Percutaneous pulmonary thrombectomy with aspiration catheters in patients with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis.

BACKGROUND: High-risk Pulmonary Embolism (PE) mortality remains very high. Systemic thrombolysis is effective but carries significant complications and contraindications related to the hemorrhagic risk. Percutaneous thrombectomy using aspiration catheters may be an alternative in patients with a high bleeding risk. OBJECTIVE: This study aimed to evaluate the results of catheter-directed thrombectomy using aspiration dedicated catheters in patients with high-risk PE and absolute contraindication to systemic thrombolysis, with specific focus on procedural success, safety, and in-hospital outcomes. METHODS: A prospective study enrolled all consecutive patients diagnosed with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis, who underwent percutaneous pulmonary thrombectomy using dedicated aspiration catheters. The study documented the effectiveness and complications of the procedure, as well as patient outcomes at discharge and during the follow-up period. RESULTS: Thirteen patients underwent percutaneous pulmonary thrombectomy using aspiration dedicated catheters. The procedure was successful for all patients, resulting in hemodynamic and respiratory improvement within the first 24 h. No deaths attributable to cardiovascular or respiratory causes occurred during admission or follow-up. Furthermore, no serious adverse events or complications were reported during the procedure or hospitalization. CONCLUSIONS: Percutaneous pulmonary thrombectomy with dedicated aspiration catheters in patients with high-risk pulmonary embolism and contraindications to systemic thrombolysis was associated with excellent clinical results and low rate of complications.

Demographic, hemodynamic characteristics, and therapeutic trends of pulmonary hypertension patients: The Pulmonary Hypertension Mexican registry (REMEHIP).

Data on demographic characteristics and therapeutic approaches in Latin American pulmonary arterial hypertension (PAH) patients are scarce. Pulmonary Hypertension Mexican registry (REMEHIP) is a multicenter Mexican registry of adult and pediatric patients, including prevalent and incident cases. Objective: assess clinical characteristics, treatment trends, and in-hospital outcomes. Inclusion: age >2 years, diagnosis of pulmonary hypertension (PH) (groups 1 and 4), right heart catheterization with mPAP ≥25 mmHg, PWP ≤ 15 mmHg, and PVR > 3 Wood unit (WU). We included 875 PH patients, 619 adults, 133 pediatric idiopathic PAH (IPAH), and 123 chronic thromboembolic pulmonary hypertension (CTEPH) patients. We enrolled 48.4% of the incident and 51.6% of the prevalent adult and pediatric patients. PAH adults: age 43 ± 15, females 81.9%, functional class (FC) (I/II) 66.5%, 6-min walk distance (6MWD) 378 ± 112 m, mPAP 57.3 ± 19.0 mmHg, confidence interval (CI) 3.3 ± 1.5 L/min/m2, PVR 12.0 ± 8.1 WU. PAH pediatrics: age 9 ± 5, females 51.1%, FC (I/II) 85.5%, 6MWD 376 ± 103 m, mPAP 49.7 ± 13.4 mmHg, CI 2.6 ± 0.9 L/min/m2, PVR 16.4 ± 13.5 WU. CTEPH: age 44 ± 17, females 56.1%, FC (I/II) 65.5%, 6MWD 369 ± 126 m, mPAP 49.7 ± 13.4 mmHg, CI 2.6 ± 0.9 L/min/m2, PVR 10.5 + 6.5 WU. When we analyzed the IPAH group separately, it sustained a high functional class I/II incidence. REMEHIP shows better functional class in young females with severe PAH than in American and European patients. Also, PAH pediatric patients had a better functional class than other registries. However, our registry also shows that our population's access to specific pharmacologic treatments is still far from optimal.

Follow-Up Study Confirms the Presence of Gastric Cancer DNA Methylation Hallmarks in High-Risk Precursor Lesions.

To adopt prevention strategies in gastric cancer, it is imperative to develop robust biomarkers with acceptable costs and feasibility in clinical practice to stratified populations according to risk scores. With this aim, we applied an unbiased genome-wide CpG methylation approach to a discovery cohort composed of gastric cancer (n = 24), and non-malignant precursor lesions (n = 64). Then, candidate-methylation approaches were performed in a validation cohort of precursor lesions obtained from an observational longitudinal study (n = 264), with a 12-year follow-up to identify repression or progression cases. H. pylori stratification and histology were considered to determine their influence on the methylation dynamics. As a result, we ascertained that intestinal metaplasia partially recapitulates patterns of aberrant methylation of intestinal type of gastric cancer, independently of the H. pylori status. Two epigenetically regulated genes in cancer, RPRM and ZNF793, consistently showed increased methylation in intestinal metaplasia with respect to earlier precursor lesions. In summary, our result supports the need to investigate the practical utilities of the quantification of DNA methylation in candidate genes as a marker for disease progression. In addition, the H. pylori-dependent methylation in intestinal metaplasia suggests that pharmacological treatments aimed at H. pylori eradication in the late stages of precursor lesions do not prevent epigenome reprogramming toward a cancer signature.

Traqueotomías en pacientes críticos durante la pandemia por COVID-19. Estudio preliminar de nuestra experiencia en el Hospital Universitario La Paz de Madrid / Tracheotomies in critical patients during the COVID-19 pandemia. Preliminary study of our experiences at La Paz University Hospital of Madrid

El brote epidémico causado por el virus SARS-CoV-2 se encuentra plenamente activo en España. Alrededor del 10-15 % de los pacientes ingresados precisan cuidados en unidades de críticos, siendo intubados de forma prolongada y precisando la realización de traqueotomías. Se realiza un estudio observacional de las traqueotomías realizadas por nuestro Servicio de Cirugía Oral y Maxilofacial a pacientes COVID-19 de unidades de cuidados intensivos realizadas entre el 17 de marzo y el 17 de abril de 2020. El estudio analiza aspectos epidemiológicos y clínicos de los pacientes, el tipo de técnica quirúrgica empleada, el tiempo quirúrgico, el tipo de cánula empleada, las complicaciones postquirúrgicas y el seguimiento clínico de los pacientes. Un total de 22 pacientes fueron sometidos a traquetomía reglada abierta. Fueron dieciocho hombres y cuatro mujeres de edades entre 40 y 77 años (64,9 años de media). En todos los casos la realización de traqueotomía fue como consecuencia del proceso pulmonar por la neumonia bilateral COVID-19. Dos pacientes presentaron un neumotórax en el postoperatorio inmediato como complicación, un paciente falleció durante la realización del procedimiento y otro tras su llegada a la Unidad de Cuidados Intensivos tras la realización de la traqueotomía. A pesar de que la traqueotomía es una técnica quirúrgica reglada, las características especiales de los pacientes COVID-19 hacen de este procedimiento una situación crítica por la inestabilidad pulmonar y la rápida desaturación del paciente. Todo ello obliga a la realización del procedimiento por facultativos con experiencia para disminuir el tiempo quirúrgico y poder enfrentarse a cualquier eventualidad

The outbreak caused by the SARS-CoV-2 virus is currently very active in Spain. Many infected people still require to be hospitalized. Around 10-15 % of hospitalized patients require intensive care, where they are intubated for a prolonged period, needing tracheotomies some weeks after the intubation. We will be conducting an observational study of the tracheotomies performed by our oral and maxillofacial Department to COVID-19 patients on intensive care units between March 17th and April 17th, 2020. This study will be analyzing the patients' epidemiological and clinical aspects, surgical technique employed, surgical time, type of cannula used, postoperative complications and the patients' clinical monitoring. A total of 22 patients underwent open elective tracheotomy. There were twenty-two males and three females aged between 40 and 77 (mean: 64,9 years-old). In all cases tracheotomy was carried out due to pulmonary process caused by COVID-19 bilateral pneumonia. Two patients presented pneumothorax in the immediate postoperatory care as a complication, one perished during the procedure and another did so after arriving to the Intensive Care Unit after the tracheotomy surgery. Even though tracheotomy is a ruled surgical technique, the special characteristics of COVID-19 patients make of this procedure a critical situation, mainly due to lung instability and quick desaturation of the patients. This requires the surgery to be carried out by experienced physicians in order to reduce operative time and to be able to react to any eventualities that may arise

Experiencia con furosemida subcutánea en una unidad de hospitalización a domicilio / Experience with subcutaneous furosemide in a home hospitalization unit

No disponible

A comprehensive phylogenetic analysis of copper transporting P1B ATPases from bacteria of the Rhizobiales order uncovers multiplicity, diversity and novel taxonomic subtypes.

The ubiquitous cytoplasmic membrane copper transporting P1B-1 and P1B-3 -type ATPases pump out Cu+ and Cu2+ , respectively, to prevent cytoplasmic accumulation and avoid toxicity. The presence of five copies of Cu-ATPases in the symbiotic nitrogen-fixing bacteria Sinorhizobium meliloti is remarkable; it is the largest number of Cu+ -transporters in a bacterial genome reported to date. Since the prevalence of multiple Cu-ATPases in members of the Rhizobiales order is unknown, we performed an in silico analysis to understand the occurrence, diversity and evolution of Cu+ -ATPases in members of the Rhizobiales order. Multiple copies of Cu-ATPase coding genes (2-8) were detected in 45 of the 53 analyzed genomes. The diversity inferred from a maximum-likelihood (ML) phylogenetic analysis classified Cu-ATPases into four monophyletic groups. Each group contained additional subtypes, based on the presence of conserved motifs. This novel phylogeny redefines the current classification, where they are divided into two subtypes (P1B-1 and P1B-3 ). Horizontal gene transfer (HGT) as well as the evolutionary dynamic of plasmid-borne genes may have played an important role in the functional diversification of Cu-ATPases. Homologous cytoplasmic and periplasmic Cu+ -chaperones, CopZ, and CusF, that integrate a CopZ-CopA-CusF tripartite efflux system in gamma-proteobacteria and archeae, were found in 19 of the 53 surveyed genomes of the Rhizobiales. This result strongly suggests a high divergence of CopZ and CusF homologs, or the existence of unexplored proteins involved in cellular copper transport.

Expanding the Donor Pool Through Intensive Care to Facilitate Organ Donation: Results of a Spanish Multicenter Study.

BACKGROUND: Intensive Care to facilitate Organ Donation (ICOD) may help to increase the donor pool. We describe the Spanish experience with ICOD. METHODS: Achieving Comprehensive Coordination in Organ Donation (ACCORD)-Spain consisted of an audit of the donation pathway from patients who died as a result of a devastating brain injury (possible donors) in 68 hospitals during November 1, 2014, to April 30, 2015. We focused on possible donors whose families were interviewed to discuss organ donation once intensive care with a therapeutic purpose was deemed futile and brain death (BD) was a likely outcome. RESULTS: Of the 1970 possible donors in ACCORD-Spain, in 257, the family was interviewed once the decision had been made not to intubate/ventilate (n = 105), with the patient under intubation/ventilation outside of the intensive care unit (n = 59), or with the patient intubated/ventilated within the intensive care unit (n = 93).Consent to ICOD was obtained in 174 cases. Consent was higher when the donor coordinator participated in the interview (odds ratio, 2.32; 95% confidence interval, 1.33-4.11; P = 0.003). One hundred thirty-one patients developed BD, of whom 117 transitioned to actual donation after BD. Of the 35 patients who did not develop BD, 2 transitioned to actual donation after circulatory death. Sixteen patients subject to ICOD were finally medically unsuitable organ donors.ICOD contributed to 24% of the 491 actual donors registered in ACCORD-Spain. CONCLUSIONS: Despite the complexity of the interview, the majority of families consented to ICOD. Estimating the probability of BD and assessing medical suitability are additional challenges of the practice. ICOD represents a clear opportunity to increase the donor pool and ensures organ donation is posed at every end-of-life care pathway.

Characterization of digestive involvement in patients with chronic T. cruzi infection in Barcelona, Spain.

BACKGROUND: Digestive damage due to Chagas disease (CD) occurs in 15-20% of patients diagnosed as a result of peristaltic dysfunction in some endemic areas. The symptoms of chronic digestive CD are non-specific, and there are numerous confounders. Diagnosis of CD may easily be missed if symptoms are not evaluated by a well trained physician. Regular tests, as barium contrast examinations, probably lack the necessary sensitivity to detect early digestive damage. METHODS: 71 individuals with T. cruzi infection (G1) and 18 without (G2) coming from Latin American countries were analyzed. They were asked for clinical and epidemiological data, changes in dietary habits, and history targeting digestive and cardiac CD symptoms. Serological tests for T. cruzi, barium swallow, barium enema, an urea breath test, and esophageal manometry were requested for all patients. PRINCIPAL FINDINGS: G1 and G2 patients did not show differences in lifestyle and past history. Fifteen (21.1%) of G1 had digestive involvement. Following Rezende criteria, esophagopathy was observed in 8 patients in G1 (11.3%) and in none of those in G2. Manometry disorders were recorded in 34 G1 patients and in six in G2. Isolated hypotensive lower esophageal sphincter (LES) was found in sixteen G1 patients (23.9%) and four G2 patients (28.8%). Achalasia was observed in two G1 patients. Among G1 patients, ineffective esophageal motility was seen in six (five with symptoms), diffuse esophageal spasm in two (one with dysphagia and regurgitation), and nutcracker esophagus in three (all with symptoms). There were six patients with hypertonic upper esophageal sphincter (UES) among G1. Following Ximenes criteria, megacolon was found in ten G1 patients (13.9%), and in none of the G2 patients. CONCLUSIONS: The prevalence of digestive chronic CD in our series was 21.1%. Dysphagia is a non-pathognomonic symptom of CD, but a good marker of early esophageal involvement. Manometry could be a useful diagnostic test in selected cases, mainly in patients with T. cruzi infection and dysphagia in whose situation barium swallow does not evidence alterations. Constipation is a common but non-specific symptom that can be easily managed. Testing for CD is mandatory in a patient from Latin America with constipation or dysphagia, and if diagnosis is confirmed, megacolon and esophageal involvement should be investigated.

Toracocentesis paliativa domiciliaria / Home palliative thoracentesis

INTRODUCCIÓN: El derrame pleural maligno (DPM) es una complicación frecuente, que suele cursar con disnea que puede disminuir significativamente la calidad de vida del paciente. Ante un DPM se acepta como primer paso la realización de una toracocentesis evacuadora que, en ocasiones, irá seguida de técnicas más definitivas. OBJETIVO: La práctica de toracocentesis fuera del ámbito hospitalario no es frecuente. En nuestra Unidad, realizamos toracocentesis evacuadora de intención paliativa en el domicilio del paciente, y para evaluar nuestros resultados revisamos las llevadas a cabo en los 4 últimos años. PACIENTES Y MÉTODOS: Estudio retrospectivo de las sucesivas toracocentesis paliativas (TP) realizadas en el domicilio en un periodo de 4 años. La indicación de TP se basa en la existencia de disnea de reposo/mínimos esfuerzos en pacientes con DPM y pronóstico vital inferior a 3 meses. Resultados Realizamos 56 TP en 26 pacientes. A su ingreso, la mediana del índice de Karnofsky de nuestros pacientes era de 40. El número de TP por paciente osciló entre uno y 9. En el 91,1% de los casos no se produjo ninguna complicación y se obtuvo alivio de la disnea en el 69,6% de ellos, con una supervivencia media tras la primera TP de 21 días. CONCLUSIONES: La TP es un método seguro, bien tolerado y eficaz para aliviar la disnea en enfermos oncológicos avanzados en los que ya no son posibles procedimientos más invasivos. Su práctica en el domicilio no parece añadir riesgos al procedimiento

INTRODUCTION: Malignant pleural effusion (MPE) is a common complication that usually causes breathlessness that can significantly decrease the quality of life of the PATIENTS: Faced with a MPE, performing a thoracentesis is accepted as a first step that could occasionally be followed by more definitive techniques. OBJECTIVE: Thoracentesis practice outside the hospital setting is rare. In our Unit, we carried out thoracentesis in the patient's home. We reviewed the procedures performed over the last4 years in order to evaluate our results PATIENTS AND METHODS: A retrospective study was conducted on the palliative thoracentesis (PT)performed at home over a period of 4 years. The indication for PT is based on the existence of dyspnea at rest/minimal exertion in patients with MPE, and a life expectancy of less than3 months. RESULTS: We performed 56 PT on 26 PATIENTS: On admission, the median Karnofsky index of our patients was 40. The number of PT per patient ranged between one and 9. In 91.1% of cases there was no complication and dyspnea relief was obtained in 69.6% of them, with a median survival after the first PT of 21 days. CONCLUSIONS: PT is a safe, well tolerated and effective in relieving dyspnea in advanced cáncer patients when invasive procedures are no longer possible. Its practice at home does not appear to add risk to the procedure

La somatostatina en el núcleo del tracto solitario comisural modula la retención de glucosa cerebral postestimulación anóxica de los quimioreceptores carotídeos en ratas / Somatostatin into the Commissural Nucleus Tractus Solitarius Modulates Brain Glucose Retention Post- Anoxic Stimulation of the Carotid Chemoreceptor in Rats

El núcleo del tracto solitario comisural (NTSc) es el centro de relevo de las fibras aferentes procedentes de los baro y quimiorreceptores carotídeos, por lo que modula la presión arterial y la glucemia ante los estímulos en dichos receptores. La estimulación anóxica con cianuro de sodio (NaCN) en los cuerpos carotídeos produce una respuesta hiperglucemiante. La somatostatina (SS) inhibe la secreción de la hormona del crecimiento y del glucagón lo que produce un efecto hipoglucemiante. La SS y sus receptores en el NTS tienen un efecto inhibidor. Se postula que la somatostatina modula la respuesta hiperglucemiante después de la estimulación de los quimiorreceptores carotídeos (QRC) con NaCN. En este trabajo, la infunsión de SS en el NTSc 4 min antes del estímulo anóxico de los QRC, disminuyó el reflejo hiperglucemiante y la retención de glucosa cerebral a los 10 min del estímulo anóxico. Se concluye que la SS en el NTSc modula la respuesta hiperglucemiante y la retención de glucosa cerebral post-estimulación anóxica de los cuerpos carotídeos en ratas

The commissural nucleus of the solitary tract (NTSc) is the relay center of the afferents fibers from the carotid baro and chemoreceptors, so that modulates blood pressure and blood sugar to stimuli in these receptors. Anoxic stimulation with sodium cyanide (NaCN) in the carotid bodies produces a hyperglycemic response. Somatostatin (SS) inhibits secretion of growth hormone and glucagon producing a hypoglycemic effect. The SS and its receptors in the NTS have an inhibitory effect. It is postulated that somatostatin modulates the hyperglycaemic response after stimulation of carotid chemoreceptors (QRC) with NaCN. In this work, the SS infusion into NTSc 4 min before the anoxic stimulation of the QRC, decreased the hyperglycemic reflex and cerebral glucose retention after 10 min of anoxic stimulus. We conclude that SS modulates the NTSc hyperglycemic response and brain glucose retention post-anoxic stimulation of the carotid bodies in rats

La somatostatina en el núcleo del tracto solitario comisural modula la retención de glucosa cerebral postestimulación anóxica de los quimioreceptores carotídeos en ratas / Somatostatin into the Commissural Nucleus Tractus Solitarius Modulates Brain Glucose Retention Post- Anoxic Stimulation of the Carotid Chemoreceptor in Rats

El núcleo del tracto solitario comisural (NTSc) es el centro de relevo de las fibras aferentes procedentes de los baro y quimiorreceptores carotídeos, por lo que modula la presión arterial y la glucemia ante los estímulos en dichos receptores. La estimulación anóxica con cianuro de sodio (NaCN) en los cuerpos carotídeos produce una respuesta hiperglucemiante. La somatostatina (SS) inhibe la secreción de la hormona del crecimiento y del glucagón lo que produce un efecto hipoglucemiante. La SS y sus receptores en el NTS tienen un efecto inhibidor. Se postula que la somatostatina modula la respuesta hiperglucemiante después de la estimulación de los quimiorreceptores carotídeos (QRC) con NaCN. En este trabajo, la infunsión de SS en el NTSc 4 min antes del estímulo anóxico de los QRC, disminuyó el reflejo hiperglucemiante y la retención de glucosa cerebral a los 10 min del estímulo anóxico. Se concluye que la SS en el NTSc modula la respuesta hiperglucemiante y la retención de glucosa cerebral post-estimulación anóxica de los cuerpos carotídeos en ratas(AU)

The commissural nucleus of the solitary tract (NTSc) is the relay center of the afferents fibers from the carotid baro and chemoreceptors, so that modulates blood pressure and blood sugar to stimuli in these receptors. Anoxic stimulation with sodium cyanide (NaCN) in the carotid bodies produces a hyperglycemic response. Somatostatin (SS) inhibits secretion of growth hormone and glucagon producing a hypoglycemic effect. The SS and its receptors in the NTS have an inhibitory effect. It is postulated that somatostatin modulates the hyperglycaemic response after stimulation of carotid chemoreceptors (QRC) with NaCN. In this work, the SS infusion into NTSc 4 min before the anoxic stimulation of the QRC, decreased the hyperglycemic reflex and cerebral glucose retention after 10 min of anoxic stimulus. We conclude that SS modulates the NTSc hyperglycemic response and brain glucose retention post-anoxic stimulation of the carotid bodies in rats(AU)

Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support.

BACKGROUND: Randomized trials assessing the effect of systemic corticosteroids on chronic obstructive pulmonary disease (COPD) exacerbations excluded patients who were mechanically ventilated or admitted to the intensive care unit (ICU). Critically ill patients constitute a population of persons who are prone to develop complications that are potentially associated with the use of corticosteroids (eg, infections, hyperglycemia, ICU-acquired paresis) that could prolong the duration of mechanical ventilation and even increase mortality. METHODS: A double-blind placebo-controlled trial was conducted to evaluate the efficacy and safety of systemic corticosteroid treatment in patients with an exacerbation of COPD who were receiving ventilatory support (invasive or noninvasive mechanical ventilation). A total of 354 adult patients who were admitted to the ICUs of 8 hospitals in 4 countries from July 2005 through July 2009 were screened, and 83 were randomized to receive intravenous methylprednisolone (0.5 mg/kg every 6 hours for 72 hours, 0.5 mg/kg every 12 hours on days 4 through 6, and 0.5 mg/kg/d on days 7 through 10) or placebo. The main outcome measures were duration of mechanical ventilation, length of ICU stay, and need for intubation in patients treated with noninvasive mechanical ventilation. RESULTS: There were no significant differences between the groups in demographics, severity of illness, reasons for COPD exacerbation, gas exchange variables, and corticosteroid rescue treatment. Corticosteroid treatment was associated with a significant reduction in the median duration of mechanical ventilation (3 days vs 4 days; P = .04), a trend toward a shorter median length of ICU stay (6 days vs 7 days; P = .09), and significant reduction in the rate of NIV failure (0% vs 37%; P = .04). CONCLUSION: Systemic corticosteroid therapy in patients with COPD exacerbations requiring mechanical ventilation is associated with a significant increase in the success of noninvasive mechanical ventilation and a reduction in the duration of mechanical ventilation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01281748.

An assessment of the Acute Kidney Injury Network creatinine-based criteria in patients submitted to mechanical ventilation.

BACKGROUND AND OBJECTIVES: The aim of our study was to assess the new diagnostic criteria of acute kidney injury (AKI) proposed by the Acute Kidney Injury Network (AKIN) in a large cohort of mechanically ventilated patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a prospective observational cohort study enrolling 2783 adult intensive care unit patients under mechanical ventilation (MV) with data on serum creatinine concentration (SCr) in the first 48 hours. The absolute and the relative AKIN diagnostic criteria (changes in SCr ≥ 0.3 mg/dl or ≥ 50% over the first 48 hours of MV, respectively) were analyzed separately. In addition, patients were classified into three groups according to their change in SCr (ΔSCr) over the first day on MV (ΔSCr): group 1, ΔSCr ≤ -0.3 mg/dl; group 2, ΔSCr between -0.3 and +0.29 mg/dl; and group 3, ΔSCr ≥ +0.3 mg/dl). The primary end point was in-hospital mortality, and secondary end points were intensive care unit and hospital length of stay, and duration of MV. RESULTS: Of 2783 patients, 803 (28.8%) had AKI according to both criteria: 431 only absolute (AKI(A)), 362 both relative and absolute (AKI(R+A)), and 10 only relative. The relative criterion identified more patients when baseline SCr (SCr0) was <0.9 mg/dl and the absolute when SCr0 was >1.5 mg/dl. The diagnosis of AKI was associated with mortality. CONCLUSIONS: Our study confirms the validity of the AKIN criteria in a population of mechanically patients and the criteria's relationship with the baseline SCr.

Epidemiology and societal costs of gastroesophageal reflux disease and Barrett's syndrome in Germany, Italy and Spain.

AIM: To estimate the economic consequences for society arising from populations with poorly treated gastroesophageal reflux disease (GERD) and Barrett's esophagus in Germany, Italy and Spain. METHODS: The following epidemiologic data were used: total population figures, the prevalence and incidence of GERD and its complications, and data on patients with poorly treated GERD, as well as data on treatment costs and active workers' presenteeism and absenteeism. These data were used to calculate the economic consequences arising from the population with poorly treated GERD and Barrett's esophagus for the healthcare system and employers in each country. RESULTS: The size of the population with poorly treated GERD with Barrett's esophagus was estimated to be 29,678 in Spain, 19,327 in Germany and 10,079 in Italy. Costs for the healthcare systems in Spain, Germany and Italy for the population with poorly treated GERD with Barrett's esophagus were estimated to be €18, 12 and 7 million, respectively, for each country. Total costs for absenteeism and presenteeism for employers due to poorly treated GERD with Barrett's esophagus were €10 million for Germany, €1 million for Italy and none for Spain. CONCLUSION: Costs due to poorly treated GERD with Barrett's esophagus represent a substantial burden for the healthcare systems of all three studied countries. Costs for employers owing to absenteeism or presenteeism of employees were low or no costs were found.

Management and outcome of mechanically ventilated neurologic patients.

OBJECTIVE: To describe and compare characteristics, ventilatory practices, and associated outcomes among mechanically ventilated patients with different types of brain injury and between neurologic and nonneurologic patients. DESIGN: Secondary analysis of a prospective, observational, and multicenter study on mechanical ventilation. SETTING: Three hundred forty-nine intensive care units from 23 countries. PATIENTS: We included 552 mechanically ventilated neurologic patients (362 patients with stroke and 190 patients with brain trauma). For comparison we used a control group of 4,030 mixed patients who were ventilated for nonneurologic reasons. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We collected demographics, ventilatory settings, organ failures, and complications arising during ventilation and outcomes. Multivariate logistic regression analysis was performed with intensive care unit mortality as the dependent variable. At admission, a Glasgow Coma Scale score ≤8 was observed in 68% of the stroke, 77% of the brain trauma, and 29% of the nonneurologic patients. Modes of ventilation and use of a lung-protective strategy within the first week of mechanical ventilation were similar between groups. In comparison with nonneurologic patients, patients with neurologic disease developed fewer complications over the course of mechanical ventilation with the exception of a higher rate of ventilator-associated pneumonia in the brain trauma cohort. Neurologic patients showed higher rates of tracheotomy and longer duration of mechanical ventilation. Mortality in the intensive care unit was significantly (p < .001) higher in patients with stroke (45%) than in brain trauma (29%) and nonneurologic disease (30%). Factors associated with mortality were: stroke (in comparison to brain trauma), Glasgow Coma Scale score on day 1, and severity at admission in the intensive care unit. CONCLUSIONS: In our study, one of every five mechanically ventilated patients received this therapy as a result of a neurologic disease. This cohort of patients showed a higher mortality rate than nonneurologic patients despite a lower incidence of extracerebral organ dysfunction.

Diagnóstico, manejo y tratamiento de la afectación digestiva en la fase crónica de la enfermedad de Chagas en países no endémicos / Diagnosis, management and treatment of chronic Chagas' gastrointestinal disease in areas where Trypanosoma cruzi infection is not endemic

La infección por Trypanosoma cruzi (T. cruzi), agente responsable de la enfermedad de Chagas, ha estado tradicionalmente ligada a las zonas rurales de América Latina, donde es transmitido por diversas especies de chinches. Esta situación epidemiológica ha ido cambiando en el transcurso de las últimas décadas, de forma que en la actualidad la enfermedad de Chagas es una patología importada diagnosticada a nivel urbano y un problema de salud pública en países no endémicos con gran número de población inmigrante, dónde la transmisión se puede producir durante el embarazo/parto, por transfusión sanguínea o por transplante de órganos. Se estima que hasta un 20% de los pacientes con infección por T. cruzi presentan afectación del aparato digestivo, que causa importante morbilidad y que requiere un manejo y tratamiento adecuado. En el presente documento se aborda el diagnóstico, manejo y tratamiento de las manifestaciones digestivas de pacientes con infección por T. cruzi en nuestro medio (AU)

Trypanosoma cruzi (T. cruzi) infection, causal agent of Chagas’ disease, has been traditionally limited to rural areas of Latinamerica, where it is transmitted by insects belonging to different species of bugs. Due to recent trends in migration, Chagas disease is now a public health problem in urban areas of endemic countries and in non endemic countries as well, where the transmission via blood products, transplantation of infected organs, or vertical transmission is possible. It is estimated that 20% of individuals infected with T. cruzi might develop symptomatic gastrointestinal disease, which causes important morbidity and needs an adequate management and treatment. The aim of this document is to improve patient care by increasing understanding among physicians and other healthcare professionals who may be involved in the management of patients infected by T. cruzi who present with gastrointestinal symptoms (AU)

Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study.

PURPOSE: To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality. METHODS: Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups. RESULTS: In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital. CONCLUSIONS: In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation.