Introduction: Selective inhibitors of the enzyme cyclooxygenase-2 were developed to reduce the gastrointestinal toxicity of conventional nonsteroidal anti-inflammatory drugs. However, this class of drugs decreases prostacyclin production and can disrupt endothelial homeostatic balance, leading to a prothrombotic state that offsets potential gastrointestinal benefits.Methods: A systematic review of all study publications linking cyclooxygenase-2 inhibitor nonsteroidal anti-inflammatory drugs and related cardiovascular events was performed.Results: The highest overall risks were seen with rofecoxib, 1.45 (95% CI 1.33 to 1.59), and diclofenac, 1.40 (1.27 to 1.55). The lowest risks recorded were with ibuprofen, 1.18 (1.11, 1.25), and naproxen, 1.09 (1.02, 1.16). The risk of VTE increased with diclofenac [OR 1.63 (95% CI: 1.53, 1.74)], ibuprofen [OR = 1.49 (95% CI: 1.38, 1.62)], meloxicam [OR = 1.29 (95% CI: 1.11, 1.50)] and coxibs [celecoxib, OR= 1.30 (95% CI: 1.11, 1.51); rofecoxib, OR= 1.44 (95% CI: 1.18, 1.76)]. Naproxen did not increase the risk of VTE [OR = 1.00 (95% CI: 0.89, 1.12)]. Furthermore, there is a significant association with atrial fibrillation for etoricoxib (HR 1.35; 95% CI 1.19–1.54). Conclusion: This review suggests that the risk of these adverse effects is greater in patients with an earlier history of cardiovascular disease or at considerable risk for developing it. Evidence shows that among the widely used NSAIDs, low-dose naproxen and ibuprofen are less likely to increase cardiovascular risk. Data for etoricoxib were sparse, but in pairwise comparisons this drug had a significantly higher relative risk than either naproxen or ibuprofen. Indomethacin is an older drug that is also toxic to the gastrointestinal system, and evidence of cardiovascular risk casts doubt on its continued clinical use.

Introduction: Propofol infusion syndrome (SIP) is a rare but extremely serious condition that can occur following the administration of high doses (>2-5 mg/kg/h) of propofol for prolonged periods (>48 hours). However, cases of SIP have also been reported after low-dose or short-duration propofol infusion. The condition is characterized by metabolic acidosis, cardiovascular and renal disturbances, rhabdomyolysis, as well as electrocardiographic abnormalities, etc. Objective: To describe the main characteristics, prevention, diagnosis, and management of SIP. Methods: A literature search and selection of articles published in the last 5 years on SIP in critically ill patients were carried out in English, Spanish, and Portuguese. This was done through the Pubmed, TRipDatabase, SciELO, and Google Scholar databases, following the PRISMA methodology. Results: 26 articles were included, which analyzed the definition, general characteristics, epidemiology, risk factors, pathophysiology, clinical manifestations, prevention, and treatment. Conclusions: The literature found reports that SIP is very rare but potentially fatal. The best treatment is prevention and early diagnosis. It is important to be aware that patients receiving propofol infusion are at risk of developing SIP. Therefore, greater monitoring and knowledge of patient clinical profiles is recommended. If SIP is suspected, propofol use should be discontinued and replaced with an alternative hypnotic agent, and management should be initiated. This includes immediate discontinuation of propofol infusion and problem-oriented management, such as hemodialysis, hemodynamic support, and extracorporeal membrane oxygenation in refractory cases. Further research is needed on SIP to obtain more data on its diagnosis, pathophysiology, and incidence.

Antiretroviral therapy (ART) is a fundamental key in the fight against HIV, it allows the patient to have a prolonged and high quality life, however in coinfection with opportunistic diseases such as tuberculosis, the initiation of ART can generate a greater risk of immune reconstitution inflammatory syndrome when associated with antituberculosis treatment, generating an exacerbated inflammatory response in tissues rich in Mycobacterium tuberculosis, characterized by the clinical worsening of the patient. The picture ranges from mild and self-limited symptoms to more severe effects and even death.Objectives: This systematic review aims to describe and evaluate the impact, incidence, severity and morbidity of immune reconstitution syndrome (IRRS) on the condition of HIV-positive patients, taking into account the time of ART initiation during antituberculosis treatment. Material and methods: Randomized clinical studies, case-control studies, prospective and retrospective cohorts of the last 11 years, without language limits, obtained from search bases such as PubMed, Cochrane, Embase, performed in adult humans co-infected with mycobacterium tuberculosis and human immunodeficiency virus ( HIV) were evaluated. Results: TO total of 22 scientific articles were selected and analyzed, 8 of which report that early, immediate and integrated ART of HIV in patients co-infected with TB improved survival despite the higher incidence of TB-SIRI, on the other hand 5 clinical studies affirm that integrated ART generated severe clinical pictures of SIRI-TB and increased mortality, however 5 studies observed that it is more beneficial to initiate ART at any time of anti-tuberculosis treatment, than not to initiate it. Conclusion:our analysis considers it necessary to implement antiretroviral treatment (ART) early in patients coinfected with HIV and TB regardless of the CD4 + cell / mm count, despite the risk of developing another complication such as LRTI associated with TB, taking into account the adequate management of prevention with the corresponding treatment of the opportunistic infection that precedes it, as well as the early diagnosis of LRTI-TB and its consequent treatment, which is not addressed in this review   .Keywords: "Immune reconstitution syndrome", "tuberculosis-HIV coinfection", "antiretroviral therapy", "Tuberculosis AND AIDS-Related Opportunistic Infections", "tuberculosis