Perfil de uso de tigeciclina en un hospital universitario en Chile

Introducción: El uso de tigeciclina ha ido en aumento en los últimos años, debido al incremento de la resistencia bacteriana y la escasez de alternativas terapéuticas. Objetivo: Caracterizar y evaluar las prescripciones de tigeciclina en pacientes internados en un hospital universitario, durante los años 2017 y 2018. Metodología: Estudio observacional retrospectivo, donde se caracterizaron los pacientes, las terapias, la microbiología asociada, los desenlaces clínicos y las reacciones adversas asociadas a los tratamientos con tigeciclina. Se determinó la proporción de prescripciones apropiadas por un comité de expertos y el consumo de tigeciclina medido en DDD/100 camas-día. Resultados: Se caracterizaron 89 pacientes, de los cuales 67 (75,3%) cumplieron los criterios de selección. El 53,7% de los pacientes eran hombres, con una edad promedio de 60 ± 15 años. El principal motivo de hospitalización fue quirúrgico (65,7%). El 67,1% de los tratamientos con tigeciclina se inició en una Unidad de Paciente Critico y el foco de infección predominante fue abdominal (64,3%). El 50% de las terapias con tigeciclina fueron dirigidas según la microbiología identificada. En 65,7% de los casos se usó tigeciclina como monoterapia en la dosis habitual (62,9%). Náuseas (8,6%), diarrea (7,1%) y vómitos (4,3%) fueron los efectos adversos más reportados. El 84,3% de los tratamientos se consideraron apropiados. El año 2017 se consumió 0,4 DDD/100 camas-día y 0,6 DDD/100 camas/día el 2018, siendo la UCI el servicio que presentó el mayor uso en ambos años. Discusión: Tigeciclina fue utilizada principalmente en monoterapia para el tratamiento de infecciones intraabdominales en pacientes hospitalizados, por motivos quirúrgicos, en una unidad de paciente crítico, en las dosis habituales recomendadas de 100 mg como dosis de carga seguida de 50 mg cada 12 hs IV. En 50% de los casos, la terapia fue dirigida según microbiología. Los eventos adversos más habituales fueron los gastrointestinales. Conclusión: La mayoría de las terapias prescritas fueron consideradas apropiadas por el comité de expertos.

Background: The use of tigecycline has been increasing in recent years, due to increase in bacterial resistance and the scarcity of therapeutics alternatives. Aim: To characterize and evaluate the tigecycline prescriptions of patients hospitalized in a university hospital, during the years 2017 and 2018. Methods: A retrospective observational study was carried out, where the patients, the therapies, the associated microbiology, the clinical outcomes and the adverse reactions associated with tigecycline were characterized. The proportion of appropriate prescriptions was determined by committee of experts and the consumption of tigecycline measure in DDD/100 bed-days. Results: 89 patients who used tigecycline were characterized, of which 67 (75.3%) met the selection criteria. 53.7% of the patients were male, with a mean age of 60 +/- 15 years The main reason for hospitalization was surgical (65.7%). 67.1% of the treatments with tigecycline were started in a critical patient unit and the predominant focus of the infection was the abdomen (64.3%). 50% of the therapies with tigecycline were ordered according to the identified microbiology. In 65.7% of the cases, tigecyclin was used as monotherapy at the usual dose (62.9%). Nausea (8.6%), diarrhea (7.1%) and vomiting (4.3%) were the most reported adverse events. 84.3% of the treatments were considered appropriate. In 2017, 0.4 DDD/100 bed/days were consumed and 0.6 DDD/100 bed/days in 2018, with de ICU being the service that presented the highest use in both years. Discussion: Tigecycline was mainly used as monotherapy for the treatment of intra-abdominal infections in patients hospitalized for surgical reasons in a critical patient unit at the usual doses of 100 mg loading followed by 50 mg every 12 hours IV. In 50% of the case the therapy was directed according to microbiology. The most common adverse events were gastrointestinal. Conclusion: Most of the prescribed therapies were considered appropriate by the expert committee.

Investigation of Tritrichomonas foetus in cryopreserved bovine semen by culture and polymerase chain reaction / Pesquisa por Tritrichomonas foetus em sêmen bovino criopreservado mediante isolamento e reação em cadeia da polimerase

Bovine Trichomoniasis (BT) is an infectious disease caused by Tritrichomonas foetus that can be transmitted either sexually or by fomites. In males, the disease is asymptomatic and permanent. T. foetus has been detected in semen samples where it is able to remain viable even when frozen. The objective of this study was to investigate the presence of T. foetus in 27 samples of commercial frozen bovine semen by culture and Polymerase Chain Reaction (PCR). Samples were thawed in water at 37°C. Part of the samples was inoculated in a test tube containing Diamond's medium and incubated at 35°C. Growth was evaluated every 24 hours via direct examination under a microscope. The other part was placed in an Eppendorf tube and frozen for later molecular analysis. After 10 days of culture, all samples were negative for T. foetus. The Quick-DNA Miniprep Kit (Zymo Research) without proteinase K was used for DNA extraction. The primers used in PCR were TRF3 and TRF4. PCR results were negative for all samples. In conclusion, bovine semen samples were negative for T. foetus in both diagnostic methods, according to the adopted methodology.(AU)

A tricomonose genital bovina (TGB), uma doença infectocontagiosa causada pelo Tritrichomonas foetus, é transmitida por via venérea e fômites contaminados. Em machos a doença é assintomática e permanente. O agente já foi encontrado em amostras de sêmen e é capaz de permanecer viável quando congelado. Este trabalho teve por objetivo investigar a presença de T. foetus em 27 amostras de sêmen bovino comercial congelado, por meio de cultivo e reação em cadeia da polimerase (PCR). As amostras foram descongeladas em água a 37ºC; parte foi inoculada em tubo de ensaio contendo meio Diamond, incubada a 35ºC com consequente avaliação de crescimento e avaliada a cada 24 horas, via exame direto em microscópio, e a outra parte foi diluída em PBS para análise molecular. Após 10 dias de cultivo, todas as amostras foram negativas. Para a detecção molecular foi utilizado o kit Quick-DNA Miniprep (Zymo Research) sem proteinase K para extração do DNA. Os iniciadores utilizados na PCR foram TRF3 e TRF4. O resultado da PCR foi negativo para todas as amostras. Conclui-se que as amostras utilizadas foram realmente negativas para a presença do patógeno em ambos os métodos diagnósticos, o que comprovou a inocuidade do sêmen testado.(AU)

Afectación respiratoria por coronavirus (COVID-19) / Respiratory involvement by coronavirus (COVID-19)

In December 2019, an epidemic of cases with unexplained lower respiratory infections detected in Wuhan, China was first reported to the WHO China Office. The respiratory picture presents in various ways, from asymptomatic or paucisymptomatic forms, to clinical conditions characterized by respiratory failure that require mechanical ventilation and support in the ICU, with multi-organ and systemic manifestations in terms of sepsis, septic shock and multiple organ dysfunction syndromes. The etiological agent was identified as a virus belonging to the coronavirus family (CoV) with a high contagion capacity that determined its rapid spread, triggering a pandemic with high morbidity and mortality. This review attempts to address the basics of this disease.

Enfermedad Pulmonar Obstructiva Crónica en el Siglo XXI - Optimismo basado en evidencia / Chronic Obstructive Pulmonary Disease in the 21st Century - Evidence-based optimism

There are increasingly more data on the prevalence and distribution of Chronic Obstructive Pulmonary Disease (COPD) from around the world. COPD is predicted to be the third most frequent cause of death in the world by 2020. COPD is mainly caused by chronic tobacco smoking, which induces important changes in both the airways and lung parenchyma. COPD is a progressive, disabling condition that ultimately ends in respiratory failure and death. Is a multicomponent disease, there is evidence that systemic inflammation and extrapulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD has been associated with a nihilistic attitude. On the basis of current evidence, this nihilistic attitude is totally unjustified. The disease must be viewed through the lens of a new paradigm: COPD is not only preventable but also treatable. The past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientific evidence now documents the efficacy of various therapies for symptoms and exacerbations. It is clear that many patients with COPD can benefit from aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. In addition, basic and clinical scientists have now identified cells, mechanisms, and molecules that appear to play key roles in disease pathogenesis. Additional novel treatments are on the horizon and the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health. The good news about COPD is to increase awareness of the disease. COPD is now viewed under a new paradigm as preventable and treatable.

Mosquito species occurrence in association with landscape composition in green urban areas / Ocorrência de espécies de mosquitos associada à composição de paisagem em áreas verdes urbanas

Abstract Aedes aegypti prefers densely populated habitats, but has been shown to explore less anthropogenic environments. We investigated composition of the abundance of mosquitoes in forested areas and assessed relationships between species occurrences and different types of land use and land cover at three spatial scales (100m, 500m and 1000m). Mosquitoes were collected from October 2012 to March 2013 using oviposition traps. We collected 4,179 mosquitoes in total including at least 10 species. Aedes albopictus and Limatus durhami were eudominant species, representing 90% of all collected individuals. We found intraspecific differences in response to land use and land cover, and species response patterns were similar at all spatial scales. Ae. albopictus relative abundance was associated with urbanized areas, while Li. durhami, Haemagogus leucocelaenus and Toxorhynchites sp., abundances were associated with native forest. Aedes aegypti were found in five of the eight areas studied, including in an Atlantic forest fragment at a considerable distance from the forest edge (370 m). Aedes aegypti occurrence was not influenced by type of land use or land cover.

Resumo Aedes aegypti tem como habitat preferencial áreas densamente povoadas, mas que tem se mostrado capaz de explorar ambientes menos antropizados. O objetivo desse trabalho foi investigar a abundância de mosquitos em áreas florestadas e avaliar a relação dos diferentes tipos de uso e cobertura do solo, em três escalas de paisagem (buffer de 100m, 500m e 1000m). Os mosquitos foram coletados entre outubro de 2012 a março de 2013 utilizando armadilhas de oviposição. Foram coletados 4,179 culicídeos, de pelo menos 10 espécies, destas, Aedes albopictus e Limatus durhami foram eudominantes, representando 90% do total de indivíduos coletados. As espécies de culicídeos respondem de maneira diversa aos tipos de uso e cobertura do solo, indicando que as afinidades mais evidentes se mantém nas três escalas avaliadas. A abundância relativa de Ae. albopictus se mostrou relacionada às áreas mais urbanizadas, enquanto a de Li. durhami, Haemagogus leucocelaenus e Toxorhynchites sp., à presença da mata nativa. Aedes aegypti esteve presente em cinco das oito áreas estudadas, incluindo um fragmento de Mata Atlântica a uma distância considerável da borda (370m). A ocorrência de Aedes aegypti nas áreas analisadas não demonstrou ser influenciada pelo tipo de uso e cobertura do solo.

Histological and Histochemical Characterization of the Midgut of Healthy Aedes aegypti Larvae

Aedes aegypti (Diptera, Culicidae) is the predominant mosquito vector of several arboviruses such as dengue fever, yellow fever, chikungunya and zika. The larval stage is the major period of feeding and growth of these insects. Many of the products tested for Ae. aegypti control are ingested by the larvae in their natural environment or under laboratory conditions. In some situations, the identification of tissue lesions caused by the ingestion of such products serves as the primary way to understand their mechanism of action and confirm their effectiveness. Therefore, we aimed to conduct studies on the histological and histochemical characteristics of Ae. aegypti larvae in order to contribute to a better understanding of the pathogenicity caused by chemical or biological products for larval control. Therefore, we characterized tissues in the midgut of healthy Ae. aegypti larvae and present high quality images. These images are intended for comparison with results of morphohistochemical studies testing the effect of control substances in mosquito larvae.

Ventilation-induced changes correlate to pulmonary vascular response and VEGF, VEGFR-1/2, and eNOS expression in the rat model of postnatal hypoxia

Neonatal asphyxia occurs due to reduction in oxygen supply to vital organs in the newborn. Rapid restoration of oxygen to the lungs after a long period of asphyxia can cause lung injury and decline of respiratory function, which result from the activity of molecules that induce vascular changes in the lung such as nitric oxide (NO) and vascular endothelial growth factors (VEGF). In this study, we evaluated the pulmonary and vascular morphometry of rats submitted to the model of neonatal asphyxia and mechanical ventilation, their expression of pulmonary VEGF, VEGF receptors (VEGFR-1/VEGFR-2), and endothelial NO synthase (eNOS). Neonate Sprague-Dawley rats (CEUA #043/2011) were divided into four groups (n=8 each): control (C), control submitted to ventilation (CV), hypoxia (H), and hypoxia submitted to ventilation (HV). The fetuses were harvested at 21.5 days of gestation. The morphometric variables measured were body weight (BW), total lung weight (TLW), left lung weight (LLW), and TLW/BW ratio. Pulmonary vascular measurements, VEGFR-1, VEGFR-2, VEGF, and eNOS immunohistochemistry were performed. The morphometric analysis showed decreased TLW and TLW/BW ratio in HV compared to C and H (P<0.005). Immunohistochemistry showed increased VEGFR-2/VEGF and decreased VEGFR-1 expression in H (P<0.05) and lower eNOS expression in H and HV. Median wall thickness was increased in H, and the expression of VEGFR-1, VEGFR-2, VEGF, and eNOS was altered, especially in neonates undergoing H and HV. These data suggested the occurrence of arteriolar wall changes mediated by NO and VEGF signaling in neonatal hypoxia.

Caracterización general de los pacientes con EPOC de la Región del Maule: resultados preliminares del estudio MaulEPOC / General characterization of COPD patients from the Maule Region, Chile: preliminary results of the MaulEPOC study

El objetivo de esta comunicación fue evaluar el perfil epidemiológico de los pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) de la Región del Maule. Para ello, se contó con 127 pacientes EPOC clínicamente estables derivados por parte del neumólogo o que fueron atendidos en el centro de diagnóstico terapéutico del Hospital Regional de Talca durante el año 2016. Los pacientes fueron sometidos a una serie de pruebas de función pulmonar y debieron contestar un cuestionario para conocer antecedentes clínicos y epidemiológicos. Tras el estudio, fueron clasificados de acuerdo al criterio GOLD que integra medidas de síntomas, disnea, espirometría y riesgo de exacerbaciones. El 56% de los pacientes fueron varones y el promedio de edad en ambos sexos fue de 71,4 años (IC 95% 67,89-71,28). Un 27% tuvieron un nivel de escolarización ≤ 4 años. El 25% fueron clasificados como GOLD A, el 33% B, el 9% C y el 33% D. El 61% de los pacientes presentaron una exposición significativa simultánea a humo de cigarrillo y humo de biomasa. Los pacientes EPOC de la Región del Maule son fundamentalmente varones, adultos mayores y, frecuentemente, con bajo nivel de escolaridad. Los principales factores de riesgo para el desarrollo de la enfermedad en esta cohorte fueron la exposición simultánea a humo de tabaco y de combustibles de biomasa. La mayoría de los pacientes se encuentran en los estadios más leves de la enfermedad. Nuestros hallazgos identificaron las principales áreas que deben ser intervenidas para mejorar el manejo de la EPOC en la Región del Maule.

This study aimed to assess the epidemiological profile of subjects from the Maule Region (Chile) suffering from Chronic Obstructive Pulmonary Disease (COPD). We recruited 127 stable-COPD patients who were attended by a pulmonologist or treated at Hospital Regional de Talca during 2016. All patients underwent lung functional tests and answered a standardized questionnaire to obtain clinical and epidemiological data. Patients were classified according to the GOLD combined COPD assessment criteria, which included symptomatic assessment with the patient's spirometric classification and risk of exacerbations. GOLD A, B, C and D categories consisted of 25%, 33%, 9% and 33% of patients respectively. The mean age was 71.4 years (CI 95% 64.7-73.7) and 56% of the patients were male. A 27% of subjects completed 4 or less years of schooling. 61% of patients showed a significant combined exposure to both cigarette and biomass smoke. COPD patients from the Maule Region are mostly elderly male, often showing a low educational level. The main COPD risk factor in this cohort was the simultaneous exposure to cigarette and biomass smoke. Most patients are in the milder stages of COPD. Our findings identified the main areas that can be intervened to improve COPD management in the Maule Region.

Mosquito species occurrence in association with landscape composition in green urban areas

Abstract Aedes aegypti prefers densely populated habitats, but has been shown to explore less anthropogenic environments. We investigated composition of the abundance of mosquitoes in forested areas and assessed relationships between species occurrences and different types of land use and land cover at three spatial scales (100m, 500m and 1000m). Mosquitoes were collected from October 2012 to March 2013 using oviposition traps. We collected 4,179 mosquitoes in total including at least 10 species. Aedes albopictus and Limatus durhami were eudominant species, representing 90% of all collected individuals. We found intraspecific differences in response to land use and land cover, and species response patterns were similar at all spatial scales. Ae. albopictus relative abundance was associated with urbanized areas, while Li. durhami, Haemagogus leucocelaenus and Toxorhynchites sp., abundances were associated with native forest. Aedes aegypti were found in five of the eight areas studied, including in an Atlantic forest fragment at a considerable distance from the forest edge (370 m). Aedes aegypti occurrence was not influenced by type of land use or land cover.

Resumo Aedes aegypti tem como habitat preferencial áreas densamente povoadas, mas que tem se mostrado capaz de explorar ambientes menos antropizados. O objetivo desse trabalho foi investigar a abundância de mosquitos em áreas florestadas e avaliar a relação dos diferentes tipos de uso e cobertura do solo, em três escalas de paisagem (buffer de 100m, 500m e 1000m). Os mosquitos foram coletados entre outubro de 2012 a março de 2013 utilizando armadilhas de oviposição. Foram coletados 4,179 culicídeos, de pelo menos 10 espécies, destas, Aedes albopictus e Limatus durhami foram eudominantes, representando 90% do total de indivíduos coletados. As espécies de culicídeos respondem de maneira diversa aos tipos de uso e cobertura do solo, indicando que as afinidades mais evidentes se mantém nas três escalas avaliadas. A abundância relativa de Ae. albopictus se mostrou relacionada às áreas mais urbanizadas, enquanto a de Li. durhami, Haemagogus leucocelaenus e Toxorhynchites sp., à presença da mata nativa. Aedes aegypti esteve presente em cinco das oito áreas estudadas, incluindo um fragmento de Mata Atlântica a uma distância considerável da borda (370m). A ocorrência de Aedes aegypti nas áreas analisadas não demonstrou ser influenciada pelo tipo de uso e cobertura do solo.

Development and evaluation of accessories to improve the posture of veterinary surgeons in surgical procedures conducted in the field / Desenvolvimento e avaliação de acessórios para melhorar a postura de cirurgiões veterinários em procedimentos cirúrgicos realizados a campo

The study was conducted based on the information collected on rural properties in the state of Goiás, during practical classes of Surgical Clinic in Large Animals at the Veterinary Hospital of the Escola de Veterinária e Zootecnia of the Universidade Federal de Goiás and during the implementation of outreach projects developed by the institution. An acropostite-phimosis surgical procedure in the bulls in the field was selected, lasting over 30 minutes and requiring movements, posture and strength on the part of the surgeon. Devices were proposed and developed to provide improved comfort and safety to surgeons. The first device was a stool to be used by the professional during the execution of the surgical intervention. The use enabled the surgeon to sit down and rest their feet on the ground, reducing knee bending and distributing the support forces in various muscle groups. For the movement restriction of the surgeon, another accessory was developed to support the foreskin of the animal. Made of wood, this other device serves as a support for keeping the foreskin away from the ground and close to the surgeon. Its length, width and thickness established a good relation with the stool height, providing minimal discomfort to the professional. The third device was designed to assist in the immobilization of the animal and increase safety for the patient and surgical team. A fourth accessory was designed to protect the scapular region and avoid the occurrence of injuries in the radial nerve, myopathies and traumas during the rollover or prolonged stay of the animal in lateral decubitus. The choice of the shape, dimensions and softness of the device was mainly based on the weight of the animal. Such devices have proven to be effective, reducing the time of surgery, making cervical and lumbar movement easier, in addition to providing better support to the surgeon, reducing risks of musculoskeletal diseases.(AU)

O estudo foi realizado com base nas informações coletadas em propriedades rurais do estado de Goiás, durante aulas práticas de Clínica Cirúrgica de Grandes Animais no Hospital Veterinário da Escola de Veterinária e Zootecnia da Universidade Federal de Goiás e durante a execução de projetos de extensão desenvolvidos pela instituição. Foi selecionado um procedimento cirúrgico de acropostite-fimose em touros a campo, com duração acima de 30 minutos e com exigência de movimentos, postura e força por parte do cirurgião. Foram propostos e desenvolvidos dispositivos para proporcionar melhor conforto e segurança aos cirurgiões. O primeiro consistiu de um assento para ser usado pelo profissional durante a execução da intervenção cirúrgica. A utilização permitiu que o cirurgião sentasse e apoiasse os pés no chão, reduzindo a flexão dos joelhos e distribuindo as forças de apoio por diversos grupos musculares. Para a restrição de movimentação do cirurgião, outro acessório foi desenvolvido para apoiar o prepúcio do animal. Confeccionado em madeira, serve de suporte para mantê-lo distante do solo e próximo ao cirurgião. Seu comprimento, largura e espessura estabeleceram boa relação com a altura do assento, proporcionando o mínimo de desconforto ao profissional. O terceiro dispositivo foi confeccionado para auxiliar na imobilização do animal e aumentar a segurança para o paciente e para a equipe de cirurgia. Um quarto acessório foi desenvolvido para proteger a região escapular e evitar a ocorrência de lesões de nervo radial, miopatias e traumas durante o derrubamento ou a permanência prolongada do animal em decúbito lateral. A escolha do formato, das dimensões e da maciez do dispositivo fundamentou-se principalmente no peso do animal. Tais dispositivos mostraram-se efetivos, pois reduziram o tempo de cirurgia, facilitaram a movimentação cervical e a lombar, além de proporcionarem um melhor apoio do cirurgião e, assim, reduzirem riscos de doenças osteomusculares.(AU)

Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1) preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4) preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated (TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW), (BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA (cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA (ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001). Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.

Efectores celulares de la respuesta inflamatoria en la enfermedad pulmonar obstructiva crónica / Cellular effectors of the inflammatory response in chronic obstructive pulmonary disease (COPD)

Approximately 3 million people in the world die every year as a consequence of COPD, which is associated with an abnormal inflammatory response of the lung to noxious particles and gases. This inflammatory pattern causes pathological changes leading to a narrowing of small airways and destruction of lung parenchyma, also known as emphysema. Classically, these changes were associated to macrophages and neutrophils, although T CD8+ lymphocytes were latter added to the equation to explain the origin of emphysematous lesions. However, in recent years, multiple evidences have arisen indicating that inflammatory response in COPD is much more complex. These findings point to a key role for mast cells, dendritic cells, T CD4+ and B cells. The aim of this article is to review such evidence and report what is known so far about those cells involved in the inflammatory response in COPD.

Bebidas azucaradas, más que un simple refresco / Soft drinks, more than just a simple drink

The excessive consumption of soft drinks (SD) has shown in studies performed in animals and humans increase the risk of obesity, diabetes mellitus, metabolic syndrome, some cancers and osteoporosis. In particular, the presence of fructose in SD is the monosaccharide that is attracting more attention because of it detrimental effects on weight gain and metabolic disorders. This review focuses on the potential role of SD on the pathogenesis of obesity and other diseases, possible mechanisms of action and policies to reduce intake recommendations.

Actualmente se observa un consumo excesivo de bebidas azucaradas (BA). Estudios en animales y humanos sugieren que su consumo incrementaría el riesgo de obesidad, diabetes mellitus, síndrome metabólico, algunos tipos de cáncer, osteoporosis. En particular, la fructosa presente en las BA es el monosacrárido que está atrayendo más la atención por sus efectos perjudiciales en términos de ganancia de peso y trastornos metabólicos. Esta revisión se centra en el papel potencial de las BA sobre la patogénesis de la obesidad y otras enfermedades, posibles mecanismos de acción y recomendaciones políticas para reducir su consumo.

Síndrome Hughes-Stovin: Caso clínico / Hughes-Stovin syndrome: Report of one case

We report a 25yearold mole admitted to a critical care unit for fever, lung opacities and acute respiratory failure. A chest angio-CAT sean showed multiple pulmonary artery aneurysms. A deep venous thrombosis of both lower limbs was also documented. A Hughes-Stovin syndrome was postulated. An inferior vena cava filter was placed. The patient received antimicrobial therapy subsiding fever and respiratory failure. Subsequently, he was treated with intravenous and oral steroids and one dose of cyclophosphamide. The patient was discharged in good conditions fifteen days after admission.

Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

Fenotipos clínicos en enfermedad pulmonar obstructiva crónica: ¿volver al futuro? / Clinical phenotypes in chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, that is defined by the degree of obstruction rendered by the forced expiratory volume in the first second (FEVj). This is a good parameter to define the severity of the disease but does not account for its heterogeneity and does not provide a good comprehension of its different clinical behaviors and responses to treatment. Therefore, the classification of these patients in different clinical phenotypes has been attempted, trying to search for common clinical behaviors and responses to treatment. These phenoptypes must be validated in longitudinal studies. Some of the phenotypes detected are COPD with chronic respiratory failure and responsive to home oxygen therapy, COPD with upper lobe emphysema and responsive to volume reduction surgery, COPD with frequent exacerbation behavior, COPD resembling bronchitis and responsive to Roflumilast and possibly, COPD with systemic involvement. Historically, the phenotypes pink puffer, blue bloater, chronic bronchitis were defined. In the next years, we will know if the definitions of these phenotypes will aid in the management of patients with COPD.