Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies.

Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.

Autoimmune diseases in the intensive care unit. An update.

Autoimmune diseases (ADs) are a challenge at the intensive care unit. The management of patients with these diseases in the critical care setting has improved over time since there are new and more aggressive alternatives to treat and diagnose them. We aimed to review the current causes of admission, clinical features, outcomes and variables associated with mortality of patients with ADs admitted to the intensive care unit (ICU). International classification criteria for ADs were used to include patients. Search was done through PubMed, SCOPUS, SciELO, and LILACS databases up to December of 2011.Twenty-nine case series and forty-one case reports were analyzed after quality assessment. Respiratory involvement was the leading cause of admission. Systemic lupus erythematosus (SLE) (33.5% of reported patients), rheumatoid arthritis (25%) and systemic vasculitis (15%) were the most frequent ADs in patients admitted to the ICU in the last decade. Mortality ranged from 17% to 55% in case series including all ADs, but in the ones that only included patients with a specific AD, such as SLE, it reached up to 79%. High APACHE score, multi-organ dysfunction, older age and cytopenia were the most reported variables associated with mortality. In conclusion, ADs should always be considered in patients with life threatening conditions that warrant critical care. Variables influencing mortality should be promptly identified in order to improve the patients' outcomes.

Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity.

A large number of autoimmune diseases (ADs) are more prevalent in women. The more frequent the AD and the later it appears, the more women are affected. Many ideas mainly based on hormonal and genetic factors that influence the autoimmune systems of females and males differently, have been proposed to explain this predominance. These hypotheses have gained credence mostly because many of these diseases appear or fluctuate when there are hormonal changes such as in late adolescence and pregnancy. Differences in X chromosome characteristics between men and women with an AD have led researchers to think that the genetic background of this group of diseases also relates to the genetic determinants of gender. These hormonal changes as well as the genetic factors that could explain why women are more prone to develop ADs are herein reviewed.

Lutzomyia antunesi, probable vector de leishmaniasis cutánea en el área rural de Villavicencio / Lutzomyia antunesi as suspected vector of cutaneous leishmaniasis in the Orinoquian region of Colombia

Objetivo Definir los posibles vectores de leishmaniasis, teniendo en cuenta su abundancia e infección natural con Leishmania spp. en un área endémica de la zona rural de Villavicencio, Meta. Materiales y Métodos En la vereda La Reforma, donde se presentaron casos de leishmaniasis cutánea en caninos y humanos, se recolectaron con trampas CDC los flebótomos en el intra, peri y extradomicilio de 15 viviendas. Grupos de 1 a 3 hembras de la misma especie fueron procesados por PCR para la detección de parásitos de Leishmania spp. Resultados Se capturaron 1 304 flebótomos distribuidos en 9 especies de las cuales L. antunesi (75,6 por ciento) y L. walkeri (19,2 por ciento) fueron las más abundantes. Otras especies reconocidas como antropofílicas (L. panamensis y L. gomezi), se presentaron con abundancias muy bajas (< 2,4). La PCR detectó infección con Leishmania spp. en dos grupos de L. antunesi (total= 123 hembras procesadas). Conclusiones L. antunesi por su abundancia e infección natural con Leishmania spp. podría estar involucrada en la transmisión de la leishmaniasis cutánea en un área rural al suroeste del municipio de Villavicencio.

Objective Identifying probable cutaneous leishmaniasis vectors in a rural area a few kilometres from the city of Villavicencio, taking the relative abundance of sand-flies and their natural infection with Leishmania spphaving into account. Materials and Methods A CDC trap was used for sampling sand-flies in and around 15 dwellings. Pools of three females from the most abundant Lutzomyia species were used for identifying Leishmania spp. by PCR, with OL1 and OL2 primers. Results 1 304 sand-flies from nine species were captured, of which L. antunesi (75,6 percent) and L. walkeri (19,2 percent) were the most abundant. These was a low abundance of L. panamensis and L. gomezi anthropophilic species (<2,4 percent). PCR detected Leishmania spp. infection in two L. antunesi groups (total=123 processed females). Conclusions Due to the fact that L. antunesi was the most abundant species and was found to have Leishmania infection, it may be considered to be the main suspected cutaneous leishmaniasis vector in the rural area being studied. It is recommended that detailed studies of this species’ biology (including biting and resting behaviour) should be carried out, aimed at furthering vector control measures.

[Lutzomyia antunesi as suspected vector of cutaneous leishmaniasis in the Orinoquian region of Colombia]. / Lutzomyia antunesi, probable vector de leishmaniasis cutánea en el area rural de villavicencio.

OBJECTIVE: Identifying probable cutaneous leishmaniasis vectors in a rural area a few kilometres from the city of Villavicencio, taking the relative abundance of sand-flies and their natural infection with Leishmania spphaving into account. MATERIALS AND METHODS: A CDC trap was used for sampling sand-flies in and around 15 dwellings. Pools of three females from the most abundant Lutzomyia species were used for identifying Leishmania spp. by PCR, with OL1 and OL2 primers. RESULTS: 1 304 sand-flies from nine species were captured, of which L. antunesi (75,6 %) and L. walkeri (19,2 %) were the most abundant. These was a low abundance of L. panamensis and L. gomezi anthropophilic species (<2,4 %). PCR detected Leishmania spp. infection in two L. antunesi groups (total=123 processed females). CONCLUSIONS: Due to the fact that L. antunesi was the most abundant species and was found to have Leishmania infection, it may be considered to be the main suspected cutaneous leishmaniasis vector in the rural area being studied. It is recommended that detailed studies of this species' biology (including biting and resting behaviour) should be carried out, aimed at furthering vector control measures.