Subject(s)
COVID-19/complications , Cytokine Release Syndrome/therapy , Immunomodulation , Membranes, Artificial , SARS-CoV-2 , Adsorption , COVID-19/immunology , Cytokine Release Syndrome/etiology , Hemofiltration/instrumentation , Hemofiltration/methods , Humans , Isoelectric Point , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
No disponible
Subject(s)
Humans , Immunomodulation , Lymphohistiocytosis, Hemophagocytic/virology , Coronavirus Infections/drug therapy , Pneumonia, Viral/complications , Coronavirus Infections/complications , Pneumonia, Viral/drug therapy , Pandemics , Cytokines/immunology , Evidence-Based Medicine , Severity of Illness Index , Risk FactorsABSTRACT
Introducción: Los paradigmas de la hemofiltración para manejar pacientes críticos con una respuesta inflamatoria desregulada (RID) evalúan la función renal para su inicio, adaptación y finalización. Presentamos la Hiperfiltración Venosa Continua (Protocolo CONVEHY), en el cual una membrana de adsorción inespecífica (AN69-ST-heparina anclada) se utiliza con citrato como líquido anticoagulante y de sustitución. El protocolo CONVEHY utiliza herramientas fácilmente disponibles para lograr objetivos renales y no renales, guiándose por las respuestas fisiopatológicas. Objetivos: Comparar la respuesta a la membrana AN69-ST-HA cuando se utilizó heparina (He, n = 5: protocolo estándar) o citrato (Ci, n = 6: protocolo CONVEHY) para evaluar si fuera factible un estudio mayor sobre los beneficios de este protocolo. Materiales y métodos: En un estudio retrospectivo, se evaluaron los beneficios del protocolo CONVEHY en pacientes con RID en una unidad de cuidados críticos quirúrgicos (UCCq), evaluando las puntuaciones SOFA (He 11 +/- 2,35; Ci 11 +/- 3,63; p = 0,54) y APACHE II (He 28,60 +/- 9,40; Ci 24 +/- 8,46; p = 0,93). Resultados: Hospitalización (He 35,2 +/- 16,3 noches; Ci 9 +/- 2,53; p = 0,004), hospitalización tras el alta de UCCq (He 40,25 +/- 21,82; Ci 13,2 +/- 4,09; p = 0,063), pacientes hospitalizados > 20 días (He 80%; Ci 0%; p = 0,048), días con ventilación mecánica (He 16 +/- 5,66; Ci 4 +/- 1,72; p = 0,004) y la mortalidad predicha (55,39 +/- 26,13%) frente a la real en ambos grupos (9,1%; p = 0,004). Conclusiones: El protocolo CONVEHY mejora las respuestas clínicas de los pacientes con una RID, destacando el valor potencial de realizar estudios más grandes y confirmatorios
Introduction: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. Objectives: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. Materials and methods: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 +/- 2.35; Ci 11 +/- 3.63: p=0.54) and APACHE II (He 28.60 +/- 9.40; Ci 24 +/- 8.46: p=0.93) scores. Results: Nights in hospital (He 35.2 +/- 16.3 nights; Ci 9 +/- 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 +/- 21.82; Ci 13.2 +/- 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 +/- 5.66; Ci 4 +/- 1.72: p=0.004), and the predicted (55.39 +/- 26.13%) versus real mortality in both groups (9.1%: p=0.004). Conclusions: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies
Subject(s)
Humans , Systemic Inflammatory Response Syndrome/therapy , Hemofiltration/methods , Heparin/therapeutic use , Citric Acid/therapeutic use , Membrane Filters/methods , Anticoagulants/therapeutic use , Reperfusion Injury/complications , Prefiltration/methodsABSTRACT
INTRODUCTION: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. OBJECTIVES: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. MATERIALS AND METHODS: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 ± 2.35; Ci 11 ± 3.63: p=0.54) and APACHE II (He 28.60 ± 9.40; Ci 24 ± 8.46: p=0.93) scores. RESULTS: Nights in hospital (He 35.2 ± 16.3 nights; Ci 9 ± 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 ± 21.82; Ci 13.2 ± 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 ± 5.66; Ci 4 ± 1.72: p=0.004), and the predicted (55.39 ± 26.13%) versus real mortality in both groups (9.1%: p=0.004). CONCLUSIONS: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies.
Subject(s)
Anticoagulants/therapeutic use , Citrates/therapeutic use , Continuous Renal Replacement Therapy/methods , Inflammation/therapy , Membranes, Artificial , Postoperative Complications/therapy , APACHE , Adult , Case-Control Studies , Clinical Protocols , Continuous Renal Replacement Therapy/instrumentation , Critical Illness , Feasibility Studies , Fluid Therapy , Heparin/therapeutic use , Hospitalization/statistics & numerical data , Humans , Inflammation/etiology , Organ Dysfunction Scores , Pilot Projects , Postoperative Complications/etiology , Retrospective Studies , Sample Size , Surgical Procedures, Operative/adverse effectsABSTRACT
OBJECTIVES: Up to 20% of HIV-related focal brain lesion (FBL) diagnoses cannot be determined without invasive procedures. In such cases, brain biopsy is an important step in the evaluation algorithm. The aims of this study were to describe the clinical outcomes of patients with FBL, the proportion of diagnoses confirmed by brain biopsies and their aetiologies, and to analyse the proportion of patients in whom the biopsy motivated a change in therapeutic management. METHODS: A retrospective cohort study was performed. The data from clinical records of patients with HIV-related FBL admitted between January 2005 and December 2015 were reviewed. RESULTS: A total of 137 patients were included in the study. The median age was 39 years [interquartile range (IQR) 33-44.5 years]. The median CD4 count was 54 cells/µL (IQR 21-124 cells/µL). Cerebral brain biopsy was performed in 21.16% of patients (29 of 137); 68.9% of these individuals (20 of 29) were diagnosed by histology, with results of central nervous system (CNS) lymphoma in 20.6% (six of 29), progressive multifocal leucoencephalopathy in 6.8% (two of 29), toxoplasmosis in 6.8% (two of 29), tuberculoma in 6.8% (two of 29), and other diagnoses in 27.6% (eight of 29). In nine patients, the histology was nonspecific. In 75.8% of patients (22 of 29), the result of the biopsy led to a change in the therapeutic management. We did not observe higher rates of mortality related to the procedure. Overall mortality at 30 and 90 days was similar in patients who were and were not biopsied. CONCLUSIONS: In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Biopsy/methods , Brain Diseases/diagnosis , Brain/pathology , HIV Infections/complications , Histocytochemistry/methods , Lymphoma, AIDS-Related/diagnosis , Adult , Female , Humans , Male , Retrospective StudiesABSTRACT
La fístula arteriovenosa pial es una malformación congénita intracraneal infrecuente (0,1-1:100.000 habitantes). Presenta un alto flujo sanguíneo entre una o más arterias piales y un drenaje en la circulación venosa. Suele diagnosticarse durante la edad pediátrica al desencadenar un cuadro de hipertensión intracraneal y/o una insuficiencia cardiaca congestiva por shunt sistémico izquierda-derecha. Al ser poco frecuente y tener una fisiopatología compleja, su manejo perioperatorio anestésico no está bien establecido. Presentamos el caso de un lactante de 6 meses con fístula arteriovenosa pial con hipertensión intracraneal e insuficiencia cardiaca congestiva por shunt izquierda-derecha, que se sometió a craneotomía y pinzamiento de la malformación vascular. Las consideraciones anestésicas en pacientes con esta afección suponen un importante reto y deben realizarse por equipos multidisciplinares con experiencia en pediatría. Especial interés ocupa el manejo de la volemia durante el curso intraoperatorio, por exceso, para no precipitar una insuficiencia cardiaca congestiva o una hipertensión intracraneal, y por defecto, una hipoxia tisular por el sangrado (AU)
Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding (AU)
Subject(s)
Humans , Male , Infant , Arteriovenous Fistula/drug therapy , Arteriovenous Fistula/surgery , Arteriovenous Fistula , Fluid Therapy/instrumentation , Fluid Therapy/methods , Heart Failure/complications , Heart Failure/therapy , Angiography/instrumentation , Angiography/methods , Fentanyl/therapeutic use , Monitoring, Intraoperative/methods , Monitoring, Intraoperative , Cerebrum/pathology , Enalapril/therapeutic use , Fluid Therapy , CerebrumABSTRACT
Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.
Subject(s)
Arteriovenous Fistula/surgery , Fluid Therapy , Heart Failure/surgery , Arteriovenous Fistula/diagnosis , Cerebral Angiography , Craniotomy , Humans , Infant , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Pain Clinics , Pain Clinics/organization & administration , Nursing Assessment/ethics , Nursing Assessment/methods , Physician Assistants/education , Physician Assistants/standards , Patient Care Team/standards , Public Health/ethics , Public Health/methods , Pain Clinics/standards , Pain Clinics , Nursing Assessment/standards , Nursing Assessment , Physician Assistants/psychology , Physician Assistants , Patient Care Team/classification , Public Health , Public Health/standardsABSTRACT
PURPOSE: Granule cells pathology in dentate gyrus, have received considerable attention in terms of understanding the pathophysiology of temporal lobe epilepsy with hippocampal sclerosis. The aim of this study was to determine the nestin (an intermediate filament protein expressed by newly formed cells), immunoreactivity (IR) in granular cells layers of hippocampal tissue extirpated during epilepsy surgical procedure, in patients with drug-resistant epilepsy. METHODS: Hippocampal sections of 16 patients with hippocampal sclerosis and drug-resistant temporal lobe epilepsy were processed using immunoperoxidase with antibody to nestin. Archival material from 8 normal post-mortem hippocampus, were simultaneously processed. Reactive area for nestin-IR, the total number of positive nestin cells per field (20×), and the MGV (mean gray value) was determined by computerized image analysis (ImageJ), and compared between groups. Student's t test was used for statistical analysis. RESULTS: Nestin-IR cells were found in granule cells layers of both controls and patients. Larger reactive somas (p < 0.01) were found in epileptic's sections but a significant reduction in the total number of nestin-IR cells per field and in the MGV was found in granular cells layers of patients with hippocampal sclerosis (p < 0.01). CONCLUSION: Reduced expression of nestin-IR in granular cells layers of epileptic's dentate gyrus may reflect changes in dentate gyrus neuroplasticity associated to chronic temporal epilepsy with hippocampal sclerosis. Further studies are required to determine the clinical implications on memory an emotional alterations such as depression.
Subject(s)
Dentate Gyrus/metabolism , Dentate Gyrus/pathology , Drug Resistant Epilepsy/pathology , Epilepsy, Temporal Lobe/pathology , Nestin/metabolism , Adult , Diagnosis , Electroencephalography , Epilepsy, Temporal Lobe/complications , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Sclerosis/etiology , Young AdultSubject(s)
Humans , Female , Pregnancy , Fentanyl/therapeutic use , Parturition , Anesthesia, Caudal/methods , Anesthesia, Caudal , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Epidural Space , Anesthesia, Epidural/standards , Anesthesia, Epidural , Labor, Obstetric , Anesthesiology/methodsABSTRACT
The occurrence of crossed aphasia as a complication after temporal lobe epilepsy surgery is extremely rare. We report the case of a 47-year-old right-handed patient with drug-resistant mesial temporal lobe epilepsy (MTLE) who developed a transitory aphasic syndrome after a right temporal anterior lobectomy. This syndrome was characterized by anomia, poor verbal fluency, verbal perseveration, and verbal comprehension difficulties. He also showed writing difficulties, reading substitutions, and calculation task errors. The patient was regularly assessed with language tasks, and showed a spontaneous and progressive recovery of his symptoms, with remaining naming difficulties. We discuss the role that epileptogenic zone could play in cortical reorganization of the language systems.
Subject(s)
Anterior Temporal Lobectomy/adverse effects , Aphasia/etiology , Postoperative Complications/physiopathology , Epilepsy, Temporal Lobe/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological TestsSubject(s)
Asthma/microbiology , Manufactured Materials/microbiology , Mucor/pathogenicity , Occupational Diseases/microbiology , Adult , Alveolitis, Extrinsic Allergic/diagnosis , Alveolitis, Extrinsic Allergic/immunology , Alveolitis, Extrinsic Allergic/microbiology , Asthma/diagnosis , Asthma/drug therapy , Asthma/prevention & control , Eosinophilia/diagnosis , Eosinophilia/immunology , Humans , Male , Occupational Diseases/diagnosis , Poaceae/microbiology , Skin Tests/methodsABSTRACT
No disponible
Subject(s)
Humans , Acupuncture Analgesia/history , Acupuncture Analgesia/methods , Acupuncture Analgesia/trends , Acupuncture/trends , Migraine Disorders/epidemiology , Pain/epidemiology , Socioeconomic Factors , 24436Subject(s)
Anesthesia, Local , Hemangioma, Cavernous/complications , Neoplasms, Multiple Primary/complications , Neoplastic Syndromes, Hereditary/complications , Nevus, Blue/complications , Rectal Fistula/surgery , Adult , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Blood Coagulation Disorders/genetics , Case Management , Contraindications , Genetic Predisposition to Disease , Hemangioma, Cavernous/genetics , Humans , Male , Mepivacaine/administration & dosage , Neoplasms, Multiple Primary/genetics , Neoplastic Syndromes, Hereditary/genetics , Nevus, Blue/genetics , Preanesthetic Medication , Preoperative Care , Rectal Fistula/complications , Subarachnoid SpaceABSTRACT
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Subject(s)
Humans , Male , Adult , Anemia, Iron-Deficiency/complications , Vascular Neoplasms/complications , Anesthesia/methods , Intraoperative Care/methods , Nevus, Blue/pathology , Vascular Neoplasms/pathology , Hemangioma, Cavernous/pathologyABSTRACT
No disponible
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Subject(s)
Male , Adult , Humans , Abdomen, Acute/etiology , Cecal Diseases/diagnosisABSTRACT
El síndrome de DiGeorge es un defecto heterogéneo relacionado con una embriogénesis anormal de la tercera y la cuarta bolsa faríngea. Los pacientes con esta anomalía suelen presentar alteraciones en el timo, que conducen, en muchos casos,a una deficiencia en la respuesta de las células T, así como a alteraciones cardiacas, hipocalcemia, hipoparatiroidismo, dimorfismo facial y retraso psicomotor. En la mayorfa de los casos, se ha identificado como responsable de esta anomalía la deleción 22q11.2, que comprende genes como el UFD1L ,TBX1y CRKL que se muestran como firmes candidatos a estar asociados con esta enfermedad. Sin embargo, existe una gran variabilidad en las alteraciones que aparecen en los distintos individuos con esta alteración cromosómica. La gravedad de la inmunodeficiencia observada en estos pacientes varia entre una función de células T similar a la de los individuos sanos a una ausencia total de células T en circulación. En estos casos de anomalía de DiGeorge completa, se ha demostrado que distintos tratamientos como el trasplante de médula ósea, de tejido tímico e incluso la infusión de células mononucleares de sangre periférica pueden reconstituir de forma eficaz el sistema inmunitario ofreciendo una protección frente a las infecciones oportunistas que pueden sufrir estos individuos inmunodeficientes
DiGeorge syndrome is a heterogeneous condition associated with an abnormal embryogenesis of the third and fourth pharyngeal pouches, which usually affects the thymus, in manycases, leading to impaired T-cell response. It can algo be associated with cardiac defects, hypocalcemia, hypoparathyroidism, facial dysmorphism and psychomotor retardation. In most cases, it is attributed to a deletion of 22q11.2, which includes genes like UFD1L , TXB1 and CRKL which are very probably associated with the disease. However, the anomalies produced by this chromosomal alteration very widely from one individual to another. The severity of the immunodeficiency observed in these patients ranges from a T-cell function similar to that of normal individuals to a total absence of circulating T-cells. In these cases of complete DiGeorge syndrome, different approaches such as bone marrow or thymic tissue transplantation, or even peripheral blood mononuclear cell infusion, have been shown to effectively reconstitute the immune system, providing protection against the opportunistic infections to which these immunodeficient patients may be subjected
Subject(s)
Male , Female , Child , Humans , DiGeorge Syndrome/genetics , Chromosome Deletion , Heart Defects, Congenital/etiology , Facies , Immunologic Deficiency Syndromes/etiology , Cleft Palate/etiology , Hypocalcemia/etiology , Hypoparathyroidism/etiology , Psychomotor Disorders/etiology , Cell Transplantation , Bone Marrow TransplantationABSTRACT
The objective of this study was to monitor the changes in the immune system of HIV-infected children with moderate or severe immunodeficiency after highly active antiretroviral therapy (HAART), comprising a follow-up study in 14 HIV-infected children on HAART at two time points separated approximately by 11.8 +/- 0.4 (9.9; 15.4) months. HIV-infected children had significantly lower TREC levels than the control group, but 1 year after HAART the levels increased significantly (P < 0.05). In contrast, viral load (VL) did not change significantly. A positive correlation between T cell receptor excision circle (TREC) levels and both CD4(+) T cell absolute counts (r = 0.558; P = 0.05) and percentages (r = 0.625; P = 0.030) was found. During follow-up on HAART, the percentages and absolute counts of naive CD4(+) and CD8(+) T cell subsets were increased significantly (P < 0.05). CD4(+) CD45RA(hi+) CD62L(+), CD4(+) CD45RA(+) and CD4(+) CD38(+) percentages, and the CD8(+) CD45RA(hi+) CD62L(+) counts reached similar values to the control group. Also, CD8(+) CD45RO(+) CD38(+) and CD8(+) CD45RO(+) percentages, and CD8(+) CD45RO(+) CD38(+) absolute counts (P < 0.05) decreased with respect to the baseline. Lymphoproliferative responses to pokeweed mitogen (PWM) before HAART were lower in HIV-infected children than the control group, but they recovered to normal levels after a year on HAART. Tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma production by PHA-activated peripheral blood mononuclear cells (PBMC) was lower before HAART (P < 0.001), but reached similar levels to the control group 1 year after HAART. In HIV-infected children IgG, IgG(1) and IgG(3) plasma levels decreased significantly after HAART. The immune system reconstitution induced by HAART in HIV-infected children seems to be the consequence of decreased immune system activation and naive T cell reconstitution, mainly of thymic origin.
