Evaluación de gravedad en pacientes agudos / Evaluation of severity in acute patients

Severity meaning the risk of adverse outcomes, death or disability, varies along disease's characteristics and patient related factors. Its evaluation is complex and besides subjective perception several, more objective, clinical tools exist along with laboratory data that independently or used in combination, allows the clinician to approach severity of a given patient's condition or a particular disease. We will review several aspects of the evaluation of severity, clinical and laboratory based in addition of some scoring systems, emphasizing perfusion and organ dysfunction evaluation as key elements to assess severity particularly in critical situations. (AU)

Pérdidas hemáticas en UCI: Breve estudio descriptivo / Blood loss in ICU: Brief descriptive study

Background: Anaemia and transfusions are frequent in critically ill patients and there are avoidable causes such as routine laboratory tests. Patients and methods: Descriptive study during one continuous week including patients over 18-years old in a medical-surgical ICU. Results: 18 patients were included during a week in 12 beds in our unit, median age 62,5 years, 50% male. Median daily blood loss was 35ml, 45% in laboratory samples and 27% related to renal replacement therapy. 3 patients required 1 transfusion of red blood cells. Conclusions: There is a pattern of continuous blood loss in critically ill patients, primarily in routine laboratory tests. (AU)

Evaluación de la corrección angular de la integral velocidad tiempo en ecocardiografía. Estudio piloto / Evaluation of the angular correction of the integral velocity time in echocardiography. Pilot study

Background: Echocardiography has now a pivotal role as a tool for hemodynamic monitoring, particularly in the critically ill. However, the ideal acoustic window for relevant measurements such as the velocity time integral are not always available. We propose to evaluate if angular correction of this variable is accurate in comparison with standard technique. Patients and methods: Adult patients were evaluated in the echocardiography unit during Juny 2017, having velocity time integral measured with angulation and standard technique, with convenience sampling. Analysis included difference, means and correlation between basal results and maximal angulation, in Stata 12. Results: 25 patients were included, mean velocity time integral was 23,01cm and with a mean angulation of 32,56º the integral was 24,27cm, with 5,5% difference, statistically significant, linear correlation had a 0,932 coefficient with R-square of 0,7897. Bland-Altman analysis revealed mean difference -1,256cm and agreement limits of -5,219 to 2,707. Discussion: In this study the result of the velocity time integral with angular correction had a good correlation and acceptable precision compared with non-angled measurements, which could allow its use when the acoustic window is sub-optimal, however, these findings should be replicated in critically ill patients. (AU)

Infarto agudo al miocardio: cómo diagnosticarlo en forma precoz / Acute myocardial infarction: how to diagnose at an early stage

Acute Myocardial infarction is the first cause of death in our country, to reduce its mortality early hospitalization is critical, so adequate treatments that have demonstrated to improve survival can be applied, particularly reperfusion therapy, that requires a diagnosis before 12 hours of evolution of symptoms to be effectively used, to do this early diagnosis two key elements are basic: clinical history and electrocardiography. This two elements are reviewed as their correct application and possible related mistake.

Síndrome de Tako-tsubo: presentación y revisión actualizada del tema / Tako-Tsubo syndrome: typical clinical case and review

An acute left ventricular disfunction, induced by physical or emotional stress, has been described, known as Tako-tsubo syndrome. Acute coronary disease has shown to be its most important differential diagnosis, based on the similar clinical findings described in this group of patients. It usually presents with chest pain, reversible ST segment elevation in the electrocardiogram, discrete myocardial enzyme elevation and transient left ventricular wall motion abnormality, with no significant coronary arteries disease demonstrated. In this article we present the case of a46 year old woman with a typical Tako-tsubo’s syndrome medical profile who was hospitalized in our Hospital, with an initial diagnosis of an acute ST elevation myocardial infarction. We describe the general study and management of this syndrome and make a discussion about the subject.

Nueva estrategia para preacondicionamiento miocárdico en pacientes sometidos a cirugía cardíaca con circulación extracorpórea / Reduction of postoperative atrial fibrillation through antioxidant supplementation

INTRODUCCION: El estrés oxidativo (EO) es importante en la génesis de diversas patologías. Su rol en patología cardiovascular es reconocido, particularmente en isquemia-reperfusión, fenómeno asociado al uso de circulación extracorpórea (CEC) en cardiocirugía. Complicación frecuente es la fibrilación auricular post-operatoria(FAPO), que ha demostrado participación del EO. Estrategias que lo atenúen podrían reducir incidencia de FAPO. Este trabajo busca determinar efectos de un esquema de suplementación para prevenir el EO y FAPO. METODOLOGIA: Ensayo clínico, doble ciego, aleatorizado. A 80 pacientes programados para cardiocirugía con CEC se administró placebo (n=40) o suplementación(n=40), consistiendo desde 7 días antes de la cirugía ácidos grasos poli-insaturados omega-3 (n-3) (2 g/día), y 2 días pre-cirugía se agrega vitamina C (1 g/día) y E (400 UI/día), todo hasta el alta. Se obtuvieron muestras sanguíneas (al ingreso, en suplementación, en cirugía, en postoperatorio y al alta) y auriculares durante cirugía. El estado antioxidante fue medido por la habilidad plasmática para reducir hierro férrico (FRAP) y el índice GSH/GSSG. Se midió actividad de enzimas catalasa, superóxido-dismutasa y glutatión-peroxidasa. Lipoperoxidación fue medida por niveles de malondialdehído. Para variables paramétricas se usó t de student, entre grupos se usó ANOVA-Bonferroni. Significancia fue p<0.05. RESULTADOS: Suplementación con n-3 disminuyó índice GSH/GSSG en 25 por ciento. En postoperatorio hubo 21 por ciento menos de lipoperoxidación y niveles de FRAP 30 por ciento mayores. Actividad de enzimas mostró incremento significativo. Además disminuyó FAPO desde 25 por ciento a 7,5 por ciento. CONCLUSION: Suplementar con n-3 y vitaminas antioxidantes disminuye ocurrencia de FAPO evitando daño miocárdico bioquímico y funcional por EO.

INTRODUCTION: Oxidative stress is important in the genesis of several diseases. Their role in cardiovascular disease is recognized, particularly in ischemia-reperfusion, a phenomenon associated with the use of cardiopulmonary bypass (CPB) in cardiac surgery. Common complication is postoperative atrial fibrillation (FOAP), which has demonstrated participation of oxidative stress, strategies to mitigate what could reduce the occurrence of FOAP. This paper tries to determine the effect of a supplementation scheme to prevent oxidative stress and its consequences. MATERIALS AND METHODS: Randomized, double-blind, controlled trial. Eighty patients scheduled for CCEC received placebo (n = 40) or supplementation (n = 40). Inclusion criteria: Age 30-80 years, sinus rhythm. Exclusion criteria: previous cardiosurgery, paroxysmal atrial fibrillation, congenital heart disease, chronic diseases. The supplementation consisting of n-3 (2 g / day), vitamins C (1 g /day) and E (400 IU / day) from 7, 2 and 2 days before surgery, respectively, until discharge. In atrial tissue and blood samples the plasma ferric reducing ability (FRAP), index GSH/GSSG, activity of catalase, superoxide dismutase and glutathione-peroxidase, and malondialdehyde levels were measured. Protein carbonylationwas measured in atrial tissue. Parametric variables expressed as mean and standard error were analyzed with student’s t-test, groups were compared using ANOVA-Bonferroni. Significance was p <0.05. RESULTS: The supplementation reduced the incidence of FOAP, lipid peroxidation and protein carbonylation in 73, 21 and 19 percent (p <0.05), respectively, and increased the FRAP (30 percent) and activity of antioxidant enzymes (p <0.05). CONCLUSIONS: Antioxidant supplementation decreases FOAP probably avoiding damage by oxidative stress.

Prevalencia de control insuficiente de factores de riesgo en prevención primaria de patología coronaria / Prevalence of insufficient control of factors of risk in primary prevention of coronary pathology

Background: Coronary artery disease is an important cause of mortality and morbidity in Chile, there are known risk factors for its beginning and progress, controling them could improve prognosis. There is insufficient information on risk factor control in primary prevention, and a descriptive study was designed. Objectives: Describe the extent of use of primary prevention measures on risk factors of coronary artery disease on Chilean patients hospitalized at the Clinical Hospital of the University of Chile on prior outpatient period. Patients and methods: A survey was applied to 63 patients on their hospitalizations rooms. Blood pressure and Low Density Lipoprotein data were obtained from their charts. A database was created and risk factors were analyzed independently. Results: 100 percent of uncontrolled hypertensive patients wereundertreated. 31.25 percent smokers had not received advise on cessation. 48 percent of overweight and 37.5 percent of obese patients were under no management. 34 percent of sedentary patients reported no advise on physical exercise from their regular physicians. Conclusions: The current study reveals several risk factors being undertreated, however it presents important limitations, studies with more patients may be required to confirm these findings. Physicians should be aware of under treatment.