Utilidad de la procalcitonina y proteina C reactiva en la unidad de terapia intensiva pediatrica / Utility of procalcitonin and C-reactive protein in pediatric intensive care unit / Utilidade da procalcitonina e proteína C-reativa na unidade de terapia intensiva pediátrica

El objetivo de este trabajo fue evaluar la utilidad de la Procalcitonina (PCT) y Proteina C Reactiva (PCR) en pacientes pediatricos con sospecha de infeccion bacteriana o sepsis al ingreso a la Unidad de Terapia Intensiva Pediatrica (UTIP) y posterior seguimiento como pronostico de internacion prolongada o muerte en un hospital de tercer nivel. Se realizo un estudio prospectivo observacional, unicentrico. Punto final primario: se considero un punto final combinado de muerte hospitalaria o internacion prolongada en la UTIP (mayor de 12 dias). Se dosaron Procalcitonina (VIDASR BRAHMS PCT) y PCR (Ensayo turbidimetrico BT 3000) al ingreso y al tercer dia de internacion y se calculo el aclaramiento de ambos marcadores. De 41 pacientes, 24 (58%) fallecieron o tuvieron internacion prolongada. El aclaramiento de PCT y PCR al tercer dia se asocio significativamente con menos mortalidad y menos dias de Internacion en UTIP (p=0,01 para PCT; p=0,0036 para PCR). El area bajo la curva ROC de PCR fue 0,773 y de PCT 0,735, sin diferencias significativas entre ambas curvas, No hubo diferencias significativas entre los dos grupos para los valores al ingreso de PCT y PCR (p=0,82 y p=0,95 respectivamente). Se concluye que los valores del aclaramiento de ambos marcadores pueden ser una herramienta util para el pronostico clinico.

The aim of the present work was to evaluate the usefulness of procalcitonin and C-reactive protein in pediatric patients with suspected bacterial infection or sepsis on admission to the Pediatric Intensive Care Unit (PICU) and subsequent monitoring and prognosis of prolonged hospitalization or death in a third level hospital. A prospective observational, single center study was performed and a combined endpoint of hospital death or prolonged hospitalization in the PICU (over 12 days) was considered as primary end point. Values of Procalcitonin (VIDAS ® BRAHMS PCT) and PCR (BT turbidimetric 3000) were obtained on admission and on the third day of hospitalization and clearance of both markers was calculated. Out of 41 patients, 24 (58%) died or had prolonged hospitalization. PCT and CRP clearance on the third day was significantly associated with lower mortality and shorter hospital stays in PICU (p=0.01 for PCT, p=0.0036 for PCR). The area under the ROC curve was 0.773 for CRP and PCT was 0.735, with no significant difference between both curves. No significant differences were observed between both groups for the PCT and CRP values at admission (p=0,82 and p=0,95 respectively). It can be concluded that clearance values of both markers can be a useful tool for clinical prognosis.

O objetivo de avaliar a utilidade da Procalcitonina e Proteína C-Reativa em pacientes pediátricos com suspeita de infecção bacteriana ou sepse na admissão na Unidade de Terapia Intensiva Pediátrica (UTIP) e posterior acompanhamento e prognóstico de hospitalização prolongada ou morte em um hospital de terceiro nível. Foi realizado um estudo prospectivo observacional, único centro. Ponto final primário: foi considerado um ponto final combinado de óbito hospitalar ou hospitalização prolongada na UTIP (mais de 12 dias). Foi dosada Procalcitonina (VIDAS ® BRAHMS PCT) e PCR (ensaio turbidimétrico BT 3000) na admissão e no terceiro dia de internação e foi calculado como se aclararam ambos os marcadores. Dos 41 pacientes, 24 (58%) morreram ou tiveram internação prolongada. A aclaração do PCT e PCR no terceiro dia foi significativamente associado a menor mortalidade e menor tempo de internação em UTI (p=0,01 para PCT, p=0,0036 para PCR). A área sob a curva ROC foi de 0,773 para PCR e PCT foi 0,735, sem diferença significativa entre as duas curvas. Não houve diferença significativa entre os dois grupos para os valores de PCT e renda PCR (p=0,82 e p=0,95 respectivamente). Concluiu-se que os valores de aclaração de ambos os marcadores podem ser uma ferramenta útil para o prognóstico clínico.

Reanimación protocolizada del shcok séptico / Protocolized reanimation of septic shock

Severe sepsis and septic shock are pathologies with an increasing incidence in the world. Annually, in the USA 200.000 people die because of severe sepsis, the same number that die because of a myocardial infarction, being this last disease much more common. In Chile, a multicentric study found a 40 percent of prevalence of severe sepsis in critically ill patients, with amortality of 27 percent. In this scenario, it becomes of great importance the appropriate and integral management of this condition, by means of an early diagnosis and the implementation of anaggressive protocolized resuscitation, guided by clear goals. During the first stage of the resuscitation cristalloids and/ or colloids can be used, in order to expand the intravascular space, searching for CVP around 8 to 12 mmHg. In case of hypotension refractory to the administration of fluids, it is recommended to start with increasing doses of norepinephrin untila MAP of 65 - 75 mmHg is achieved. The intensity of the septic shock can be stratified according to the requirements of norepinephrine. It is of great importance to obtain blood cultures of the patients and to start with empiric antibiotic therapy as soon as possible. The initial metabolic goal must be the normalization of the central venous oxygen saturation. The implementation of the resuscitation bundle during the first six hours, since the diagnose of severe sepsis is done, increases the chances of surviving. Protocols of sedation and analgesia, and the use of protective mechanical ventilation is highly recommended. The use of hydrocortisone and human recombinant protein C in selected patients, may have a beneficial result in the outcome.Vasopressin, terlipressin and high-volume hemofiltration can be used as rescue measures for the most severe patients.

Calcitonina: fisiologia e deficiência / Calcitonin: physiology and defficiency

O desenvolvimento e o aprimoramento das técnicas de dosagem da calcitonina sérica (CT) (radioimunoensaio e ensaios imunométricos), os avanços da biologia molecular, abriram novas e interessantes perspectivas, permitindo amplicar o conhecimento acerca da CT, este hormônio tantas vezes dito "sem funçao". Nesta revisao, sao discutidos aspectos históricos, estruturais e moleculares da CT, os métodos de dosagem, a importância e utilidade dos testes provocativos, sobretudo no diagnóstico do câncer medular da tireóide. Além disso, sao abordados os principais aspectos fisiológicos conhecidos, bem como as condiçoes caracterizadas por deficiente reserva secretóia de CT como no hipotireoidismo congênito, na tireoidite crônica autoimune, em pacientes tireoidectomizados e em mulheres no período pós-menopausa.

Efectividad de la calcitonina para detener la reabsorción externa posterior a un reimplante / Effectiveness of calcitonin to arrest external root resorption after reimplantation

La capacidad de detener el desarrollo de la reabsorción radicular externa por medio de la calcitonina (Ct) fue evaluada histopatológicamente en 53 incisivos laterales superiores e inferiores de perros, en los culaes se simuló una avulsión y una subsecuente reimplantación, con obturación de los conductos, a las 5 semanas. El período de observación fue de treinta días, y se concluyó que la Ct, tenía éxito en detener la reabsorción inflamatoria, cuando se comparó con el grupo control, y que su aplicación en dientes avulsionados disminuye la probabilidad de ocurrencia de reabsorción por reemplazo activa

Metabolismo del hueso periodontal: Parte III. Control sistémico del metabolismo de hueso / Periodontal bone metabolism: Part III. Systemic control of bone metabolism

El presente trabajo es el tercero de una serie de 5 artículos dedicados al estudio del metabolismo del hueso periodontal. En los dos primeros se hizo una descripción de la biología celular del hueso periodontal y de los fenómenos fisiológicos que se encadenan en el ciclo de remodelado óseo. El objetivo del presente trabajo es presentar una revisión actualizada del control sistémico del metabolismo de hueso. A nivel sistémico, tres hormonas principales inciden en el metabolismo del hueso periodontal: la paratohormona (PHT), la calcitonina (CT) y el metabolito activo de la vitamina D3 (1,25-dihydroxivitamina D3). La primera y la tercera tienen una acción semejante y sinérgica que está dirigida a la estimulación de la reabsorción ósea. La CT, por el contrario, tiene un efecto antagónico, ya que inhibe la función osteoclástica. Las próximas entregas tratarán acerca del control local del metabolismo óseo, así como del comportamiento del hueso periodontal en salud y enfermedad

Inhibitory effect of calcitonin on growth hormone response to growth hormone releasing hormone in acromegaly

1. A neuroendocrine role for calcitonin (CT) has been suggested by the finding of CT receptors in the hypothalamus. We have recently shown that salmon calcitonin (sCT) inhibits growth hormone releasing hormone (GHRH)-induced GH secretion in msn by a mechanism apparently independent of changes in peripheral cortisol, glucose, calcium or parathyroid levels. 2. We have further investigated the inhibitory action of sCT on GH secretion by studying the effects of sCT (100 MRC units, im) or placebo on basal and GHRH (1-29) NH2 (50µg, iv) stimulated GH secretion in 6 acromemgalic patients with active disease. 3. Basal GH lelvels were not altered by sCT administration (placebo: 136 ñ 99 µg/1 vs sCT: 99 ñ 53 µg/1). However, the GH response to GHRH was decreased by sCT. The area under the curve was signficantly smaller when patients were treated with sCT compared to placebo controls (placebo: 77202 ñ 57036 vs sCT: 64828 ñ 51909 µg min-1 1-1; P < 0.01). No changes in glucose or calcium levels were observed. 4 These results demonstrate that sCT decresases GHRH-induced GH secretion in acromegalic patients. Although the mechanism of action of sCT on GH secretion is unknown, our results indicate that the inhibitory effect of this peptide on GH secretion is also observed in patients harboring pituitary adenomas