Taponamiento cardíaco por hematoma retroauricular

Durante el postoperatorio de sustitución de aorta ascendente con tubo valvulado tipo Hamsfield por disección aórtica tipo A, una paciente presentó hipotensión con oliguria, sin pulso paradójico. Mediante ecografía transesofágica en la unidad de cuidados intensivos se puso de manifiesto un hematoma pericárdico que comprimía la aurícula derecha. Se realizó un drenaje subxifoideo mediante una cánula de aspiración bajo control ecocardiográfico, se aspiró el coágulo y se solucionó el compromiso hemodinámico

Treatment intensification with raltegravir in subjects with sustained HIV―1 viraemia suppression: a randomized 48―week study

Background Residual viraemia is a major obstacle to HIV-1 eradication in subjects receiving HAART. The intensification with raltegravir could impact latent reservoirs and might lead to a reduction of plasma HIV-1 viraemia (viral load [VL]), complementary DNA intermediates and immune activation. Methods This was a prospective, open-label, randomized study comprising 69 individuals on suppressive HAART randomly assigned 2:1 to add raltegravir during 48 weeks. Results Total and integrated HIV-1 DNA, and ultrasensitive VL remained stable despite intensification. There was a significant increase in episomal HIV DNA at weeks 2–4 in the raltegravir group returning to baseline levels at week 48. Median CD4+ T-cell counts increased 124 and 80 cells/μl in the intensified and control groups after 48 weeks ( P=0.005 and P=0.027, respectively), without significant differences between groups. No major changes were observed in activation of CD4+ T-cells. Conversely, raltegravir intensification significantly reduced activation of CD8+ T-cells at week 48 (HLA-DR+CD38+, P=0.005), especially in the memory compartment (CD38+ of CD8+CD45RO+, P&lt;0.0001). Linear mix models also depicted a larger decrease in CD8+ T-cell activation in the intensification group ( P=0.036 and P=0.010, respectively). Raltegravir intensification was not associated to any particular adverse event. Conclusions Intensification of HAART with raltegravir during 48 weeks was safe and associated with a significant decrease in CD8+ T-cell activation, and a transient increase of episomal HIV-1 DNA. However, raltegravir did not significantly contribute to changes in CD4+ T-cell counts, ultrasensitive VL, and total and integrated HIV-1 DNA. These findings suggest that raltegravir impacts residual HIV-1 replication and support new strategies to impair HIV-1 persistence. ClinicalTrials.gov identifier: NCT00554398. </jats:sec