Worldwide prevalence of fungal coinfections among COVID-19 patients: a comprehensive systematic review and meta-analysis

Microbial coinfections can increase the morbidity and mortality rates of viral respiratory diseases. Therefore, this study aimed to determine the pooled prevalence of fungal coinfections in coronavirus disease 2019 (COVID-19) patients. Web of Science, Medline, Scopus, and Embase were searched without language restrictions to identify the related research on COVID-19 patients with fungal coinfections from December 1, 2019, to December 30, 2020. A random-effects model was used for analysis. The sample size included 2,246 patients from 8 studies. The pooled prevalence of fungal coinfections was 12.60%. The frequency of fungal subtype coinfections was 3.71% for Aspergillus, 2.39% for Candida, and 0.39% for other. The World Health Organization’s Regional Office for Europe and Regional Office for Southeast Asia had the highest (23.28%) and lowest (4.53%) estimated prevalence of fungal coinfection, respectively. Our findings showed a high prevalence of fungal coinfections in COVID-19 cases, which is a likely contributor to mortality in COVID-19 patients. Early identification of fungal pathogens in the laboratory for COVID-19 patients can lead to timely treatment and prevention of further damage by this hidden infection.     

What is the minimum effective volume of local anesthetic required for sciatic nerve blockade? A prospective, randomized comparison between a popliteal and a subgluteal approach

For sciatic nerve blockade, no study has defined the optimal volume of local anesthetic required to block the nerve. The current, prospective, randomized investigation was designed to find a minimum volume of 1.5% mepivacaine required to block the sciatic nerve using the subgluteal and posterior popliteal approaches. A total of 56 patients undergoing foot surgery were randomly assigned to receive sciatic nerve block by means of a posterior subgluteal (group subgluteal, n = 28) or a posterior popliteal (group popliteal, n = 28) approaches. All blocks were performed with the use a nerve stimulator (stimulating frequency, 2 Hz, intensity 1.5-0.5 mA) and a perineural stimulating catheter. In all patients, plantar flexion of the foot was elicited at <0.5 mA, to maintain consistency among groups. The volume of local anesthetic used in each patient was based on the modified Dixon's up-and-down method. Complete anesthesia was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot 20 min after injection. The mean volume of local anesthetic required to block the sciatic nerve was 12 +/- 3 mL in the subgluteal group and 20 +/- 3 mL in the popliteal group (P < 0.05). The ED95 for adequate block of the sciatic nerve was 17 mL in the subgluteal group and 30 mL in the popliteal group. The authors conclude that a larger volume of local anesthetic is necessary to block the sciatic nerve at a more distal site (popliteal approach) as compared with a more proximal level (subgluteal approach).     

Comparison of 4 techniques for general anesthesia for carotid endarterectomy: inflammatory response, cardiocirculatory complications, and postoperative analgesia

OBJETIVE: To study the analgesia, hemodynamic stability and inflammatory response in patients undergoing carotid endarterectomy under different types of general anesthesia. MATERIALS AND METHODS: A comparison of 80 patients randomized to 4 groups: group 1, maintenance with sevoflurane at a minimum alveolar concentration (MAC) of 1; group 2, sevoflurane at MAC 1.5; group 3, remifentanil; group 4, propofol. Variables studied were hemodynamic alterations during and after surgery, level of postoperative analgesia, differential white cell counts, levels of interleukin-6 (IL-6), and clinical signs and symptoms of systemic inflammatory response syndrome in the first 24 hours after surgery. RESULTS: The incidences of episodes of intraoperative hypertension were 60% in group 1, 65% in group 2, 50% in group 3, and 60% in group 4. The incidences of episodes of intraoperative hypotension were 85% in group 1, 80% in group 2, 80% in group 3, and 75% in group 4. Patients in groups 3 and 4 had higher incidences of systemic inflammatory response syndrome (p<0.05) in the first 24 hours after surgery and higher levels of IL-6 (p<0.05). Postoperative analgesia was similar in all 4 groups. CONCLUSIONS: Increased levels of IL-6 in peripheral blood and of systemic inflammatory response syndrome were found in the early postoperative period in groups that did not receive halogenated gases. Hemodynamic stability and analgesia were similar in all groups, however.     

Anesthetic management of coagulation factor V deficiency

Factor V deficiency, or Owren's disease, is a rare inherited recessive autonomic disorder that is congenital. The bleeding in patients with this disease depends on plasma levels of factor V. Anesthetic management is similar to that used for patients with other coagulation disorders. On the one hand, it is useful to initiate infusion of plasma if purified concentrates are not available. On the other hand, it is important to monitor hemostasis carefully so that bleeding during postoperative recovery can be prevented. Plasma and antifibrinolytic drugs such as tranexamic acid should continue to be administered in the first few days after surgery. We report the case of a man with homozygotic factor V deficiency who underwent surgery for colon cancer. This article reviews the main aspects of anesthetic management of this coagulation disorder.     

Comparison of intralesionally injected zinc sulfate with meglumine antimoniate in the treatment of acute cutaneous leishmaniasis

BACKGROUND: Cutaneous leishmaniasis is an endemic disease in developing countries. The first-line drugs for its treatment are the pentavalent antimony compounds such as meglumine antimoniate (MA). High cost, side effects, multiple injections and incomplete efficacy are limitations of this therapy. Zinc sulfate (ZS) has been reported to be effective in the treatment of cutaneous leishmaniasis. OBJECTIVE: To compare the efficacy of intralesional injections of ZS 2% with those of MA in the treatment of cutaneous leishmaniasis. METHODS: This was a prospective, double-blind, case-control clinical study. 104 patients with typical lesions of acute cutaneous leishmaniasis (ACL) were included. The duration of treatment was 6 weeks. Improvement was evaluated by clinical examination and direct smear. RESULTS: The study was completed in only 66 patients: 35 patients received MA and 31 received ZS. The cure rates were 60% for MA and 83.8% for ZS. After the second and fourth weeks, the efficacy of treatment with ZS was higher than that with MA (p < 0.01), but after 6 weeks no significant differences were observed between the two groups (p > 0.05). CONCLUSION: On the basis of this trial and despite the high number of drop-outs, we consider that the intralesional injection of ZS 2% is an alternative treatment in ACL.     

Effects of fluorocarbon propellants on respiratory flow and ECG.

Ten subjects were exposed to the propellants freon 11, freon 12, freon 114, to two mixtures of freon 11 and 12 and to a mixture of freon 12 and 114. The length of exposure was 15, 45 or 60 seconds. Maximum expiratory flow-volume (MEF) curves and ECG were recorded before, and intermittently up to 1 hour after, exposure. Breathing level concentrations of propellants during exposure were determined by gas chromatography. All freons induced biphasic reduction of ventilatory capacity on inhalation. The first fall occurred within a few minutes of exposure while the second was delayed 13-30 minutes after exposure. The effects of mixtures were greater than those of individual freons. The relative fall in MEF 75% was more pronounced than that in MEF 50%. No clear-cut pathological changes in ECG were found. Nevertheless, most subjects developed variations in heart rate exceeding those noted before exposure. In a few cases inversion of the T wave, and in one case atrioventricular block, were observed.