Convalescent Plasma as Adjunctive Therapy for Hospitalized Patients with COVID-19: The Co-CLARITY Trial.

Background and Objective: Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods: In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results: A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions: Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Influence of Milling Parameters on Mechanical Properties of AA7075 Aluminum under Corrosion Conditions.

The paper describes an experimental study developed on the AA7075 T651, which is an aluminum alloy extensively used in the aeronautical industry. This work presents a double approach of investigation where there is no literature about previous research. This includes the analysis of the results obtained by the combination of mechanical and chemical actions on the mechanical properties of this material. On the one hand, the combinations of relevant milling parameters (feed rate, cutting speed) on flat samples (flat specimens have been selected by attempting to reproduce with the most accurate way the geometry and the type of machining process known as face milling is usually used in this manufacturing field). On the other hand, the stimulating effect of the corrosion by salt spray on selected batches of specimens was machined in the previous stage. Results from tensile tests performed on the whole of specimens allowed us to evaluate how the main mechanical properties (yield strength, tensile strength, and elongation at break) have been affected by the processes applied. Elongation at the break presents a reduction in an inverse order to feed a rate increase (up to 24.5%) and this reduction is extended (additional 19.17%) in specimens under corrosion conditions, which results in a greater fragility of the material.

Percepción de la relación anestesiólogo-paciente valorada en el posoperatorio de pacientes ASA I y II en instituciones de nivel III y IV (estudio RAP-2) en Cali, Colombia / Perception about the anesthesiologist-patient relationship assessed during the post-operative of ASA I and II patients at level III and IV institutions (RAP-2 trial) in Cali, Colombia

Contexto:La consulta preanestésica es frecuentemente el momento para establecer la relación anestesiólogo-paciente. Es usual que los pacientes recuerden a su cirujano, pero no a su anestesiólogo, o la importancia que este tiene en su cuidado perioperatorio. El objetivo de este trabajo fue analizar la percepción actual de los pacientes ambulatorios (ASA I y II) en el posoperatorio inmediato sobre la relación anestesiólogo-paciente mediante una encuesta de opinión. Diseño:Estudio descriptivo multicéntrico de corte transversal realizado en 4 instituciones de salud entre agosto de 2011 y mayo de 2012. Palabras clave: Anestesiología Periodo perioperatorio Servicios de Salud Satisfacción del paciente Anestesia Métodos:Se aplicaron 340 encuestas a sujetos adultos programados para cirugía ambulatoria, ASA I y II con Aldrette de 10 en recuperación, antes del alta. Resultados:Solo un 74,1% de las personas reconocía a su anestesiólogo como un médico especialista. El 21,2% desconocía la formación profesional real de este. El 99% de los pacientes refirió como agradable que quien realizó su valoración preoperatoria fuera el mismo que estuviera en su cirugía, pero esta situación se dio solamente en un 35% de los casos. Conclusiones: A pesar de la alta satisfacción de los pacientes ambulatorios sobre su cuidado anestésico, se requieren estrategias para fortalecer la percepción que tienen sobre nuestra especialidad. La relación anestesiólogo-paciente no debería limitarse solamente a la ejecución de la valoración preoperatoria y del procedimiento quirúrgico; adicionalmente deberían incluir espacios que poco se abordan. Es indispensable un mayor acercamiento a la comunidad para dar a conocer el papel del anestesiólogo y su contribución preponderante al cuidado y la seguridad del paciente.

Background:The preoperative visit is often the time to establish the anesthesiologist-patient relationship (APR). Frequently patients remember their surgeon but fail to remember who their anesthesiologist was and his/her key role in perioperative care. Using an opinion survey, the aim of this study was to analyze the current perception of outpatients (ASA I and II) about the APR during the immediate postoperative period. Design: Descriptive cross-sectional multicenter trial including four healthcare institutions between August 2011 and May 2012. Methods: 340 surveys were administered to ASA I and II adult subjects scheduled for outpa-tient surgery, with Aldrette recovery score of 10 prior to discharge. Results:Only 74.1% of the people acknowledged their anesthesiologist as a specialized physician. 21.2% were unaware of the professional trainingrequired to become an anesthe-siologist and 99% of the patients said that it was gratifying to have the doctor who did the preoperative evaluation in the OR; however this only occurred in 35% of the cases. Conclusions:Notwithstanding the high level of outpatient satisfaction with their anesthetic care, some strategies are required to strengthen their perception about the specialty. The APR a preoperative evaluation for the surgical procedure, but should be more comprehen-sive. There is a need to establish closer links with the community to create awareness about the role of the anesthesiologist and his/her outstanding contribution to the patient's care and safety.

Experiencia con el fijador articulado en el manejo de la inestabilidad severa del codo / Elbow external fixator for management severe instability

Objetivo: describir la experiencia de los últimos 7 años con fijadores articulados utilizados en el manejo del trauma severo de codo, posterior a la liberación de contracturas articulares y en luxaciones abandonadas. Materiales y métodos: se realizó un estudio descriptivo retrospectivo tipo serie de casos de pacientes a quienes se les colocó un fijador articulado de codo entre los años 2000 y 2007. Se revisaron las historias clínicas de 20 pacientes y se registraron los datos en un formulario diseñado para tal fin. Al final del tratamiento se aplicó el índice funcional para codo de la Clínica Mayo para realizar una evaluación objetiva. Resultados: el tiempo promedio con el fijador fue de 3,2 meses (0,7 a 9). Once pacientes asistieron al último control y se les aplicó el índice funcional encontrando los siguientes resultados: excelente en el 63,6% de los casos, bueno en el 27,2% y regular en el 9%. Los arcos de movilidad articular pasaron en promedio de 35,4 a 84,8º y de 70,8º a 133º en flexoextensión y en pronosupinación respectivamente. Trece pacientes requirieron uno o varios procedimientos complementarios durante la colocación del fijador. En 7 pacientes (35%) se presentaron complicaciones; la más frecuente fue la infección en el tracto de los clavos (osteítis). Conclusiones: el fijador articulado de codo proporciona una alternativa viable para el manejo de lesiones complejas agudas o crónicas y como protección de los tejidos blandos cuando se realiza liberación de contracturas. La ventaja del fijador, al tener un diseño acorde con la biomecánica de la articulación, es que permite un inicio temprano de la movilidad.

Artrodesis de rodilla y alargamiento óseo simultáneo / Knee arthroplasty with concomitant bone lengthening

Objetivo: describir la artrodesis de rodilla con un alargamiento óseo simultáneo usando fijadores externos como un procedimiento adecuado de salvamento. Materiales y métodos: se realizó un estudio descriptivo retrospectivo tipo serie de casos con pacientes manejados en el Hospital Universitario del Valle y el Centro Médico Imbanaco, a quienes se les practicó una artrodesis de rodilla empleando fijadores externos entre los años 2001 y 2007. Se seleccionaron las historias clínicas de 18 pacientes que presentaron defectos óseos mayores de 5 cm que requirieron alargamiento o transporte óseo simultáneo para recuperar la longitud de la extremidad. Los pacientes llenaron la encuesta SF-36 v2 en español, para evaluar funcionalidad y calidad de vida al final del tratamiento. Resultados: la fusión ósea de la artrodesis se alcanzó en todos los pacientes (100%); en 2 pacientes se suspendió el alargamiento óseo porque no toleraron la fijación externa. El tiempo promedio con el fijador fue de 11 meses. El promedio de alargamiento fue de 7,8 cm (1-13 cm). El índice de consolidación del regenerado fue de 1,2 meses/cm (0,8-3). Con el SF-36 v2 se obtuvieron valores por encima de 50 puntos en 4 de las 8 dimensiones, en especial en la salud general y el dolor corporal. Conclusiones: la artrodesis de rodilla con alargamiento óseo simultáneo es un procedimiento de salvamento adecuado ante lesiones complejas del miembro inferior y se convierte en una alternativa a la amputación. La osteogénesis por distracción es útil cuando se realiza una artrodesis de rodilla porque permite tener una extremidad con una longitud óptima y funcional, mejorando la calidad de vida de los pacientes.

Estudio de la actividad antisecretora de ácido gástrico del cannabis sativa en un modelo animal / Study of the gastric acid anti-secretory activity of cannabis sativa in an animal model

Introducción: Hay pocos estudios que describan el efecto de los cannabinoides en el sistema gástrico, pues en sólo uno se encontró referencia a alteraciones del pH gástrico. Objetivo: Determinar el efecto antisecretor de la especie Cannabis sativa. 4 Metodología: Se utilizaron 45 ratas Sprague Dawley que se sometieron a un ayuno de 24 horas, al cabo del cual se les ligó el píloro durante 2 ó 4 horas según el grupo experimental. Luego, se anestesiaron, se extirparon los estómagos y se analizó el contenido gástrico en términos de volumen y pH. Resultados: Se encontró que el extracto de Cannabis aumentó el pH gástrico con respecto al grupo control (p <0.05), sin hallar diferenciassignificativas entre el fármaco de referencia (ranitidina) y el extracto de Cannabis (p >0.05). El volumen medido no mostró diferencias entre los grupos. Conclusiones: Estos resultados, sugieren que el extracto de Cannabis sativa disminuye la secreción de ácido en el estómago.

Introduction: There are few studies that describe the effects of cannabinoids in the gastric system, although in only one, there was the description of a gastric pH alteration. Objective: To determine the anti-secretory effect of the species Cannabis sativa. Methodology: In this study forty five Sprague Dawley rats were used, they were submitted to a 24 hours fasting period, after which the pylorus was ligated for 2-4 hours, according to the experimental group. Thereafter, the rats were anesthetized, their stomachs extirpated and the gastric content analyzed for volume and pH. Results: The Cannabis extract raised the gastric pH when compared to the control group (p <0.05), with no significant differences found between the reference drug (ranitidine) and the Cannabis extract (p >0.05). There were no differences in the measured volumes. Conclusions: These results suggest that the Cannabis sativa extract diminishes the gastric acid output.