Effects of rapid fluid infusion on hemoglobin concentration: a systematic review and meta-analysis.

BACKGROUND: Rapid fluid administration may decrease hemoglobin concentration (Hb) by a diluting effect, which could limit the increase in oxygen delivery (DO2) expected with a positive response to fluid challenge in critically ill patients. Our aim was to quantify the decrease in Hb after rapid fluid administration. METHODS: Our protocol was registered in PROSPERO (CRD42020165146). We searched PubMed, the Cochrane Database, and Embase from inception until February 15, 2022. We selected studies that reported Hb before and after rapid fluid administration (bolus fluid given over less than 120 min) with crystalloids and/or colloids in adults. Exclusion criteria were studies that included bleeding patients, or used transfusions or extracorporeal circulation procedures. Studies were divided according to whether they involved non-acutely ill or acutely ill (surgical/trauma, sepsis, circulatory shock or severe hypovolemia, and mixed conditions) subjects. The mean Hb difference and, where reported, the DO2 difference before and after fluid administration were extracted. Meta-analyses were conducted to assess differences in Hb before and after rapid fluid administration in all subjects and across subgroups. Random-effect models, meta-regressions and subgroup analyses were performed for meta-analyses. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. RESULTS: Sixty-five studies met our inclusion criteria (40 in non-acutely ill and 25 in acutely ill subjects), with a total of 2794 participants. Risk of bias was assessed as "low" for randomized controlled trials (RCTs) and 'low to moderate' for non-RCTs. Across 63 studies suitable for meta-analysis, the Hb decreased significantly by a mean of 1.33 g/dL [95% CI - 1.45 to - 1.12; p < 0.001; I2 = 96.88] after fluid administration: in non-acutely ill subjects, the mean decrease was 1.56 g/dL [95% CI - 1.69 to - 1.42; p < 0.001; I2 = 96.71] and in acutely ill patients 0.84 g/dL [95% CI - 1.03 to - 0.64; p = 0.033; I2 = 92.91]. The decrease in Hb was less marked in patients with sepsis than in other acutely ill patients. The DO2 decreased significantly in fluid non-responders with a significant decrease in Hb. CONCLUSIONS: Hb decreased consistently after rapid fluid administration with moderate certainty of evidence. This effect may limit the positive effects of fluid challenges on DO2 and thus on tissue oxygenation.

Pancoast Tumor as the Initial Presentation of a Metastatic Colon Adenocarcinoma.

A Pancoast tumor is a rare condition, representing 3% to 5% of all lung cancers. The particular location of these lesions leads to the invasion of structures in the thoracic inlet, causing a constellation of symptoms known as Pancoast-Tobias syndrome. Diagnosis can be challenging due to their low prevalence and the possibility of being asymptomatic. Most of these tumors are non-small cell lung cancers. However, rare conditions might arise at the same location, and histologic confirmation is relevant. We report the case of a 45-year-old man admitted to the internal medicine department with a one-month history of night sweats. A full-body computed tomography (CT) scan revealed a mass on the upper lobe of the left lung, with soft tissue invasion. Histopathologic examination revealed an adenocarcinoma pattern originating from the colon. Colonoscopy showed two synchronous lesions. Hitherto, this is the second case ever described of a Pancoast tumor as metastasis of colon adenocarcinoma.

Breve historia y fisiopatología del covid-19 / A brief history and pathophysiology of covid-19

PROPÓSITO: este artículo se realizó para contribuir con la difusión del conocimiento sobre el COVID-19 en la lengua hispana. HALLAZGOS: el SARS-CoV-2 fue descubierto en diciembre del 2019 y se difundió mundialmente desde entonces; el 11 de marzo de 2020 la OMS declaró globalmente estado de pandemia. Mientras fue incrementando la gravedad y frecuencia del COVID-19 en el mundo, la comunidad científica trabajó arduamente produciendo evidencia capaz de dilucidar los detalles de esta patología. Esta serie de artículos pretende agregar información lo más actualizada posible, interpretándola y adaptándola a la realidad boliviana. SUMARIO: la elaboración de este artículo está basado en información conocida sobre la historia de la aparición de esta nueva enfermedad e información vigente y actualizada sobre las características fisiopatológicas descritas en la literatura mundial