Aspectos clínicos del tratamiento de la hiperglucemia no complicada en la unidad de cuidados intensivos / Clinical aspects of the treatment of uncomplicated hyperglycemia in the intensive care unit

Resumen Introducción: La glucosa es una variable dinámica en el paciente crítico. La hiperglucemia (mayor a 140 mg/dL) es frecuente en este grupo de pacientes, existiendo distintos enfoques terapéuticos para el control adecuado de la misma. Objetivo: Revisar los aspectos clínicos de la glucemia y la importancia del control glucémico en el paciente crítico adulto. } Metodología de búsqueda: En base de datos Pubmed, utilizando los términos MeSH: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Se incluyeron artículos de revisión y originales, en inglés y español. Conclusiones: El manejo de la hiperglucemia en el paciente crítico es un objetivo primordial en el enfoque integral del paciente de la unidad de cuidados intensivos, dada su asociación con mortalidad, morbilidad y estancia hospitalaria. MÉD. UIS.2020;33(2): 49-54.

Abstract Introduction: Glucose is a dynamic variable in the critically ill patient. Hyperglycemia (greater than 140 mg/dL) is frequent in this group of patients, and there are different therapeutic treatments for its adequate control. Objectives: To evaluate the clinical aspects of glycemia and the importance of glycemic control in the critically ill adult patient. Methodology: Search in Pubmed database using the MeSH terms: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Original and review articles are included, in English and Spanish. Conclusions: The management of hyperglycemia in the critically ill patient is a primary objective in the comprehensive approach of the patient in the intensive care unit due to its association with mortality, morbidity and hospital stay.MÉD.UIS.2020;33(2): 49-54.

Long-term survival after intraperitoneal chemotherapy with paclitaxel-cisplatin for recurrent primary peritoneal cancer resistant to multiple lines of intravenous chemotherapy.

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.

Long-term survival after intraperitoneal chemotherapy with paclitaxel-cisplatin for recurrent primary peritoneal cancer resistant to multiple lines of intravenous chemotherapy

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.

Terapia intraperitoneal paliativa en ascitis maligna fîlcrossMark refractaria / Intraperitoneal palliative therapy in refractory malignant ascites

Resumen El tratamiento convencional de la ascitis maligna refractaria es un reto oncológico pues provee mejoría sintomática poco duradera. La terapia intraperitoneal ha sido evaluada principalmente en reportes y series de casos, y en algunos ensayos clínicos, estudiados principalmente en la ascitis por cáncer ovárico y gastrointestinal. Esta terapia incluye: isótopos radioactivos, quimioterapia con hipertermia y sin esta, terapia inmunológica, biológica y otras. Los tratamientos más exitosos con respuestas variables, y aunque la comparación directa no es posible, son: la quimioterapia intraperitoneal hipertérmica (respuesta global entre 85,7% y 100%) y el catumaxomab, que frente a la paracentesis demostró una supervivencia libre de punción de 46 vs 11 días (HR 0,254) y una mediana a la próxima paracentesis de 77 vs 13 días (HR 0,169), con impacto positivo en la calidad de vida, principal fin en el escenario paliativo. La investigación en este campo continúa buscando resultados más duraderos, seguros y costo-efectivos.

Abstract Conventional treatment of refractory malignant ascites is an oncological challenge since it provides little lasting symptomatic improvement. Intraperitoneal therapy, evaluated mainly through series and case reports, and some clinical trials include the use of radioisotopes, chemotherapy, with and without hyperthermia, immunological and biological therapy and others. It has been studied mainly in ascites from ovarian and gastrointestinal cancer. With variable response rates, and although direct comparison is not possible, the most successfully treatments are hyperthermic intraperitoneal chemotherapy (overall response rate between 85.7% and 100%), and catumaxomab, which compared to paracentesis, demonstrated a puncture-free survival of 46 vs. 11 days (HR 0.254) and a median time to next paracentesis of 77 vs. 13 days (HR 0.169). This had a positive impact on quality of life, which is the main goal in the palliative setting. Research in this field continues looking for more lasting, safe, and cost-effective results.

[Altered orientation and aggressiveness in an 89-year-old woman]. / Wechselnde Vigilanz und Fremdaggressivität bei einer 89­jährigen Patientin.

An 89-year-old woman with Alzheimer's dementia was admitted because of altered orientation, aggressiveness and inability to take care of herself at home. Her patient history indicated that 14 days ago the battery of the pacemaker had be renewed. During that time the patient suffered from psychomotor alterations. Therefore, melperone had been initiated. Inspection of the urine and laboratory findings pointed towards an acute exacerbation of acute intermittent porphyria as a possible cause of the delirium. After discontinuation of melperone with additional parenteral therapy with physiological fluids, the signs of delirium significantly improved.

Clinical observation of growth hormone intrauterine perfusion combined with replacement cycle in the treatment of thin endometrium / 中国医师杂志

Objective To investigate the effects of the frozen embryo transplantation for patients with poor outcome of endometrial growth by using growth hormone (GH) intrauterine perfusion combined with replacement cycle in the treatment of thin endometrium.Methods This was a prospective study and study participants were consecutively recruited between Jun 2014 and September 2015.A total of 88 frozen thawed embryo transfer cycles was divided into two groups from the Reproductive Center of Hunan Provincial Maternal and Child Health Hospital.Group A were 63 hormone replacement therapy (HRT) cycles and Group B were 25 GH intrauterine perfusion combined HRT cycles.Results The endometrial thickness of 22 thin endometrium patients from Group B were increased above 7 mm on progesterone day.The endometrial thickness on transplant day of Group A was (9.28 ± 1.64) mm,which was significantly higher than Group B (7.9 ± 0.86) mm (P ＜ 0.05).The clinical pregnancy rate (50.79％ vs 52.0％),implantation rate 31.1％ vs 47.17％),miscarriage rate (9.38％ vs 15.38％) had no significant difference between Groups A and B.The endometrial thickness from 7 mm to 7.9 mm on transplant day,the clinical pregnancy rate (30.76％ vs 54.54％) had no significant difference in two groups (P ＞0.05),but the implantation rate of group A was significantly lower than that of group B (20％ vs 52.17％) (P ＜0.05).When the endometrial thickness was above 8 mm on transplant day,the clinical pregnancy rate (58.33％ vs 63.63％),implantation rate (36.36％ vs 50％) had no significant difference between groups A and B (P ＞ 0.05).Conclusions GH uterine cavity perfusion was a useful method for treatment of thin endometrium,and was helpful for improvement of endometrial thickness and receptivity,improved embryo implantation environment by assistance for HRT under the high estrogen levels.

Residual volume in vials of antibiotics used in pediatrics / Volumen residual de antibióticos en frascos-ampolla utilizados en pediatría / Volume residual de antibióticos em frascos-ampola utilizados na pediatria

Abstract OBJECTIVE Quantifying residual volume contained in vials of antibiotics used in pediatrics. METHOD This is an experiment involving samples from vials of antibiotics used in a pediatric hospital. Residual volume was identified by calculating the difference in weight measurement before and after the vials were washed. Evaluation of the residual volume difference in the vials was determined by the Wilcoxon non-parametric test for a sample and established at a significance level of 5%. RESULTS 105 samples of antibiotics were selected. The correct use of the antibiotics oxacillin (88.57%) and ceftriaxone (94.28%) predominated with low residual values. The same did not occur for procaine benzylpenicillin + potassium benzylpenicillin, since a greater residual volume was discarded in 74.28% of the vials. CONCLUSION We highlight the need for improvements in managing antibiotics in the institution under study, so that the excess volume of the antibiotics in the vials is used within the acceptable stable time. It is also necessary that the disposal of the residual volume be adequately disposed, since it presents a risk to public health and the environment.

Resumen OBJETIVO Cuantificar el volumen residual contenido en frascos-ampolla de antibióticos utilizados en pediatría. MÉTODO Se trata de un experimento con muestras de frascos-ampolla de antibióticos utilizados en hospital pediátrico. El volumen residual fue identificado calculándose la diferencia de la verificación del peso antes y después del lavado del frasco-ampolla. La evaluación de la diferencia de los volúmenes residuales en los frascos-ampolla fue determinada por la prueba no paramétrica de Wilcoxon para una muestra y establecido el nivel de significación del 5%. RESULTADOS Fueron seleccionadas 105 muestras de antibióticos. Predominó el correcto aprovechamiento de los antibióticos oxacilina (88,57%) y ceftriaxona (94,28%), con bajos valores residuales. Lo mismo no ocurrió con la bencilpenicilina procaína + potásica, pues en el 74,28% de los frascos hubo descarte de volumen residual superior. CONCLUSIÓN Se destaca la necesidad de mejorías en la gestión de los antibióticos en la institución en estudio, a fin de que el volumen excedente del antibiótico en frasco-ampolla se aproveche hasta el tiempo de estabilidad permitido, así como es necesario que haya la adecuación de la manera de descarte del volumen residual, que presenta riesgo a la salud pública y al medio ambiente.

Resumo OBJETIVO Quantificar o volume residual contido em frascos-ampola de antibióticos utilizados na pediatria. MÉTODO Trata-se de um experimento com amostras de frascos-ampola de antibióticos utilizados em hospital pediátrico. O volume residual foi identificado calculando-se a diferença da aferição do peso antes e após a lavagem do frasco-ampola. A avaliação da diferença dos volumes residuais nos frascos-ampola foi determinada pelo teste não paramétrico de Wilcoxon para uma amostra e estabelecido o nível de significância de 5%. RESULTADOS Foram selecionadas 105 amostras de antibióticos. Predominou o correto aproveitamento dos antibióticos oxacilina (88,57%) e ceftriaxona (94,28%), com baixos valores residuais. O mesmo não ocorreu com a benzilpenicilina procaína + potássica, pois em 74,28% dos frascos houve descarte de volume residual superior. CONCLUSÃO Destaca-se a necessidade de melhorias na gestão dos antibióticos na instituição em estudo, para que o volume excedente do antibiótico em frasco-ampola seja aproveitado até o tempo de estabilidade permitido, assim como é necessário que haja a adequação da forma de descarte do volume residual, que apresenta risco à saúde pública e ao meio ambiente.

Probiotics for prevention of necrotizing enterocolitis in preterm infants.

BACKGROUND: Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity. OBJECTIVES: To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants. SEARCH METHODS: For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013). SELECTION CRITERIA: Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome. DATA COLLECTION AND ANALYSIS: Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis. MAIN RESULTS: Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotics organism. Probiotics preparations containing either lactobacillus alone or in combination with bifidobacterium were found to be effective. AUTHORS' CONCLUSIONS: Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice. Head to head comparative studies are required to assess the most effective preparations, timing, and length of therapy to be utilized. PLAIN LANGUAGE SUMMARY: Probiotics for prevention of necrotizing enterocolitis in preterm infants Necrotizing enterocolitis (NEC) is a serious disease that affects the bowel of premature infants in the first few weeks of life. Although the cause of NEC is not entirely known, milk feeding and bacterial growth play a role. Probiotics (dietary supplements containing potentially beneficial bacteria or yeast) have been used to prevent NEC. Our review of studies found that the use of probiotics reduces the occurrence of NEC and death in premature infants born weighing less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants weighing less than 1000 grams at birth.

Efficacy of precise hyperthermic intraperitoneal perfusion chemotherapy in the treatment of advanced pancreatic cancer / 中国医师杂志

Objective To investigate the efficacy of precise hyperthermic intraperitoneal perfusion chemotherapy (HIPEC) in the treatment of advanced pancreatic cancer.Methods Thirty-six patients with advanced pancreatic cancer were analyzed retrospectively.Eighteen patients who received HIPEC combined with radiotherapy and chemotherapy were assigned as the treatment group and the other 18 patients who received chemotherapy and radiotherapy were assigned as the control group.Recent curative efficacy,Karnofsky Performance Status (KPS) score,postoperative complications and survivals between the two groups were analyzed,respectively.Results Significant differences were found between two groups in total short-term effective rate (P ＜ 0.05).The total short-term effective rate of treatment group and control group were 66.67％ (12/18) and 27.78％ (5/18),respectively.The increment of KPS score of treatment group was significantly higher than that of control group (P ＜ 0.05).There was no significant difference between two groups in postoperative complications (P ＞ 0.05).The median overall survival time (OS) of treatment group was 11 months (7 ～ 31 months),and the median OS of control group was 7 months (4 ～ 18 months).The survival of the treatment group was longer than the control group (P ＜ 0.05).Conclusions HIPEC treatment improved significantly the survival and life quality of advanced pancreatic cancer patients.With acceptable morbidity and mortality rates,HIPEC regime was an effective treatment modality for patients with advanced pancreatic cancer.

Impact of noradrenaline infusion set on mean arterial pressure: a retrospective clinical study.

OBJECTIVES: Noradrenaline (NA) can be infused through various systems including single or double syringe pumps. The aim of this study was to define the best and most efficient infusion system in an emergency context. STUDY DESIGN: This was a retrospective clinical study based on the analysis of patients' hemodynamic data. PATIENTS AND METHOD: Three infusion lines used presently in our postoperative ICU were compared through a retrospective clinical study: an NA syringe pump at 2mL/h and a saline carrier solution syringe pump at 8mL/h (infusion system 1- IS1) or 5mL/h (IS2), both connected to a very low dead-space volume set (V=0.046mL); IS3 with the same NA syringe at 2mL/h directly connected to the central venous catheter. Mean arterial pressure (MAP) was obtained from retrospective data analysis of ICU patients with postoperative septic shock criteria. Infusion systems were compared according to the time required to reach an MAP greater than 65mmHg after the onset of infusion. RESULTS: Data from 37 patients was analysed. The MAP objective was attained in 14:00 minutes (9:20 - 26:10, n=15) with IS1, in 19:10 minutes (12:20 - 27:20, n=13) with IS2 and in 34:10 minutes (23:10 - 62:30, n=9) with IS3 (P=0.00032). CONCLUSION: The use of a double syringe pump system associated with a very low dead-space volume infusion set appears to be the most appropriate system for NA infusion.

Efficacy and safety of triplecombination therapy with paclitaxel, cisplatin and TS-1 in patients with advanced gastric cancer / 肿瘤

Objective: To evaluate the efficacy and safety of triplecombination therapy with paclitaxel, cisplatin (intra-abdominal administration) and TS-1 in patients with advanced gastric cancer. Methods: Fifty eligible inpatients with advanced gastric cancer were recruited between January 2008 and January 2011 and treated with triple-combination therapy with paclitaxel (intravenous administration), cisplatin (intra-abdominal administration) and TS-1 (oral administration). The short-term response and adverse reactions were evaluated. The average follow-up time was 11.4 months. The PFS (progression-free survival) and OS (overall survival) were calculated. Results: Of 50 patients, 5 patients achieved complete response and 23 patients achieved partial response, and the objective response rate was 56%. The median PFS was 6.0 months (95% confidence interval: 3.4-8.6 months) and the median OS was 13.0 months (95% confidence interval: 7.9-18.1 months). The major adverse reactions were gastrointestinal reactions, hematologic toxicities and fatigue. Most of these adverse reactions were grades II Grades II adverse reactions were observed in three patients (one had serious vomiting, two had liver dysfunction). The bowel obstruction was relieved after two cycles of chemotherapy in 2 patients who had incomplete bowel obstruction before chemotherapy, and the chemotherapy-associated bowel obstruction after two cycles of chemotherapy occurred in another patient who had no bowel obstruction before chemotherapy. Conclusion: The triple combination therapy with paclitaxel, cisplatin and TS-1 demonstrates benefits in short-term response and the survival for patients with advanced gastric cancer, and it is also well-tolerated. © 2012 by Tumor.

Utilização de medicamentos parenterais em frascos-ampola em uma unidade pediátrica de um hospital universitário / Utilization of parenteral drugs in vials at a pediatric unit of a university hospital / Uso de medicamentos parenterales en frascos-ampolla en un servicio pediátrica de un hospital universitario

Este estudo observacional determinou a freqüência de utilização de medicamentos parenterais em frascos-ampola em uma unidade pediátrica, e identificou as ações da equipe de enfermagem associadas ao preparo e administração desses medicamentos. Os dados foram coletados por meio da prescrição médica e observação direta dos medicamentos nas geladeiras e armários da unidade. A apresentação em frascos-ampola foi prescrita para 30,8 por cento dos pacientes. Foram observados aspectos quanto à reconstituição, ao armazenamento, à temperatura e à rotulagem dos medicamentos, fatores importantes para utilização segura dos mesmos. As informações pesquisadas para avaliar o processo de preparo e de administração estavam todas presentes em apenas 6,8 por cento dos medicamentos. A identificação correta dos frascos-ampola é importante para o uso seguro dos medicamentos. O treinamento da equipe de saúde e a adoção de diretrizes de terapia endovenosa são instrumentos essenciais para otimizar o processo de utilização de medicamentos parenterais.

This observational study aimed to determine the frequency of utilization of vials containing parenteral medications in a pediatric unit, and to identify nursing team actions related to their preparation and administration. Data were collected from prescription forms and by checking these drugs in the refrigerator and stocks at the unit. Vials were prescribed to 30.8 percent of patients. Aspects such as: reconstitution, storage, temperature and drug label were observed. Only 6.8 percent of the drugs had all the information researched in order to evaluate the process of preparation and administration. The correct identification of vials is important for the safe use of medication. Training programs for the healthcare team and the adoption of intravenous therapy guidelines are essential tools to optimize the utilization of parenteral medication.

Este estudio de observación determinó la frecuencia para utilizar medicamentos parenterales en frascos-ampolla en una unidad pediátrica, identificando las acciones del equipo de enfermería con respecto a su preparación y administración. Para la recolección de datos se utilizó la prescripción médica y la observación directa de los medicamentos en los frigideres y estantes del servicio. La presentación en frascos-ampolla fue prescripta en 30.8 por ciento de los pacientes. Se observó la reconstitución, el almacenamiento, la temperatura y los rótulos de los medicamentos, factores importantes para asegurar su administración. Las informaciones investigadas para evaluar el proceso de preparación y administración estuvieron presentes en apenas 6.8 por ciento de los medicamentos. La correcta identificación de los frascos-ampolla es importante para su administración. El entrenamiento del equipo de salud y la adopción de directrices sobre tratamiento endovenoso son instrumentos esenciales para optimizar la utilización del medicamento parenteral.

Comparative study of different chemotherapy approaches for advanced epithelial ovarian cancer / 中华妇产科杂志

Objecfive To investigate the relationship between single nucleotide polymorphism-56(SNP-56)in calpain-10(CAPN-10)gene and polycystic ovary syndrome(PCOS)in Chinese.Methods The genotypes of SNP-56 of CAPN-10 were determined through polymerase chain reaction Tm-shift genotyping method in 638 local women in Shandong Province.Among them,334 were patients with PCOS (PCOS group)and 304 were normal women(control group).The baseline parameters including levels of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),estradiol(E2),testosterone(T)and lipid,as well as the body mass index(BMI)and waist/hip ratio(WHR)were measured.Glucose tolerance and insulin releasing before and after loading with 75 g of glucose were also assayed.Results(1)The frequencies of two allelotypes or three genotypes did not differ between PCOS women and normal women(P＞0.05).(2)In PCOS group,patients with AA genotype had a significantly higher plasma glucose of 180 minutes OGTT(5.7±2.2)mmol/L[P＜0.01 compared to Gagenotype(4.9±1.2) mmol/L,P＜0.01 compared to GG genotype(4.9±1.4)mmol/L]and serum total cholesterol(TC)level(4.9±1.0)mmol/L[P＜0.05 compared to Gagenotype(4.5±0.9)mmol/L].(3)Compared to PCOS patients with GA+GG genotype(P＜0.05,P＜0.01)or GG genotype(P＜0.05,P＜0.01),there was significantly higher attack rate of diabetes and tumor in the family history of patients with AA genotype.Conclusions These findings suggest that CAPN-10 gene SNP-56 which may not contribute to the genetic susceptibility of PCOS plays a role in glucose and lipid metabolism in Chinese PCOS patients.It may also be correlated with attack rate of diabetes and tumor in the family history of PCOS patients.