OS PRINCIPAIS FATORES DA ECMO NA UTI PEDIÁTRICA

Although Extracorporeal Membrane Oxygenation (ECMO) provides many benefits in the treatment of critically ill pediatric intensive care patients, having many connectors and access points in the circuit is not without risks. In view of this, the objective was to investigate the complications that are susceptible to pediatric patients using ECMO in the Pediatric Intensive Care Unit and the respective interventions for the recovery of the state of health. To this end, a narrative review of the literature was carried out in the LILACS, MEDLINE and SCIELO databases, in the period 2018-2023. With the results obtained in research, there is evidence of a great interest in Intensive Care Medicine in improving the approach to pediatric patients undergoing ECMO, due to the risk of complications, such as, for example, the presence and/or formation of clots, gas embolism and /or failure of the oxygenator when performing the technique. Such events are associated with the interactions of the blood with the artificial surfaces of the circuit and changes in the blood flow pattern, in addition to a greater number of adverse events related to the prolonged treatment time, but which can be prevented by prioritizing monitoring in two lines of action: monitoring the technique, including cannula care, oxygenator output, oxygenator rotations, oxygenator pressures, circuit temperature, coagulation index, gasometric evaluation in the oxygenator; and patient monitoring by assessing vital parameters and capillary blood glucose, the neurological system, diuresis and blood loss, positioning, as well as ventilatory and gasometric parameters.Embora a Oxigenação por Membrana Extracorpórea (ECMO) proporcione muitos benefícios no tratamento de pacientes pediátricos sob cuidados intensivos em estado crítico, o fato de possuir muitos conectores e pontos de acesso no circuito não encontra-se isenta de riscos. Em vista disso, objetivou-se investigar as complicações que encontram-se suscetíveis os pacientes pediátricos em uso da ECMO na Unidade de Terapia Intensiva Pediátrica e as respectivas intervenções para a recuperação do estado de saúde. Para tanto, realizou-se uma revisão narrativa da literatura nas bases de dados LILACS, MEDLINE e SCIELO, no período de 2018-2023. Com os resultados obtidos em pesquisa, evidencia-se um grande interesse na Medicina Intensiva em melhorar a abordagem do paciente pediátrico submetido à ECMO, pelo risco de complicações como, por exemplo, presença e/ou formação de trombos, embolia gasosa e/ou falha do oxigenador durante a execução da técnica. Esses eventos estão associados a interações do sangue com superfícies artificiais do circuito e alterações no padrão de fluxo sanguíneo, além de um maior número de eventos adversos relacionados à duração prolongada do tratamento, mas que podem ser retidos priorizando o monitoramento em dois itinerários de tratamento.ação: técnica de monitoramento, incluindo manutenção da cânula, fluxo do oxigenador, rotações do oxigenador, pressões do oxigenador, temperatura do circuito, índice de coagulação, avaliação gasométrica no oxigenador; e monitoramento do paciente por meio da avaliação de parâmetros vitais e glicemia capilar, sistema neurológico, diurese e perda sanguínea, posicionamento, bem como parâmetros ventilatórios e gasometria arteria

El rol de VEGF en la Angiogénesis fisiológica y tumoral

El proceso de angiogénesis, en el cual se desarrollan nuevos vasos sanguíneos a partir de una red vascular existente, requiere de la activación de los receptores en la superficie de las células endoteliales. En sus procesos fisiológicos, como la reparación de heridas, se observa un aumento en la permeabilidad vascular que induce el depósito de proteínas plasmáticas en la matriz extracelular y favorece la reparación y la cicatrización. No obstante, en algunas patologías como el cáncer, desempeña un papel importante para el crecimiento y la diseminación de las células tumorales. Su activación en el tumor permite, pero no garantiza, la expansión tumoral y, por ende, la ausencia de angiogénesis puede limitar el crecimiento. Por eso, se han desarrollado varios inhibidores con el propósito de interferir específicamente en diferentes etapas de este proceso, por ejemplo, el bevacizumab (Avastin) que se distingue como un anticuerpo monoclonal que reconoce y se une al Factor de Crecimiento Endotelial Vascular (por sus siglas en inglés VEGF).   The role of VEGF in Physiological and tumoral angiogénesis Abstract Angiogenesis, the cellular process leading to the development of new blood vessels from an existing vascular network, requires activation of surface receptors of normal endothelial cells by signaling molecules such as the Vascular Endothelial Growth Factor (VEGF). During physiological processes of angiogenesis leading to injury repair, an increase of vascular permeability favors deposits of plasma proteins in the extracellular matrix. However, in pathological processes such as cancer, angiogenesis plays an important role in the growth and proliferation of the tumor cells. The activation of angiogenesis in a tumor induces, but does not guarantee, tumor expansion; hence, the absence of angiogenesis may limit the tumor growth. Angiogenesis inhibitors been developed to interfere with different stages of the process. For example, bevacizumab (Avastin) is recognized as a monoclonal antibody binds specifically to VEGF and inhibits its angiogenic function

Evaluación de la sensibilidad de cepas de Pseudomonas aeruginosa multi-resistentes frente a ceftolozano/tazobactam.

Pseudomonas aeruginosa is an opportunistic pathogen associated with high morbidity and mortality. For multidrug-resistant strains (MDR), ceftolozane/tazobactam (CTZ) has been authorized by the European Medicines Agency (EMA) for complicated urinary tract infections, acute pyelonephritis, and complicated intraabdominal infections. To determine the susceptibility to CTZ of P. aeruginosa MDR in isolated clinical samples at the University Hospital Puerto Real. The susceptibility according to the EUCAST to CTZ criteria of strains of P. aeruginosa MDR, between January 2015 and August 2017 has been studied. The multiresistance criteria were those defined by the Centers for Disease Control and Prevention. The antibiotic susceptibility was obtained by automated MicroScan® system (Beckman Coulter). Susceptibility to CTZ was determined using gradient strips (Liofilchem®, Werfen). Of 1253 strains isolated, 7% presented MDR. We studied the susceptibility of a total of 78 strains of MDR P. aeruginosa, of which 5 (6.4%) were resistant to CTZ according to the EUCAST criteria. In our environment, the in vitro resistance to CTZ in MDR P. aeruginosa strains is approximately 6%. CTZ is an option for the treatment of infections by MDR P. aeruginosa when there is no other alternative and its in-vitro susceptibility has been proven

Limited Value of Single Sampling for IgM Antibody Determination as a Diagnostic Approach for Acute Hepatitis E Virus Infection

The objective was to evaluate the accuracy of a single determination of IgM antibodies for hepatitis E virus (HEV) diagnosis in patients with acute hepatitis. A prospective study included patients with suspicion of HEV infection, defined as individuals with acute hepatitis showing negative results for serological and molecular markers of other hepatitis viruses. All patients were evaluated for hepatitis E virus infection, including both IgM antibodies and viral RNA determinations. Hepatitis E virus infection was defined as positivity for any of these markers. A total of 182 patients were included in the study, of whom 68 (37.4%) were diagnosed with HEV infection. Of these, 29 (42.6%) were positive for both IgM and HEV RNA, 25 (36.8%) were positive only for IgM antibodies, and 14 (20.6%) were positive only for HEV RNA. Considering only those individuals who were positive for IgM antibodies, 54 of the 68 total cases (79.4%) could be identified, showing a percentage of false-negative individuals of 20.6%. The diagnostic algorithm of hepatitis E virus infection in patients with acute hepatitis should include the determination of both IgM antibodies and HEV RNA because single sampling for IgM antibody determination led to an important proportion of misdiagnosed cases.This work was supported by the Ministerio de Sanidad (RD12/0017/0012) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Fundación para la Investigación en Salud (FIS) del Instituto Carlos III (research project grant number PI19/00864); and the Red de Investigación en SIDA de España ISCIII-RETIC (grant number RD16/0025/0034). A.R.-J. is the recipient of a Miguel Servet research contract by the Ministerio de Ciencia, Promoción, y Universidades of Spain (CP18/00111). M.F. is the recipient of a Sara Borrell research contract program by the Ministerio de Ciencia, Promoción, y Universidades of Spain (CD18/00091). A.R. is the beneficiary of Contratos para la Intensificación de la Actividad Investigadora en el Sistema Nacional de Salud by the Ministerio de Ciencia, Promoción, y Universidades of Spain (INT20-00028)