Oral supplementation with postbiotics modulates the immune response produced by myxomatosis vaccination in wild rabbits.

Rabbits (Oryctolagus cuniculus) are vitally important species in the Iberian Peninsula ecosystem. However, since 1950, there has been a significant population decline, with major repercussions. This situation is mainly due to the presence of infectious diseases, such as myxomatosis, which is expanding and is characterized by severe and fatal clinical manifestations. Current control measures, mainly those based on vaccinations, are ineffective. Therefore, new strategies need to be developed and implemented. This study aimed to evaluate whether supplementation with postbiotic products modulates the immune response in wild rabbits vaccinated against myxomatosis. For this purpose, two groups of rabbits were established: a control group fed with standard feed ad libitum from weaning (28 days) until two months of age, and a treated group, which was fed under the same conditions but supplemented with postbiotics (3 kg/Tm). All the studied rabbits were vaccinated against this disease during weaning. In addition, a blood samples were obtained from all animals immediately before vaccination and 30 days later, which allowed us to evaluate the level of antibodies against myxomatosis virus (ELISA detection) and the relative expression of gene encoding to cytokines related to the immune response (IL6, TNFα and IFNγ), at both times of the experience. Weight and length measurements were also taken at both times to calculate body index and mean daily gain (MDG). No statistically significant differences in growth parameters were observed. There were also no differences in the serological response among groups. However, a relative underexpression of gene codifying to TNFα (p-value = 0.03683) and a higher expression on IFNγ (p-value = 0.045) were observed in the treated group. This modulation in cytokines could lead to less severe lesions in wild rabbit naturally infected with myxomatosis virus.

Does Early Decompressive Craniectomy Improve Outcome? Experience from an Active UK Recruiter Centre.

Introduction. The results of the recent DECRA study suggest that although craniectomy decreases ICP and ICU length of stay, it is also associated with worst outcomes. Our experience, illustrated by these two striking cases, supports that early decompressive craniectomy may significantly improve the outcome in selected patients. Case Reports. The first patient, a 20-year-old man who suffered severe brain contusion and subarachnoid haemorrhage after a fall downstairs, with refractory ICP of 35 mmHg, despite maximal medical therapy, eventually underwent decompressive craniectomy. After 18 days in intensive care, he was discharged for rehabilitation. The second patient, a 23-year-old man was found at the scene of a road accident with a GCS of 3 and fixed, dilated pupils who underwent extensive unilateral decompressive craniectomy for refractory intracranial hypertension. After three weeks of cooling, paralysis, and neuroprotection, he eventually left ICU for rehabilitation. Outcomes. Four months after leaving ICU, the first patient abseiled 40 m down the main building of St. Mary's Hospital to raise money for the Trauma Unit. He has returned to part-time work. The second patient, was decannulated less than a month later and made a full cognitive recovery. A year later, with a titanium skull prosthesis, he is back to part-time work and to playing football. Conclusions. Despite the conclusions of the DECRA study, our experience of the use of early decompressive craniectomy has been associated with outstanding outcomes. We are currently actively recruiting patients into the RESCUEicp trial and have high hopes that it will clarify the role of the decompressive craniectomy in traumatic brain injury and whether it effectively improves outcomes.

Ventilación mecánica invasiva en EPOC y asma / Invasive mechanical ventilation in COPD and asthma

Los pacientes con EPOC y asmáticos utilizan una proporción sustancial de ventilación mecánica en la UCI, y su mortalidad global en tratamiento con ventilación mecánica puede ser significativa. Desde el punto de vista fisiopatológico, muestran un incremento de la resistencia de la vía aérea, hiperinsuflación pulmonar y elevado espacio muerto anatómico, lo que conduce a un mayor trabajo respiratorio. Si la demanda ventilatoria sobrepasa la capacidad de la musculatura respiratoria, se producirá el fracaso respiratorio agudo.El principal objetivo de la ventilación mecánica en este tipo de pacientes es proporcionar una mejora en el intercambio gaseoso, así como el suficiente descanso para la musculatura respiratoria tras un periodo de agotamiento. La evidencia actual apoya el uso de la ventilación mecánica no invasiva en estos pacientes (especialmente en la EPOC), pero con frecuencia se precisa de la ventilación mecánica invasiva para los pacientes con enfermedad más severa. El clínico debe ser muy cauto para evitar complicaciones relacionadas con la ventilación mecánica durante el soporte ventilatorio. Una causa mayor de morbilidad y mortalidad en estos pacientes es la excesiva hiperinsuflación dinámica pulmonar con presión positiva al final de la espiración (PEEP intrínseca o auto-PEEP). El objetivo de este artículo es proporcionar una concisa actualización de los aspectos más relevantes para el óptimo manejo ventilatorio en estos pacientes (AU)

COPD and asthmatic patients use a substantial proportion of mechanical ventilationin the ICU, and their overall mortality with ventilatory support can be significant. From the pathophysiologicalstandpoint, they have increased airway resistance, pulmonary hyperinflation,and high pulmonary dead space, leading to increased work of breathing. If ventilatory demandexceeds work output of the respiratory muscles, acute respiratory failure follows. The main goal of mechanical ventilation in this kind of patients is to improve pulmonary gasexchange and to allow for sufficient rest of compromised respiratory muscles to recover fromthe fatigued state. The current evidence supports the use of noninvasive positive-pressureventilation for these patients (especially in COPD), but invasive ventilation also is requiredfrequently in patients who have more severe disease. The physician must be cautious to avoidcomplications related to mechanical ventilation during ventilatory support. One major cause ofthe morbidity and mortality arising during mechanical ventilation in these patients is excessivedynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsicPEEP or auto-PEEP). The purpose of this article is to provide a concise update of the mostrelevant aspects for the optimal ventilatory management in these patients (AU)

[Invasive mechanical ventilation in COPD and asthma]. / Ventilación mecánica invasiva en EPOC y asma.

COPD and asthmatic patients use a substantial proportion of mechanical ventilation in the ICU, and their overall mortality with ventilatory support can be significant. From the pathophysiological standpoint, they have increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to increased work of breathing. If ventilatory demand exceeds work output of the respiratory muscles, acute respiratory failure follows. The main goal of mechanical ventilation in this kind of patients is to improve pulmonary gas exchange and to allow for sufficient rest of compromised respiratory muscles to recover from the fatigued state. The current evidence supports the use of noninvasive positive-pressure ventilation for these patients (especially in COPD), but invasive ventilation also is required frequently in patients who have more severe disease. The physician must be cautious to avoid complications related to mechanical ventilation during ventilatory support. One major cause of the morbidity and mortality arising during mechanical ventilation in these patients is excessive dynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsic PEEP or auto-PEEP). The purpose of this article is to provide a concise update of the most relevant aspects for the optimal ventilatory management in these patients.

[Echocardiography in the Intensive Care Unit]. / Ecocardiografía en la Unidad de Cuidados Intensivos.

The echocardiography can provide important and relevant information and the critically ill patient presents a challenge for the echocardiographer: from limitations in image acquisition to interpretation in the context of rapid physiological and intervention changes. The most frequent reason for requesting an echocardiogram in the ICU is probably to assess left ventricular function. In any case, information of direct relevance for clinical management can in relationship to abnormalities of structure and function can be obtained and used to estimate pulmonary arterial and venous pressures. It can help to investigate the consequences of myocardial ischemia, valvular dysfunction and pericardial disease and detect changes characteristic of specific conditions (e.g. sepsis, pulmonary thromboembolism), although this must be interpreted in the context of each individual patient. The echocardiography also can be used to monitor the therapeutic interventions. The applications of echocardiography in the critical care setting are reviewed, with special emphasis on the assessment of cardiac physiology.

Ecocardiografía en la Unidad de Cuidados Intensivos / Echocardiography in the intensive care unit

La ecocardiografía puede proporcionar una importantey relevante información, y el paciente críticosupone un desafío para el ecocardiografista:desde limitaciones en la adquisición de la imagen, ala interpretación en el contexto de rápidos cambiosfisiológicos e intervenciones. Probablementela razón más frecuente para solicitar un ecocardiogramaen la Unidad de Cuidados Intensivos (UCI) es el estudio de la función ventricular izquierda. De cualquier modo, puede obtenerse información de relevancia directa para el manejo clínico relacionada con anormalidades de laestructura y función, y puede usarse para estimarpresiones arteriales y venosas pulmonares. Pue defacilitar la investigación de isquemia miocárdica,disfunción valvular y patología pericárdica, ypueden detectarse cambios característicos decondiciones específicas (por ejemplo: sepsis ytromboembolismo pulmonar), aunque esto debeinterpretarse en el contexto de cada paciente. Laecocardiografía puede también usarse para monitorizarla terapéutica. Las aplicaciones de l ecocardiografía en la UCI se revisan en este artículo, haciendo especial énfasis en la fisiología cardíaca

The echocardiography can provide importantand relevant information and the critically ill patientpresents a challenge for the echocardiographer:from limitations in image acquisition to interpretationin the context of rapid physiologicaland intervention changes. The most frequent reasonfor requesting an echocardiogram in the ICUis probably to assess left ventricular function. Inany case, information of direct relevance for clinicalmanagement can in relationship to abnormalitiesof structure and function can be obtainedand used to estimate pulmonary arterial and venouspressures. It can help to investigate theconsequences of myocardial ischemia, valvulardysfunction and pericardial disease and detectchanges characteristic of specific conditions (e.g.sepsis, pulmonary thromboembolism), althoughthis must be interpreted in the context of each individual patient. The echocardiography also canbe used to monitor the therapeutic interventions.The applications of echocardiography in the criticalcare setting are reviewed, with special emphasison the assessment of cardiac physiology

Ruptura de aneurisma micótico aórtico infrarrenal por Staphylococcus aureus originado en lesiones cutáneas / Mycotic aortic infrarrenal anaurysm rupture by staphylococcus aureus origined in skin lesions

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[Post-myocardial infarction depression]. / La depresión tras el infarto agudo de miocardio.

Major depression is a common finding among patients recovering from a myocardial infarction. Additionally, clinically significant depressive symptoms are present in other patients whose symptom severity or duration does not meet established criteria for a diagnosis of major depression. Over the last decade, increasing evidence suggests that in addition to its effect on patient s quality of life, post-MI depression also deserves attention because of a reported relation to increased morbidity and mortality. This evidence report reviews the studies that have studied depression or depressive symptoms in patients after an MI and focuses on the prevalence, clinical significance, treatment, and methods of evaluating this condition. A large number of studies have evaluated various aspects of post-MI depression including prevalence, its association with mortality, and major adverse events, and treatment.

PDA y anestesiología / No disponible

No disponible

Dificultad de intubación resulta con Airtraq(R) / No disponible

No disponible

La depresión tras el infarto agudo de miocardio / Post-myocardial infarction depression

La depresión mayor es un cuadro común entre pacientes convalecientes de un infarto agudo de miocardio (IAM). Además, síntomas depresivos clínicamente significativos se hallan presentes en otros pacientes cuya severidad sintomática o duración no reúne suficientes criterios establecidos para configurar el diagnóstico de depresión mayor. Durante la pasada década, la evidencia creciente sugiere que junto a su efecto sobre la calidad de vida del paciente, la depresión post-infarto también merece una atención especial ya que se ha descrito un incremento de morbilidad y mortalidad asociadas. Este artículo revisa los estudios que han estudiado la depresión o los síntomas depresivos en pacientes que han sufrido un infarto agudo de miocardio y se centra en la prevalencia, significación clínica, tratamiento, y métodos de evaluación de este cuadro. Un amplio número de estudios han evaluado varios aspectos de la depresión post-infarto incluyendo la prevalencia, su asociación con mortalidad, efectos adversos mayores y tratamiento

Major depression is a common finding among patients recovering from a myocardial infarction. Additionally, clinically significant depressive symptoms are present in other patients whose symptom severity or duration does not meet established criteria for a diagnosis of major depression. Over the last decade, increasing evidence suggests that in addition to its effect on patient´s quality of life, post-MI depression also deserves attention because of a reported relation to increased morbidity and mortality. This evidence report reviews the studies that have studied depression or depressive symptoms in patients after an MI and focuses on the prevalence, clinical significance, treatment, and methods of evaluating this condition. A large number of studies have evaluated various aspects of post-MI depression including prevalence, its association with mortality, and major adverse events, and treatment