Mammalian Target of Rapamycin Inhibitors Vs Calcineurin Inhibitors in Chronic Graft Rejection After Lung Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: The number of lung transplantations has been rising constantly. However, use of this therapeutic resource is limited by several issues that are difficult to resolve, such as chronic graft rejection and complications secondary to immunosuppression. METHODS: This systematic review compared mammalian target of rapamycin (mTOR) inhibitor immunosuppression associated with low-dose calcineurin inhibitors with isolated calcineurin inhibitor immunosuppression on the new-onset chronic rejection development and mortality 12 months after lung transplantation. Three controlled randomized clinical trials (SHITRIT, NOCTET, and 4EVERLUNG) were selected from electronic databases. RESULTS: Meta-analysis of the data at 12 months postintervention showed that only 4EVERLUNG assessed chronic graft rejection, with a higher incidence in the control group; however, the difference was not statistically significant (P = .197). Significant data were related to an increase in the number of adverse events (P = .0064) and improved renal function (P < .0001) in the mTOR inhibitor-based scheme. The other outcomes indicated a trend toward greater risk of death and acute graft rejection with the use of mTORs. CONCLUSIONS: The researchers suggest considering the use of mTOR inhibitors, whose greatest benefit is felt by patients with renal dysfunction, in association with the use of calcineurin inhibitors, because of the imminent risk of death among patients with renal failure.

Aspectos práticos indicações e técnicas de implante de marcapasso provisório / Pratical aspects, indications and techniques of implantation of pacemaker

As indicações da estimulação cardíaca temporária são apresentadas em várias situações de infarto agudo, pós operatório de cirurgia cardíaca, pré operatório em geral, intoxicações medicamentosas e processos inflamatórios, entre outras.A técnica de estimulação é classificada em cinco tipos: cutânea-torácica, esofágica, miocárdica percutânea, epicárdica, descrevendo-se os procedimentos e os detalhes tático-técnicos.A utilização do marcapasso externo com a determinação dos limiares de estimulação e sensibilidade, a programação a ser establecida do gerador e os cuidados e condutas a serem tomados durante sua utilização são explicados.A vantagem da estimulação com sincronismo atrioventricular, apresentando-se o cabo elétrodo temporário quadripolar desenvolvido para estimulação VDD ou DDD, é ressaltada