Vertical distribution of Ostreopsis cf. ovata in NW Mediterranean Sea: Impact on Monitoring Strategy

International audienc

Continuous hemoglobin and plethysmography variability index monitoring can modify blood transfusion practice and is associated with lower mortality

International audienceTo determine the effect of implementing an algorithm of fluid and blood administration based on continuous monitoring of hemoglobin (SpHb) and PVI (plethysmography variability index) on mortality and transfusion on a whole hospital scale. This single-center quality program compared transfusion at 48 h and mortality at 30 days and 90 days after surgery between two 11-month periods in 2013 and 2014 during which all the operating and recovery rooms and intensive care units were equipped with SpHb/PVI monitors. The entire team was trained to use monitors and the algorithm. Team members were free to decide whether or not to use devices. Each device was connected to an electronic wireless acquired database to anonymously acquire parameters on-line and identify patients who received the monitoring. All data were available from electronic files. Patients were divided in three groups; 2013 (G1, n = 9285), 2014 without (G2, n = 5856) and with (G3, n = 3575) goal-directed therapy. The influence of age, ASA class, severity and urgency of surgery and use of algorithm on mortality and blood use were analyzed with cox-proportional hazard models. Because in 2015, SpHb/PVI monitors were no longer available, we assessed post-study mortality observed in 2015 to measure the impact of team training to adjust vascular filling on a patient to patient basis. During non-cardiac surgery, blood was more often transfused during surgery in G3 patients as compared to G2 (66.6% vs. 50.7%, p < 0.001) but with fewer blood units per patient. After adjustment, survival analysis showed a lower risk of transfusion at 48 h in G3 [OR 0.79 (0.68-0.93), p = 0.004] but not in G2 [OR 0.90 (0.78-1.04) p = 0.17] as compared to G1. When adjusting to the severity of surgery as covariable, there was 0.5 and 0.7% differences of mortality at day 30 and 90 whether patients had goal directed therapy (GDT). After high risk surgery, the mortality at day 30 is reduced by 4% when using GDT, and 1% after intermediate risk surgery. There was no difference for low risk surgery. G3 Patients had a lower risk of death at 30 days post-surgery [OR 0.67 (0.49-0.92) p = 0.01] but not G2 patients [OR 1.01, (0.78-1.29), p = 0.96]. In 2015, mortality at 30 days and 90 days increased again to similar levels as those of 2013, respectively 2.18 and 3.09%. Monitoring SpHb and PVI integrated in a vascular filling algorithm is associated with earlier transfusion and reduced 30 and 90-day mortality on a whole hospital scale

Relevancia del control metabólico en el pronóstico de los pacientes diabéticos con COVID-19

Durante la pandemia de COVID-19 y otras similares previamente, la diabetes mellitus (DM) ha sido identificada como un factor de riesgo independiente de morbimortalidad, estando presente en una proporci&oacute;n significativa de los casos que han desarrollado complicaciones fatales. En efecto, en los pacientes con COVID-19 los niveles de glicemia son un factor determinante debido a que los individuos con hiperglicemia presentan mayor riesgo y peor pron&oacute;stico en comparaci&oacute;n a los euglic&eacute;micos. Esto es clave, puesto que actualmente se conoce que la hiperglicemia juega un papel importante en la patog&eacute;nesis y pron&oacute;stico de las enfermedades respiratorias virales en los pacientes diab&eacute;ticos. No obstante, un control muy estricto de los niveles de glucosa puede dar lugar a episodios de hipoglicemia, que a su vez puede aumentar la mortalidad de dichos pacientes. Considerando la alta prevalencia de DM en los pacientes con COVID-19 y el peor pron&oacute;stico asociado a la coexistencia de ambas entidades, se hace evidente la necesidad de un abordaje oportuno y adecuado de estos pacientes. El objetivo de la presente revisi&oacute;n es presentar la evidencia cl&iacute;nicoepidemiol&oacute;gica disponible sobre la relevancia del control metab&oacute;lico en los pacientes diab&eacute;ticos con COVID-19 y los posibles mecanismos fisiopatol&oacute;gicos implicados

Relevancia del control metabólico en el pronóstico de los pacientes diabéticos con COVID-19

Durante la pandemia de COVID-19 y otras similares previamente, la diabetes mellitus (DM) ha sido identificada como un factor de riesgo independiente de morbimortalidad, estando presente en una proporci&oacute;n significativa de los casos que han desarrollado complicaciones fatales. En efecto, en los pacientes con COVID-19 los niveles de glicemia son un factor determinante debido a que los individuos con hiperglicemia presentan mayor riesgo y peor pron&oacute;stico en comparaci&oacute;n a los euglic&eacute;micos. Esto es clave, puesto que actualmente se conoce que la hiperglicemia juega un papel importante en la patog&eacute;nesis y pron&oacute;stico de las enfermedades respiratorias virales en los pacientes diab&eacute;ticos. No obstante, un control muy estricto de los niveles de glucosa puede dar lugar a episodios de hipoglicemia, que a su vez puede aumentar la mortalidad de dichos pacientes. Considerando la alta prevalencia de DM en los pacientes con COVID-19 y el peor pron&oacute;stico asociado a la coexistencia de ambas entidades, se hace evidente la necesidad de un abordaje oportuno y adecuado de estos pacientes. El objetivo de la presente revisi&oacute;n es presentar la evidencia cl&iacute;nicoepidemiol&oacute;gica disponible sobre la relevancia del control metab&oacute;lico en los pacientes diab&eacute;ticos con COVID-19 y los posibles mecanismos fisiopatol&oacute;gicos implicados

Aspectos clínicos de la covid-19 en los pacientes con cáncer

La enfermedad por Coronavirus 2019 (COVID-19), causada por el SARS-CoV-2, ha representado un reto cient&iacute;fico y sanitario en los &uacute;ltimos meses. Los individuos de edad avanzada parecen ser los m&aacute;s frecuentemente afectados; adicionalmente, estos individuos tienden a presentar comorbilidades como la hipertensi&oacute;n arterial, diabetes mellitus, enfermedades cardiovasculares y el c&aacute;ncer, empeorando el pron&oacute;stico y curso cl&iacute;nico de la infecci&oacute;n. El impacto de esta pandemia en los pacientes oncol&oacute;gicos ha sido sumamente extenso. Estudios observacionales han demostrado que las tasas de infecci&oacute;n en los pacientes con c&aacute;ncer tienden a ser mucho mayores que en la poblaci&oacute;n general. De igual forma, se ha reconocido que los pacientes oncol&oacute;gicos tienen mayor riesgo de desarrollar complicaciones severas de la COVID-19, incluyendo la muerte. Adem&aacute;s, los tratamientos oncol&oacute;gicos implican la constante visita a instalaciones de cuidados de la salud, lo cual incrementa de forma significativa el riesgo de transmisi&oacute;n viral independientemente del tratamiento recibido. Adicionalmente, muchos tratamientos antineopl&aacute;sicos tienen efectos inmunosupresores, y los onc&oacute;logos tratantes se enfrentan a la incertidumbre de suspender o continuar el tratamiento en los pacientes con riesgo de contagiarse de COVID-19. El objetivo de esta revisi&oacute;n es abordar los aspectos cl&iacute;nicos m&aacute;s relevantes de la COVID-19 en el paciente con c&aacute;ncer, y revisar las recomendaciones actuales en relaci&oacute;n al manejo terap&eacute;utico en este contexto

Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches

International audienceAim The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). Methods The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. Results After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. Conclusion Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications