Efecto de una dosis de lidocaína y ketamina sobre el consumo intraoperatorio de opioides en pacientes sometidas a cirugía ginecológica electiva bajo anestesia general. Estudio piloto aleatorizado y controlado con placebo

Background and goal of study: there is evidence that perioperative intravenous ketamine and lidocaine reduce postoperative pain, postoperative opioids consumption, shortens hospital stay and accelerates intestinal function recovery. However, it has not been studied the beneficial effects in the intraoperative period. The aim of this study was to evaluate the effect of a single dose of lidocaine and ketamine on intraoperative opioids requirements in patients undergoing elective gynecological laparotomies under general anesthesia. Materials and methods: we performed a single-centre, prospective, randomized, double-blinded, placebo-controlled study. We included 33 patients (11 in the ketamine group, 11 in the lidocaine group and 11 in the placebo group). Postoperative analgesia was accomplished by patient-controlled morphine. Patients were randomly assigned to receive either a 1.5 mg/kg of 2% lidocaine, 0.5 mg/kg of 5% ketamine or 0.9% saline bolus. The primary outcome was the opioids consumption during surgery. The secondary outcomes included: emergence time, pain scores, opioids consumption within 24 h after surgery and side effects. Results: decreased intraoperative opioids requirements were noted in the experimental groups (ketamine: 402.3±106.3 and lidocaine: 397.7±107.5, compared with saline: 561.4±97.1); p=0.001. We found a positive correlation between intraoperative opioids consumption and emergence time (r=0.864, p<0.001). There was no significant difference between the groups in VAS pain scores at rest within the first 24 postoperative hours. Total morphine consumption within 24 h after surgery did not differ significantly among the groups (placebo: 27.54±11.75; ketamine: 30.95±7.88; lidocaine 34.77±10.25; p=0.26). Postoperative nausea and vomiting were more common in placebo group (it was observed in 3 subjects in ketamine group, in 5 subjects in lidocaine group and in 9 subjects in placebo group; p=0.027). Conclusion: our results do not support the use of intraoperative single dose of lidocaine or ketamine to reduce postoperative pain and postoperative opioids consumption after open gynecological surgery. However, they seem to decrease intraoperative opioids requirements and shorten emergence time. Nevertheless, these findings should be validating in further studies with large sample size.Introducción y objetivos del estudio: existe evidencia de que la administración perioperatoria de ketamina y lidocaína intravenosa reduce el dolor y el consumo de opioides postoperatorio, acorta la estancia hospitalaria y acelera la recuperación de la función intestinal. Sin embargo, no se han estudiado los efectos beneficiosos en el período intraoperatorio. El objetivo de este estudio fue evaluar el efecto de una única dosis de lidocaína y ketamina sobre el consumo intraoperatorio de opioides en pacientes sometidas a cirugía ginecológica electiva bajo anestesia general. Material y métodos: estudio prospectivo, aleatorizado, doble ciego, controlado con placebo en un solo centro. Se incluyeron 33 pacientes (11 en el grupo ketamina, 11 en el grupo lidocaína y 11 en el grupo placebo). Para la analgesia postoperatoria se utilizó una bomba PCA (Analgesia Controlada por el Paciente ) de morfina. Los pacientes fueron asignados al azar a uno de los tres grupos de estudio: 1,5 mg/kg de lidocaína al 2%, 0,5 mg/kg de ketamina al 5% o solución salina 0.9%. La variable principal del estudio fue el consumo de opioides durante la cirugía. Las variables secundarias fueron: tiempo de educción de la anestesia, intensidad del dolor, consumo de opioides en las 24 horas posteriores a la cirugía y efectos adversos. Resultados: se observó una disminución del consumo intraoperatorio de opioides en los grupos ketamina (402,3 ± 106,3) y lidocaína (397,7 ± 107,5) frente al grupo placebo (561,4 ± 97,1); p = 0,001. Se encontró una correlación positiva entre el consumo intraoperatorio de opioides y el tiempo de despertar (r = 0,864, p <0,001). No hubo diferencias significativas respecto a la intensidad del dolor en reposo en las 24 horas posteriores a la cirugía. El consumo total de morfina en las primeras 24 horas tras la cirugía no difirió significativamente entre los grupos (placebo: 27,54 ± 11,75; ketamina: 30,95 ± 7,88; lidocaína 34,77 ± 10,25; p = 0,26). Las náuseas y vómitos postoperatorios fueron más frecuentes en el grupo placebo (se observó en 3 pacientes del grupo ketamina, en 5 del grupo lidocaína y en 9 del grupo placebo; p = 0,027). Conclusión: Nuestros resultados no apoyan el uso de una única dosis intraoperatoria de lidocaína o ketamina para disminuir el dolor postoperatorio y el consumo de opioides tras cirugía ginecológica abierta. Sin embargo, si parece disminuir los requerimientos intraoperatorios de opioides y acortar el tiempo de educción de la anestesia. No obstante, estos resultados deben ser validados en futuros estudios con mayor tamaño muestral

Cost-effectiveness of a potential Zika vaccine candidate: a case study for Colombia

Background: A number of Zika vaccine platforms are currently being investigated, some of which have entered clinical trials. We sought to evaluate the cost-effectiveness of a potential Zika vaccine candidate under the WHO Vaccine Target Product Profile for outbreak response, prioritizing women of reproductive age to prevent microcephaly and other neurological disorders. Methods: Using an agent-based simulation model of ZIKV transmission dynamics in a Colombian population setting, we conducted cost-effectiveness analysis with and without pre-existing herd immunity. The model was parameterized with estimates associated with ZIKV infection, risks of microcephaly in different trimesters, direct medical costs, and vaccination costs. We assumed that a single dose of vaccine provides a protection efficacy in the range 60% to 90% against infection. Cost-effectiveness analysis was conducted from a government perspective. Results: Under a favorable scenario when the reproduction number is relatively low (R0 = 2.2) and the relative transmissibility of asymptomatic infection is 10% compared with symptomatic infection, a vaccine is cost-saving (with negative incremental cost-effective ratio; ICER) for vaccination costs up to US$6 per individual without herd immunity, and up to US$4 per individual with 8% herd immunity. For positive ICER values, vaccination is highly cost-effective for vaccination costs up to US$10 (US$7) in the respective scenarios with the willingness-to-pay of US$6610 per disability-adjusted life-year, corresponding to the average per capita GDP of Colombia between 2013 and 2017. Our results indicate that the effect of other control measures targeted to reduce ZIKV transmission decreases the range of vaccination costs for cost-effectiveness due to reduced returns of vaccine-induced herd immunity. In all scenarios investigated, the median reduction of microcephaly exceeded 64% with vaccination. Conclusions: Our study suggests that a Zika vaccine with protection efficacy as low as 60% could significantly reduce the incidence of microcephaly. From a government perspective, Zika vaccination is highly cost-effective, and even cost-saving in Colombia if vaccination costs per individual is sufficiently low. Efficacy data from clinical trials and number of vaccine doses will be important requirements in future studies to refine our estimates, and conduct similar studies in other at-risk populations. Keywords: Zika, Microcephaly, Vaccination, Agent-based modeling, Cost-effectivenessYork University Librarie

Catalogue of Anti-Patterns for formal Ontology debugging

Debugging of inconsistent OWL ontologies is normally a tedious and time-consuming task where a combination of ontology engineers and domain expert is often required to understand whether the changes to be performed in order to make the OWL ontology consistent are actually changing the intended meaning of the original knowledge model. This task is aided by existing ontology debugging systems, incorporated in existing reasoners and ontology engineering tools, which ameliorate this problem but in complex cases are still far from providing adequate support to ontology engineers, due to lack of efficiency or lack of precision in determining the main causes for inconsistencies. In this paper we describe a set of anti-patterns commonly found in OWL ontologies, which can be useful in the task of ontology debugging in combination with those debugging tools

Lusternik-Schnirelmann category of simplicial complexes and finite spaces

In this paper we establish a natural definition of Lusternik-Schnirelmann category for simplicial complexes via the well known notion of contiguity. This category has the property of being homotopy invariant under strong equivalences, and only depends on the simplicial structure rather than its geometric realization. In a similar way to the classical case, we also develop a notion of geometric category for simplicial complexes. We prove that the maximum value over the homotopy class of a given complex is attained in the core of the complex. Finally, by means of well known relations between simplicial complexes and posets, specific new results for the topological notion of category are obtained in the setting of finite topological spaces.Comment: 18 pages, 10 figures, this is a new version with some minor changes and a new exampl

Tecnologías digitales al servicio de los archivos de imágenes

La información televisiva, las series de televisión y la publicidad ocupan la mayor parte del tiempo en las broadcast, tanto de sistemas analógicos y digitales como terrestre y de satélite. Estos géneros televisivos constituyen, más allá de la industria y del mercado, también el espejo de una identidad social y cultural. Por eso, una de las cuestiones clave de la cultura del próximo milenio será la constitución, documentación, almacenamiento, reutilización y análisis del patrimonio audiovisual. El archivo, la catalogación, el análisis y la consulta on line de este acervo cultural digitalizado pone una serie de problemas técnicos y teóricos que han de resolverse con la alianza entre investigadores de las ciencias humanas y la industria de la información.Television news, TV series, and spot advertising occupy the greater part of broadcast time. This is as much the case for analogue and digital systems as for cable and satellite TV. These television genres constitute, in addition to the TV industry and market aspects, a mirror of social and cultural identity. Therefore, one of the key issues for culture in the next millennium will be communications, documentation, storing, reusing and analysing the audio-visual heritage. The archive, cataloguing, the analysis and on-line consulting of this digitalised common property poses a series of technical and theoretical problems that will have to be resolved in a joint effort involving researchers in the social sciences and the information industry