ABSTRACT
Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.
Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , Humans , COVID-19/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/etiology , SARS-CoV-2 , Magnetic Resonance Imaging , BrainABSTRACT
El síndrome de encefalopatía posterior reversible es un trastorno neurológico agudo caracterizado por una sintomatología variable e imágenes radiológicas características de edema vasogénico parietooccipital. Está asociado a condiciones clínicas como hipertensión arterial, infección/sepsis o fármacos citotóxicos/inmunosupresores, entre otros. Se caracteriza fisiopatológicamente por daño endotelial con rotura de la barrera hematoencefálica, hipoperfusión cerebral y edema vasogénico. Presentamos 2 casos de pacientes críticos COVID-19 que ingresaron por neumonía con necesidad de ventilación mecánica y que tras retirar la sedación desarrollaron clínica neurológica aguda y reversible consistente en epilepsia y encefalopatía, asociada a lesiones subcorticales hiperintensas en la resonancia magnética cerebral compatibles con síndrome de encefalopatía posterior reversible. El coronavirus SARS-CoV-2 activaría una respuesta inflamatoria que produciría daño en el endotelio cerebral. Este último podría ser desencadenado por la liberación de citocinas, así como por una lesión viral directa, dado que el endotelio expresa receptores ACE2. Esto podría explicar la posible asociación entre el síndrome de encefalopatía posterior reversible y la COVID-19.(AU)
Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.(AU)
Subject(s)
Humans , Male , Aged , Brain Diseases , Coronavirus Infections , Epilepsy , Inpatients , Physical Examination , Leukoencephalopathy, Progressive Multifocal , Nervous System DiseasesABSTRACT
Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema.The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome.SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.
ABSTRACT
Introducción: Tanto el dolor como las náuseas y vómitos postoperatorios constituyen condicionantes principales del tiempo y la calidad de la recuperación en cirugía laparoscópica. Objetivo: Determinar los factores perioperatorios que contribuyen a la aparición de dolor y de náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria. Materiales y métodos: Estudio prospectivo de una cohorte de 297 pacientes intervenidos mediante cirugía laparoscópica ambulatoria. Como variables de estudio se consideraron: a) factores preoperatorios, incluyendo medicación habitual y riesgo anestésico; b) intraoperatorios, entre otros tiempos quirúrgico y anestésico, fármacos y presión de neumoperitoneo y c) postoperatorios, como complicaciones mayores o menores y tiempos de recuperación. Como variables dependientes se consideraron los síntomas postoperatorios náuseas, vómitos y dolor. Resultados: Considerando como variable combinada la aparición de náuseas, vómitos o dolor moderado/severo según una escala visual analógica, presentaron uno o más de estos síntomas el 58,7% de los pacientes (IC 95%: 52,8-64,4). Mediante regresión logística, las variables asociadas a la aparición de síntomas fueron: sexo femenino (OR: 3,4), tiempo de espera previo a quirófano superior a 45 min (OR: 4,9) y ausencia de profilaxis antiemética (OR: 12,2). Conclusiones: En pacientes operados mediante cirugía laparoscópica ambulatoria, uno de cada 4presenta náuseas y vómitos postoperatorios y la mitad presentan dolor de intensidad moderada antes del alta. Considerando globalmente la aparición de dolor o náuseas y vómitos postoperatorios, estos síntomas afectan a más de la mitad de los pacientes y son más frecuentes en mujeres y en quienes más tardan en acceder al quirófano
Introduction: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. Objective: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. Material and methods: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. Results: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). Conclusions: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Laparoscopy/methods , Ambulatory Surgical Procedures/methods , Postoperative Nausea and Vomiting/etiology , Pain, Postoperative/etiology , Laparoscopy/rehabilitation , Perioperative Care/methods , Prospective Studies , Anesthesia Recovery Period , Monitoring, Intraoperative/methodsABSTRACT
INTRODUCTION: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. OBJECTIVE: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. MATERIAL AND METHODS: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. RESULTS: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). CONCLUSIONS: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room.
Subject(s)
Laparoscopy/adverse effects , Pain, Postoperative/etiology , Postoperative Nausea and Vomiting/etiology , Adolescent , Adult , Aged , Ambulatory Surgical Procedures , Female , Humans , Laparoscopy/instrumentation , Laparoscopy/methods , Logistic Models , Male , Middle Aged , Monitoring, Physiologic/methods , Prospective Studies , Risk Factors , Sex Factors , Time Factors , Time-to-Treatment , Young AdultABSTRACT
Introducción: El estreñimiento en pacientes con hipertensión arterial o diabetes es un motivo frecuente de consulta al farmacéutico. La indicación farmacéutica no debe interferir con la medicación habitual de estos pacientes. Objetivos: Formular recomendaciones sobre indicación farmacéutica a pacientes con diabetes y/o hipertensión arterial que acuden a la oficina de farmacia solicitando tratamiento farmacológico para el estreñimiento. Material y métodos: Mediante revisión sistemática de Guías de Práctica Clínica sobre abordaje del estreñimiento, se han elaborado recomendaciones sobre indicación farmacéutica a pacientes con diabetes y/o hipertensión arterial que acuden a la oficina de farmacia solicitando tratamiento farmacológico. Tras diseñar una estrategia de búsqueda, se seleccionaron las fuentes bibliográficas y se llevó a cabo la recogida de información. La búsqueda bibliográfica se realizó en los siguientes recursos web: Medline, GuíaSalud, National Guideline Clearinghouse, Canadian Medical Association Infobase, Scottish Intercollegiate Guidelines Network, Australias Clinical Practice Guidelines Portal, Trip Database y National Health Service Evidence. Como fuentes complementarias, se consultó UpToDate, Base de Datos BOT plus 2.0 y un tratado de Farmacología Humana. Resultados: Las recomendaciones se refieren al manejo del estreñimiento idiopático no complicado en pacientes sin síntomas de alarma e incluyen, como tratamiento de primera línea, el consumo de fibra o de agentes formadores de masa. En pacientes que no toleran los laxantes formadores de masa o responden mal a suplementos de fibra, se recomienda el uso de laxantes osmóticos. Por último, si no hay una respuesta satisfactoria, las recomendaciones incluyen los laxantes estimulantes. En pacientes hipertensos, debe tenerse en cuenta que el hidróxido de magnesio presenta potenciales interacciones con algunos fármacos antihipertensivos. Conclusión: La indicación farmacéutica incluye, como tratamiento de primera línea, suplementos de fibra o agentes formadores de masa. En quienes no los toleran o no responden satisfactoriamente, pueden recomendarse laxantes osmóticos o estimulantes
Introduction: Constipation in patients with arterial hypertension or diabetes is a frequent reason for consulting the pharmacist. The pharmaceutical indication should not interfere with the usual medication of these patients. Objectives: To make recommendations on pharmaceutical indication for patients with diabetes and / or hypertension who come to the pharmacy seeking pharmacological treatment for constipation. Material and methods: Through the systematic review of Clinical Practice Guidelines on the treatment of constipation, have been made recommendations on the pharmaceutical indication for patients with diabetes and/or hypertension who come to the pharmacy seeking pharmacological treatment. After having designed a search strategy, bibliographic sources were selected and it was carried out a data collection. The bibliographic search was done in the following web resources: Medline, GuíaSalud, National Guideline Clearinghouse, Canadian Medical Association Infobase, Scottish Intercollegiate Guidelines Network, Australias Clinical Practice Guidelines Portal, Trip Database and National Health Service Evidence. As complementary sources of data, UpToDate, Database BOT plus 2.0 and a treaty of Human Pharmacology were consulted. Results: Recommendations relate to the management of uncomplicated idiopathic constipation in patients without symptoms of alarm and include, as first-line treatment, the consumption of fiber or mass-forming agents. In patients who do not tolerate mass-forming laxatives or respond poorly to fiber supplements, the use of osmotic laxatives is recommended. Finally, if no satisfactory response, recommendations include stimulant laxatives. In hypertensive patients, it should be taken into account that magnesium hydroxide has potential interactions with some antihypertensive drugs. Conclusion: The pharmaceutical indication includes, as a first-line treatment, fiber supplements or mass-forming agents. In those who do not tolerate or do not respond satisfactorily, osmotic or stimulant laxatives may be recommended
