[Ultrasound-guided insertion and the proportion of catheter-associated thrombosis]. / Inserción con técnica ecoguiada y la proporción de trombosis asociada a catéter.

Background: Central venous accesses are of great importance in daily medical practice. Insertion into the jugular vein is common due to its accessibility. Catheter-associated venous thrombosis is a relatively common medium-term complication. The use of ultrasound to guide catheterization offers multiple advantages and promises to make vascular access installation a safer technique. Objective: To compare the proportion of catheter-associated jugular thrombosis when an anatomical landmark technique is used with respect to the ultrasound-guided technique. Material and methods: An observational, cross-sectional, and analytical study that compares the frequency of thrombosis when the ultrasound-guided technique was used concerning anatomical reference technique in patients in an intensive care unit. Results: A total of 91 patients were studied: in 44 an ultrasound-guided technique was used, and in 47 anatomical references. A single case of mural thrombosis (2.7%) was observed in the ultrasound-guided insertion group vs. 11 cases (23.4%) in the other group, resulting in a significant association between the anatomical reference insertion technique and thrombosis. Chi squared (1, n = 91) = 8.86, p = 0.004. Conclusion: The proportion of catheter-associated jugular thrombosis is greater when an anatomical reference technique is used compared to the ultrasound-guided technique.

Introducción: los accesos venosos centrales tienen mucha importancia en la práctica médica diaria. La inserción en la vena yugular es habitual debido a su accesibilidad. La trombosis venosa asociada a catéter es una complicación relativamente común y de mediano plazo. El empleo de la ecografía para guiar la inserción y la evaluación posterior del vaso sanguíneo ofrece múltiples ventajas y promete hacer de la instalación de accesos vasculares una técnica más segura. Objetivo: comparar la proporción de trombosis yugular asociada a catéter cuando se emplea una técnica de referencias anatómicas con respecto a la técnica de guía ecográfica. Material y métodos: estudio observacional, transversal y analítico que compara la frecuencia de trombosis yugular según la técnica de inserción utilizada en pacientes de una unidad de cuidados intensivos. Resultados: se estudiaron un total de 91 pacientes: en 44 se utilizó una técnica de guía ecográfica y en 47 se empleó referencia anatómica. Se observó un solo caso de trombosis mural (2.7 %) en el grupo de inserción por guía ecográfica frente a 11 casos (23.4%) del grupo por referencias anatómicas, con lo cual se obtuvo como resultado una asociación significativa entre la técnica de inserción por referencia anatómica y trombosis. Chi cuadrada (1, n = 91) = 8.86, p = 0.004. Conclusión: la proporción de trombosis yugular asociada a catéter es mayor cuando se emplea una técnica de referencias anatómicas con respecto a la técnica de guía ecográfica.

[Comparison of cervical fusion with autografting of fibula vs titanium cage]. / Comparación de artrodesis cervical mediante autoinjerto de peroné frente a caja de titanio.

Background: The anterior cervical discectomy and fusion (ACDF) is the gold standard in the treatment of cervical compression pathology and the titanium cage for fusion represents the most used procedure at an institutional level. A technique using fibular autograft has been described, with good results, lower morbidity and lower cost. Objective: To compare the rate of fusion, subsidence and functional clinical results after discectomy with titanium cage and fibular autograft. Material and methods: A clinical trial with follow-up at 3 and 6 months was carried out in patients diagnosed with cervical spondylosis, candidates for ACDF. 2 groups were formed: fibular autograft and titanium cage. Pre and post functional evaluation using the cervical disability score was made, as well as radiographic fusion and subsidence evaluation. Descriptive statistics, Fisher's exact test, t-test and ANOVA were obtained, establishing p < 0.05. Results: A sample of 20 patients with an average age of 56 years was obtained, finding a fusion rate of 90% for fibular autograft and 30% for titanium (p = 0.02) at 3 months. 10% of patients with fibular autograft presented subsidence and 70% with titanium cage at 3 and 6 months (p = 0.02). In the functional results was not found difference between both procedures (p = 0.874). Conclusions: The use of autologous fibular graft offers a better rate of fusion and subsidence compared to the titanium cage, as well as similar functional results at 3 months of follow-up. It represents an excellent treatment option for cervical spondylosis.

Introducción: la disectomía cervical anterior y fusión (ACDF) es el estándar de oro en el tratamiento de la patología compresiva cervical. La caja de titanio para artrodesis es el procedimiento más usado a nivel institucional. Se ha descrito una técnica con autoinjerto de peroné, con buenos resultados, menor morbilidad y menor costo. Objetivo: comparar la tasa de fusión, subsidencia y resultados clínicos funcionales posteriores a disectomía con caja de titanio y autoinjerto de peroné. Material y métodos: ensayo clínico con seguimiento a tres y seis meses en pacientes con diagnóstico de espondilosis cervical, candidatos a ACDF. Se formaron dos grupos: autoinjerto de peroné y caja de titanio. Se hizo evaluación funcional antes y después mediante la escala de discapacidad cervical, y evaluación de fusión y subsidencia radiográficas. Se usó estadística descriptiva, prueba exacta de Fisher, prueba t y ANOVA, estableciendo una p < 0.05. Resultados: se obtuvo una muestra de 20 pacientes con promedio de 56 años; hubo una tasa de fusión del 90% para autoinjerto de peroné y 30% para titanio (p = 0.02) a los tres meses. De los pacientes con autoinjerto de peroné, 10% presentaron subsidencia y un 70% con caja de titanio a los tres y seis meses (p = 0.02). No se encontró diferencia en los resultados funcionales a tres y seis meses de ambos procedimientos. Conclusiones: el uso de injerto autólogo de peroné ofrece mejor tasa de fusión y subsidencia en comparación con la caja de titanio, así como resultados funcionales similares a los tres meses. Es una excelente opción para tratar la espondilosis cervical.

[Mortality in patients with COVID-19 and acute kidney injury on hemodialysis]. / Mortalidad en pacientes con COVID-19 y lesión renal aguda en hemodiálisis.

Background: A high in-hospital mortality has been identified in patients with COVID-19 who develop acute kidney injury, particularly in those who received renal replacement therapy. In our country there are few studies up until now that report the proportion of deaths in this group of patients. Objective: To identify the proportion of deaths in patients with COVID-19 who developed acute kidney injury and required hemodialysis. Material and methods: an observational, descriptive, cross-sectional, retrospective study was carried out and the total population was studied. It included patients over 18 years of age who required dialysis, who received one or more sessions of conventional hemodialysis. The data were obtained from the electronic file and the registry of the hemodialysis unit. For the descriptive analysis, measures of central tendency were used and the proportion of deaths in patients with COVID-19 was calculated. Results: The study population was made up of 40 patients; the proportion of deaths was 86.1%. The average number of days elapsed from admission to the development of acute kidney injury and dialysis requirement was 5.2 days and the average number of hemodialysis sessions received was 1.7 sessions. Conclusions: In this study it was documented a high proportion of deaths in patients with COVID-19 who developed acute kidney injury and required renal replacement therapy, which coincides with similar studies reported internationally.

Advances in two-dimensional engineered nanomaterials applications for the agro- and food-industries.

Two-dimensional nanomaterials, such as graphene, transition metal dichalcogenides, MXenes, and other layered compounds, are the subject of intense theoretical and experimental research for applications in a wide range of advanced technological solutions, given their outstanding physical, chemical, and mechanical properties. In the context of food science and technology, their contributions are starting to appear, based on the advantages that two-dimensional nanostructures offer to agricultural- and food-related key topics, such as sustainable water use, nano-agrochemicals, novel nanosensing devices, and smart packaging technologies. These application categories facilitate the grasping of the current and potential uses of such advanced nanomaterials in the field, backed by their advantageous physical, chemical, and structural properties. Developments for water cleaning and reuse, efficient nanofertilizers and pesticides, ultrasensitive sensors for food contamination, and intelligent nanoelectronic disposable food packages are among the most promising application examples reviewed here and demonstrate the tremendous impact that further developments would have in the area as the fundamental and applied research of two-dimensional nanostructures continues. We expect this work will contribute to a better understanding of the promising characteristics of two-dimensional nanomaterials that could be used for the design of novel and feasible solutions in the agriculture and food areas. © 2023 Society of Chemical Industry.

Terapia de electroestimulación para el tratamiento de la atrofia diafragmática inducida por ventilación mecánica / Electrostimulation therapy for the treatment of diaphragmatic atrophy induced by mechanical ventilation / Terapia de eletroestimulação para o tratamento da atrofia diafragmática induzida por ventilação mecânica

Resumen: Introducción: La atrofia y disfunción del músculo diafragmático es frecuente en pacientes sometidos a ventilación mecánica. La terapia de electroestimulación diafragmática transcutánea (TEDT) ha demostrado mejorar la fuerza en pacientes con debilidad muscular; sin embargo, no ha sido evaluada como tratamiento para la atrofia en la disfunción diafragmática inducida por ventilación mecánica (DDIVM). Objetivo: Determinar si la TEDT puede mejorar el grosor diafragmático de los pacientes que se encuentran bajo ventilación mecánica. Material y métodos: Se realizó un ensayo clínico aleatorizado en dos grupos independientes: un grupo intervención con 15 pacientes y un grupo control con 17 pacientes. El grupo de intervención recibió TEDT con sesiones de 20 minutos cada seis horas en las 72 horas subsecuentes a su inclusión al estudio. El grosor diafragmático basal fue medido mediante ecografía en ambos grupos, después de la TEDT para el grupo intervención y 72 horas después en el grupo control. Resultados: De los 32 pacientes evaluados se documentó una media de grosor diafragmático inicial para el grupo control de 2.04 ± 0.43 mm y de 1.9 ± 0.52 mm para el grupo intervención con un valor de p = 0.652. Posterior a la intervención, se registró una media de grosor diafragmático final de 1.7 ± 0.43 mm para el grupo control y 2.3 ± 0.55 mm para el grupo intervención con un valor de p = 0.002 al comparar ambos grupos. Conclusión: Se encontró diferencia estadísticamente significativa en ambos grupos al aplicar la TEDT, evidenciando un aumento del grosor diafragmático basal en el grupo intervención y disminución del mismo en el grupo control.

Abstract: Introduction: Muscle involvement in critically ill patients is present in the majority of those admitted to the intensive care unit, including alteration of the diaphragmatic muscle, especially during mechanical ventilation (MV). Transcutaneous diaphragmatic electrostimulation therapy (TEDT) has been shown to improve respiratory strength in patients with muscle weakness. However, it has not been evaluated as a treatment for atrophy in Ventilation-Induced Diaphragmatic Dysfunction (DDIVM). Objective: To determine if TEDT can improve diaphragmatic thickness in patients undergoing mechanical ventilation. Material and methods: A randomized clinical trial was carried out in two independent groups: an intervention group with 15 patients and a control group with 17 patients. The intervention group received TEDT with sessions of 20 minutes every 6 hours in the 72 hours after their inclusion in the study. Baseline diaphragm thickness was measured by ultrasound in both groups, after TEDT for the intervention group and 72 hours later in the control group. Results: Of the 32 patients evaluated, a mean initial diaphragmatic thickness was documented for the control group of 2.04 ± 0.43 mm and of 1.9 ± 0.52 mm for the intervention group with a p value of 0.652. After the intervention, a mean final diaphragmatic thickness of 1.7 ± 0.43 mm was recorded for the control group and 2.3 ± 0.55 mm for the intervention group with a p value of 0.002 when comparing both groups. Conclusion: A statistically significant difference was found in both groups when applying TEDT, showing an increase in baseline diaphragmatic thickness in the intervention group and a decrease in it in the control group.

Resumo: Introdução: Atrofia e disfunção do músculo diafragmático é comum em pacientes submetidos à ventilação mecânica. A terapia de estimulação elétrica diafragmática transcutânea (TEDT) demonstrou melhorar a força em pacientes com debilidade muscular, mas não foi avaliada como tratamento para atrofia na disfunção diafragmática induzida pela ventilação (DDIVM). Objetivo: Determinar se a TEDT pode melhorar a espessura diafragmática de pacientes com ventilação mecânica. Material e métodos: Realizou-se um ensaio clínico randomizado em 2 grupos independentes: um grupo intervenção com 15 pacientes e um grupo controle com 17 pacientes. O grupo intervenção recebeu TEDT com sessões de 20 minutos a cada 6 horas por 72 horas após a inclusão no estudo. A espessura diafragmática basal foi medida por ultra-som em ambos os grupos, após TEDT para o grupo de intervenção e 72 horas depois no grupo controle. Resultados: Dos 32 pacientes avaliados, (17 grupo controle, 15 grupo intervenção). Documentou-se uma média da espessura diafragmática basal para o grupo controle de 2.04 ± 0.43 mm e 1.9 ± 0.52 mm para o grupo intervenção com um valor de p = 0.652. Após a intervenção, foi registrada uma espessura média final do diafragma de 1.7 ± 0.43 mm para o grupo controle e 2.3 ± 0.55 mm para o grupo intervenção, com valor de p = 0.002 na comparação entre os dois grupos. Conclusão: Encontrou-se diferença estatisticamente significativa em ambos os grupos na aplicação do TEDT, mostrando aumento da espessura basal do diafragma no grupo intervenção e diminuição da mesma no grupo controle.

Implementación del ultrasonido pulmonar en la UCI durante la pandemia de COVID-19 / Implementation of lung ultrasound in the ICU during the COVID-19 pandemic / Implementação do ultrassom pulmonar na UTI durante a pandemia de COVID-19

Resumen: El surgimiento del nuevo coronavirus SARS-CoV-2 está desafiando seriamente a la comunidad médica en prácticamente todo el mundo. La neumonía causada por COVID-19 tiene características peculiares y puede estudiarse mediante ultrasonografía pulmonar. La ecografía permite identificar el comportamiento de la infección y su progresión al lado de la cama del paciente. La técnica ha evolucionado considerablemente en los últimos años en lo que respecta a sus aspectos teóricos y operativos. En consecuencia, su aplicación clínica ha llegado a ser suficientemente conocida y generalizada en el contexto del paciente críticamente enfermo. Sugerimos la identificación de cuatro patrones en el ultrasonido pulmonar, los cuales permiten una mejor caracterización de la enfermedad. Debido a la sobredemanda de los servicios de salud en la actualidad, el conocimiento y aplicación de la ecografía pulmonar resulta de gran relevancia. Esta revisión incluye un enfoque práctico y proporciona un resumen de la evidencia para el uso e interpretación del ultrasonido pulmonar.

Abstract: The emergence of the novel coronavirus (SARS-CoV-2) is seriously challenging the medical community virtually the entire world. Pneumonia in COVID-19 has peculiar characteristics and can be studied by lung ultrasound. The ultrasound allows identifying the behavior of the infection and its progression at the bedside of the patient. The technique has evolved considerably in recent years in terms of its theoretical and operational aspects. Consequently, its clinical application has become sufficiently known and generalized in the context of the critically ill patient. We suggest the identification of 4 patterns on lung ultrasound which allow a better characterization of the disease. Due to the current demand for health services, the knowledge and application of lung ultrasound is highly relevant. This review includes a pragmatic approach and provides a summary of the evidence for the use and interpretation of lung ultrasound.

Resumo: O surgimento do novo coronavírus SARS-CoV-2 está desafiando seriamente a comunidade médica em praticamente todo o mundo. A pneumonia no COVID-19 tem características peculiares e pode ser estudada por ultrassom pulmonar. A ultrassonografia permite identificar o comportamento da infecção e sua progressão na beira do leito do paciente. A técnica evoluiu consideravelmente nos últimos anos em relação aos seus aspectos teóricos e operacionais. Consequentemente, sua aplicação clínica tornou-se suficientemente conhecida e generalizada no contexto do paciente crítico. Sugerimos a identificação de quatro padrões na ultrassonografia pulmonar, o que permite uma melhor caracterização da doença. Devido à demanda atual por serviços de saúde, o conhecimento e a aplicação da ultrassonografia pulmonar são altamente relevantes. Esta revisão inclui uma abordagem prática e fornece um resumo das evidências para o uso e a interpretação do ultrassom pulmonar.