OBJECTIVES:RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. DESIGN:This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. SETTING:ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. PATIENTS:Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65-75, 75-85, and > 85 yr). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65-75 years, 17% were 75-85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups ( p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). "Age" and "improve general state" were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. CONCLUSIONS:Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.
Introduction: Ocular trauma is a significant cause of preventable monocular blindness among young adults in Latin America, frequently linked to assaults and high-energy projectiles. Case description: A 35-year-old male presented to the emergency department after being struck in the right eye by a compressed-air rubber projectile. Clinical findings: Examination revealed no light perception, enophthalmos, a 1 cm scleral laceration, extensive corneal perforation, intraocular tissue loss, and a central rubber foreign body (OTS category 1; IGATES: penetrating trauma with foreign body). Patient evaluation: Ultrasound and CT scans confirmed intraocular hemorrhage, globe deformity, and periorbital emphysema without bone fracture. Intervention: Urgent primary evisceration was performed under general anesthesia and loco-regional block, involving thorough uveal curettage and hydrogen peroxide irrigation to prevent sympathetic ophthalmia; an orbital conformer was not implanted due to a lack of hospital supplies. The postoperative course was free of pain or infection, and the patient was referred for disability and mental health assessment. Conclusions: Timely primary evisceration under general anesthesia and loco-regional block is an effective approach for non-reconstructible open-globe injuries with irreversible vision loss, mitigating severe immunological complications. Furthermore, this case highlights the critical need to ensure the availability of prosthetic supplies in public facilities and to provide comprehensive psychological and vocational support, given the severe socioeconomic and self-image impact on productive adults.
Background:Infantile neuroaxonal dystrophy is a rare autosomal recessive neurodegenerative disorder within the spectrum of PLA2G6-associated neurodegeneration. It is typically characterized by early psychomotor regression, progressive motor impairment, bulbar dysfunction, and characteristic neuroimaging abnormalities, including cerebellar atrophy and, in some cases, brain iron accumulation. Case report:We report the case of a 4-year-11-month-old girl with progressive neurodevelopmental regression beginning at approximately 18 months of age. The patient presented with loss of previously acquired motor abilities, absence of verbal language, marked hypotonia, preserved deep tendon reflexes, and progressive feeding difficulties. Laboratory evaluation was largely unremarkable, except for persistent isolated elevation of aspartate aminotransferase (AST). Brain MRI showed no overt structural or signal abnormalities despite advanced neurological impairment. Electroencephalography (EEG) did not reveal epileptiform activity. Given the progressive course and suspicion of an underlying neurodegenerative disorder, whole-exome sequencing was performed and identified a homozygous PLA2G6 variant, supporting the diagnosis of PLA2G6-associated neurodegeneration. During follow-up, the patient developed dysphagia and grade II gastroesophageal reflux, requiring gastrostomy placement and Nissen fundoplication. Conclusion:This case highlights the importance of early molecular diagnosis in pediatric regression syndromes and emphasizes that normal neuroimaging does not exclude PLA2G6-associated neurodegeneration, particularly in atypical presentations. Early recognition enables timely multidisciplinary management, prognostic assessment, and appropriate genetic counseling for the family.
Introducción: Las patologías gastrointestinales constituyen una causa principal de morbilidad y mortalidad a nivel mundial. El tratamiento quirúrgico ha evolucionado hacia técnicas mínimamente invasivas, incluyendo laparoscopia avanzada, cirugía robótica y endoscopia intervencionista, que mejoran la recuperación y calidad de vida de los pacientes. Sin embargo, persisten controversias sobre su seguridad oncológica y efectividad comparativa. Objetivo: Realizar una revisión sistemática de la literatura para evaluar la eficacia, seguridad, resultados clínicos y curvas de aprendizaje de las técnicas quirúrgicas mínimamente invasivas aplicadas a patologías gastrointestinales. Metodología: Siguiendo la declaración PRISMA 2020, se realizó una búsqueda sistemática en PubMed, Scopus y Web of Science (enero 2021 - julio 2026). Se incluyeron 48 estudios (n=8.342 pacientes) que evaluaban técnicas laparoscópicas, robóticas, endoscópicas avanzadas (ESD, EMR, EFTR, POEM) y cirugía cooperativa (LECS). La calidad metodológica se evaluó con las herramientas Cochrane RoB 2, Newcastle-Ottawa, JBI y AMSTAR-2. Se realizó una síntesis narrativa estructurada siguiendo las guías SWiM. Resultados: La laparoscopia avanzada logró tasas de resección R0 del 96,2% (rango: 94,8-97,6%) y redujo la estancia hospitalaria en una media de 4,7 días frente a cirugía abierta. La cirugía robótica mejoró la disección ganglionar (diferencia media: 7,1 ganglios; p=0,02), pero prolongó los tiempos quirúrgicos (+47 minutos; p<0,001). Los procedimientos endoscópicos mostraron una tasa de éxito del 92,4% y estancias hospitalarias de 1,8±0,7 días. La curva de aprendizaje requirió entre 25 y 50 casos según la técnica. El uso de verde de indocianina redujo las fugas anastomóticas del 8,2% al 3,1%. Los centros de alto volumen presentaron menores tasas de conversión (3,2% vs 12,8%; p=0,003). Conclusiones: La cirugía mínimamente invasiva ofrece resultados oncológicos comparables a la cirugía abierta con mejores beneficios perioperatorios. Futuras investigaciones deben resolver controversias sobre la superioridad robótica mediante ensayos aleatorizados, validar el concepto de "cirugía súper mínimamente invasiva" y evaluar su coste-efectividad en distintos sistemas de salud.
