórax espontáneo o secundario puede presentarse en pacientes con COVID-19, ayudado por patologías de base como la enfermedad pulmonar obstructiva crónica. Es necesario garantizar procedimientos seguros para los pacientes y buscar todas las medidas posibles para la protección del personal de la salud, por eso el drenaje de neumotórax con catéter pleural en lugar de sonda de toracostomía puede ser una de ellas.El objetivo de este estudio es presentar a los cirujanos una alternativa a la toracostomía tradicional, mediante la utilización de catéteres de menor diámetro, para la resolución de la ocupación pleural.Aspectos Técnicos. Se presenta el protocolo para inserción segura de un catéter pleural para el drenaje de neumotórax, mediante un sistema completamente cerrado, y se dan recomendaciones sobre el uso de filtros virales y solución viricida en el sistema de drenaje pleural conectado al catéter. Conclusión. El estado de pandemia por COVID-19 y el riesgo que representa para los profesionales de la salud la exposición a fuentes de transmisión durante procedimientos generadores de aerosoles, hace que se deban extremar las medidas para evitar el contagio.

Introduction. The transmission of SARS-CoV-2 mainly occurs by drops and close contact with infected people, but aerosols also seem to be a source of infection. Spontaneous or secondary pneumothorax can occur in patients with COVID-19, helped by underlying pathologies such as chronic obstructive pulmonary disease. It is necessary to guarantee safe procedures for patients and to seek all possible measures for the protection of health personnel, so drainage of pneumothorax with a pleural catheter instead of a thoracostomy tube may be one of those. The objective of this study is to present surgeons with an alternative to traditional thoracostomy, using smaller diameter catheters, to resolve pleural occupancy.Technical aspects. The protocol for the safe insertion of a pleural catheter for pneumothorax drainage is presented, using a completely closed system, and recommendations are given on the use of viral filters and viricidal solution in the pleural drainage system connected to the catheter.Conclusions. The state of the COVID-19 pandemic and the risk that exposure to sources of transmission sources during aerosol-generating procedures represents for health professionals means that extreme measures must be taken to avoid contagion.

Técnica quirúrgica de la traqueostomía percutánea en el paciente con COVID-19 / Percutaneous tracheostomy surgical technique in the patient with COVID-19

Generalidades. Desde diciembre de 2019 se detectó una nueva infección respiratoria, causada por el virus denominado SARS-CoV-2, decretada posteriormente como pandemia, lo cual ha exigido al personal de salud replantear la forma de prestar sus servicios en salud y garantizar la auto-protección con recursos que han sido insuficientes incluso en los países más desarrollados.Dado que la transmisión del SARS-CoV-2 ocurre a través de aerosoles expulsados de la vía aérea, que pueden ser inhalados o llevados a las mucosas por contacto con las manos contaminadas, se requiere minimizar la posibilidad de contagio para los equipos de atención en salud.Objetivos. Brindar herramientas a los cirujanos que les permitan elegir la técnica con menor probabilidad de exposición a aerosoles. Describir el paso a paso de la técnica quirúrgica de la traqueostomía percutánea, enfati-zando en el control sobre la generación de aerosoles en pasos críticos.Aspectos técnicos. La técnica completamente percutánea con kit de traqueostomía permite un mejor sello entre tejidos y dispositivos. Los escenarios más frecuentes para realizar una traqueostomía son: el paciente intubado con ventilación mecánica y el paciente con falla en la intubación que requiere una intervención de emergencia.Conclusión. El alto contagio del COVID-19 al practicar intervenciones en la vía aérea nos obliga a hacer énfasis en las estrategias que reduzcan la formación de aerosoles y permitan la contención de los mismos durante la realización de traqueostomías

Background: Since December 2019, a new respiratory infection was detected, caused by the virus called SARS-CoV-2, later decreed as a pandemic, which has required health personnel to rethink the way of providing their health services and guarantee the self-protection with resources that have been insufficient even in the most developed countries. As the transmission of SARS-CoV-2 occurs through aerosols expelled from the airway, which can be inhaled or brought to the mucosa by contact with contaminated hands, it is necessary to minimize the possibility of contagion for the health care teams.Objectives: Provide tools to surgeons that allow them to choose the technique with the least probability of exposure to aerosols. Describe the step-by-step of the percutaneous tracheostomy technique, emphasizing control about the generation of aerosols in critical steps.Technical aspects: The fully percutaneous technique with a tracheostomy kit allows a better seal between tissues and devices. The most frequent scenarios for performing a tracheostomy are an intubated patient with mechanical ventilation and a patient with failure of intubation that requires emergency intervention.Conclusion: The high contagion of COVID-19 when practicing airway interventions forces us to emphasize strategies that reduce the formation of aerosols and allow them to be contained during tracheostomies

Perforación del yeyuno por enfermedad diverticular: una condición a considerar en ancianos / Perforation of the jejunum due to diverticular disease: A condition to consider in the elderly

Resumen La enfermedad diverticular constituye la principal afección intestinal después de los 40 años; tiene gran relevancia por sus amplias manifestaciones, que llevan a consultas frecuentes en todos los servicios de urgencias y corresponden al hallazgo más usual en los procedimientos endoscópicos electivos. Por su parte, la diverticulosis del intestino delgado tiene una prevalencia que oscila entre 2 % y 5 %. Las presentaciones clínicas como sangrado, obstrucción, dolor abdominal, perforación, formación de abscesos y fístulas suelen ser más floridas cuando afectan el colon. Se presenta el caso de un paciente anciano quien consultó a urgencias con abdomen agudo secundario a peritonitis generalizada por perforación intestinal debida a enfermedad diverticular del yeyuno.

Abstract Diverticular disease is the most common bowel disease after the age of 40 years. It is the most common finding in elective endoscopic procedures, and it has great relevance because of its broad manifestations which lead to frequent emergency service consultations. On the other hand, the prevalence of diverticulosis of the small intestine ranges from 2% to 5%. Clinical presentations such as bleeding, obstructions, abdominal pain, perforations, formation of abscesses and fistulas are usually more florid when they affect the colon. We present the case of an elderly emergency room patient with acute abdomen secondary to generalized peritonitis due to intestinal perforation caused by diverticular disease of the jejunum.

Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis.

OBJECTIVE: To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI). METHODS: We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison. RESULTS: We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of - 0.00 (95% CI - 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of - 0.00 (95% CI - 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported. CONCLUSIONS: This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.