Jorge Dagnino

Use of methylene blue in patients with refractory septic shock: Impact on hemodynamics and gas exchange

PURPOSE The purpose of this study was to assess the acute effects of methylene blue, an inhibitor of nitric oxide synthesis, on hemodynamics and gas exchange in patients with refractory septic shock in a prospective clinical trial at medical and surgical intensive care units in a tertiary university hospital. PATIENTS AND METHODS Prospective, sequential study of 10 consecutive patients admitted with severe septic shock of diverse causes and unable to achieve an adequate arterial pressure despite the use of at least two vasoactive drugs. Six of them also developed acute lung injury. All received 1 mg/kg intravenous bolus of methylene blue. Hemodynamic and respiratory parameters were measured at baseline and at 30, 60, 120, and 180 minutes after the bolus injection. RESULTS Systolic, diastolic, mean arterial blood pressure, and systemic vascular resistance increased significantly in all patients, whereas no significant changes were observed in cardiac output, oxygen consumption, or oxygen extraction ratio. Gas exchange remained unaffected in patients with acute lung injury. CONCLUSIONS Methylene blue had an acute vasopressor effect in patients with refractory septic shock, and it was not deleterious on respiratory function.

Revitalising medical education: the School of Medicine at the Pontificia Universidad Católica de Chile

H igher education in Chile experienced significant diversification, after a significant growth in the number of private universities, which increased the heterogeneous nature of educational quality. This diversification involved educational reform and a new accreditation system for both traditional and new universities, and the number of students increased dramatically. Until the late 1970s, only a few ‘traditional’ universities in Chile had provided higher education. However, by 1981, as a result of the establishment of private educational institutions, there were more than 60 universities. Currently there are 25 traditional and ‘derived’ universities (that is, those originating from traditional universities), 36 new private universities and 45 professional institutes, totalling over 100 higher education institutions. Although many claim to be teaching universities, only 10 per cent of them can be identified as complex universities with a relevant role in both research and the generation of new knowledge.

Catholic students at war: the Federazione Universitaria Cattolica Italiana, 1940–43

Abstract This article deals with the religious experience of the Federazione Universitaria Cattolica Italiana during the Second World War. Since many of the future Christian Democrat leaders that would rule the country after the conflict were formed in the ranks of the organization, most of the existing literature has tended to focus on the formation of this ruling class and their political trajectory and, has tended to overstate the origins and character of their anti-fascist departure, neglecting the initial support for many aspects of the Regimes war effort. This article contends, instead, that the most salient features of the war experience of the university students are to be located in the spiritual dimension and in their effort to contrive a religiosity adapted to warfare and modernity in general, interlaced with the powerful myth of a Catholic Italy that, at least in the early stages of the conflict, fuelled the expectations of many in the federation of a primordial role to be played by Italy in a new world order.

Intramucosal gastric pH during liver transplantation

Intramucosal gastric pH (pHi) was measured during liver transplantation in a 3‐year‐old girl. The basal value was below that reported as normal for paediatric patients under stable normal ventilatory and haemodynamic conditions. Additional reductions of the pHi were observed during the hepatectomy and anhepatic phase, in the absence of haemodynamic or ventilatory alterations. The reperfusion phase was characterized by a progressive return toward normal values. Because we did not measure oxygen delivery and consumption, we cannot determine whether the reduction of the pHi was due to insufficient oxygen delivery or a result of the vascular anatomical alterations due to the surgical procedure.