Guillain-Barré syndrome associated with SARS-CoV-2 infection: A case series from 4 Colombian cities during the pandemic.

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barré syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies; however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region; thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.

En el año 2020 se declaro la pandemia ocasionada por la infección por el virus SARSCoV-2, virus de la familia del coronavirus, adoptándose el nombre de COVID-19 a la enfermedad 1. En Bogotá, Colombia, se confirmó el primer caso de COVID-19 el 6 de marzo de 2020 (2). Los principales síntomas reportados en la infección por SARSCoV-2 son fiebre (43.8% en la admisión y 88.7% durante la hospitalización) y tos (67.8%) (3). Otros síntomas encontrados son fatiga (38.1%), producción de esputo (33.7%) y cefalea (13.6%). Los principales signos neurológicos reportados en los pacientes con infección severa por SARS-Cov-2 son agitación (69%), compromiso en tracto corticoespinal (67%) y delirium (65%) (4). Las principales complicaciones neurológicas descritas asociadas a Covid 19 son: anosmia, disgeusia, encefalopatia, Síndrome de Guillain Barre, complicaciones cerebrovasculares y daño en musculo esquelético (5­8).En el presente articulo se presenta una serie de casos de pacientes con síndrome de Guillain-Barré asociado a infección por SARS-CoV-2. Se recolectaron casos de diferentes instituciones medicas de Colombia.

Developments and trends in fruit bar production and characterization.

Fruits serve as a source of energy, vitamins, minerals, and dietary fiber. One of the barriers in increasing fruit and vegetables consumption is time required to prepare them. Overall, fruit bars have a far greater nutritional value than the fresh fruits because all nutrients are concentrated and, therefore, would be a convenience food assortment to benefit from the health benefits of fruits. The consumers prefer fruit bars that are more tasted followed by proper textural features that could be obtained by establishing the equilibrium of ingredients, the proper choosing of manufacturing stages and the control of the product final moisture content. Fruit bar preparations may include a mixture of pulps, fresh or dried fruit, sugar, binders, and a variety of minor ingredients. Additionally to the conventional steps of manufacturing (pulping, homogenizing, heating, concentrating, and drying) there have been proposed the use of gelled fruit matrices, dried gels or sponges, and extruders as new trends for processing fruit bars. Different single-type dehydration or combined methods include, in order of increasing process time, air-infrared, vacuum and vacuum-microwave drying convective-solar drying, convective drying, and freeze drying are also suggested as alternative to solar traditional drying stage. The dehydration methods that use vacuum exhibited not only higher retention of antioxidants but also better color, texture, and rehydration capacity. Antioxidant activity resulting from the presence of phenolic compounds in the bars is well established. Besides this, fruit bars are also important sources of carbohydrates and minerals. Given the wide range of bioactive factors in fresh fruits that are preserved in fruit bars, it is plausible that their uptake consumption have a positive effect in reducing the risk of many diseases.

Total intravenous anesthesia with a propofol-ketamine combination during coronary artery surgery.

OBJECTIVE: To evaluate the cardiovascular effects of a propofol-ketamine combination in patients undergoing coronary artery surgery. DESIGN: Prospective, randomized study. SETTING: Tertiary care teaching hospital, single center. PARTICIPANTS: Seventy-eight adult patients. INTERVENTIONS: Patients were randomly allocated to receive propofol-ketamine for induction and maintenance of anesthesia (n = 36) or fentanyl-enflurane (controls, n = 42). MEASUREMENTS AND MAIN RESULTS: Hemodynamics and other variables were recorded during and after surgery and for 24 hours in the intensive care unit. Before cardiopulmonary bypass (CPB), there was similar incidence of treatment for hypotension (42% of patients in both groups), tachycardia (propofol-ketamine, 6%; controls, 5%), and myocardial ischemia (propofol-ketamine, 3%; controls, 12%). In the propofol-ketamine group, there was a decreased requirement for inotropic agents after CPB (22% of patients) compared with controls (49% of patients; p = 0.02). There was a reduced incidence of myocardial infarctions (creatine kinase myocardial band >133 U/L) in the propofol-ketamine group compared with the control group (0% v 14%; p = 0.02; Fisher's exact test). Patients in the propofol-ketamine group were more likely to have their tracheas extubated within 8 hours of arrival in the intensive care unit compared with controls (33% v 7%; p = 0.01; Cochran-Mantel-Haenzel test). CONCLUSIONS: The propofol-ketamine combination was associated with a similar incidence of pre-CPB hypotension and ischemia, a decreased need for inotropes after CPB, an earlier time to tracheal extubation, and a reduced incidence of myocardial infarctions compared with controls.