ABSTRACT
Chemo-radiotherapy and systemic therapies have proven satisfactory outcomes as standard treatments for various thoracic malignancies; however, adverse pulmonary effects, like pneumonitis, can be life-threatening. Pneumonitis is caused by direct cytotoxic effect, oxidative stress, and immune-mediated injury. Radiotherapy Induced Lung Injury (RILI) encompasses two phases: an early phase known as Radiation Pneumonitis (RP), characterized by acute lung tissue inflammation as a result of exposure to radiation; and a late phase called Radiation Fibrosis (RF), a clinical syndrome that results from chronic pulmonary tissue damage. Currently, diagnoses are made by exclusion using clinical assessment and radiological findings. Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity. Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event. This review aims to discuss the clinicopathological features of pneumonitis and provide practical clinical recommendations for prevention, diagnosis, and management.
Subject(s)
Lung Injury/etiology , Neoplasms/radiotherapy , Radiation Injuries/etiology , Humans , Lung Injury/physiopathology , Lung Injury/therapy , Radiation Injuries/physiopathology , Radiation Injuries/therapy , Radiation Pneumonitis/etiology , Radiation Pneumonitis/physiopathology , Radiation Pneumonitis/therapy , Respiratory Function TestsABSTRACT
La insuficiencia cardíaca (IC) es el conjunto de signos y síntomas generados tras una falla de bomba cardíaca que origina incapacidad del corazón para proveer requerimientos metabólicos suficientes. Objetivo: Identificar los factores de riesgo de morbimortalidad en pacientes hospitalizados por IC aguda. Método: se obtuvieron datos de 60 historias que cumplían con criterios de inclusión, del periodo 2002-2012. Resultados: 60% de la población correspondía al género masculino con edad promedio de 64 años (DE +14 años). La presencia de enfermedades subyacentes se registró en 96,7% siendo la hipertensión arterial la más frecuente. La principal causa de descompensación fueron procesos infecciosos (33,3%). Las alteraciones electrocardiográficas más frecuentes fueron arritmias (33,4%), anormalidad auricular izquierda (50%) e hipertrofia ventricular izquierda (32,1%), mientras que en el ecocardiograma se evidenció fracción de eyección <45% en 73,7% de los casos y disfunción sistólica del ventrículo izquierdo en 47,4%. El tratamiento farmacológico más utilizado al ingreso se correspondió con diuréticos de asa (88%), seguido de fármacos moduladores del Sistema Renina Angiotensina Aldosterona (SRAA) con 76,7%, invirtiéndose esta proporción al egreso (moduladores del SRAA 90% y diuréticos de asa 85%). Conclusiones: predominó el género masculino con edades menores a la reportada en la literatura. La hipertensión arterial fue la patología subyacente más frecuente. Los hallazgos electrocardiográficos y ecocardiográficos concuerdan con los de estudios previos. El tratamiento de elección en nuestro centro es el recomendado en las guías de actuación(AU)
Heart failure (HF) is defined as the set of symptoms and signs secundary to cardiac pump failure, which causes inability to provide the tissues's metabolics requirements. Objective: To identify the risk factors of morbimortality in patients hospitalized with acute HF. Methods: Data from 60 medical charts were obtained, between 2002-2012. Results: 60% of the patients were males with an average age of 64 years (SD + 14 years). Underlaying diseases were recorded in 96.7% of population being the most common, hypertension. The main cause of decompensation was secondary to infectious processes (33.3%). The most frequent electrocardiographic abnormalities were arrhythmias (33.4%), left atrial abnormality (50%) and left ventricular hypertrophy (32.1%), while in the echocardiogram, ejection fraction <45% was evident in 73.7% of cases and left ventricular systolic dysfunction in 47.4%. Loop diuretics were the most widely used drug treatment at admission (88%), followed by Renin Angiotensin Aldosterone System (RAAS) modulating drugs (76.7%), reversing this ratio at discharge (RAAS modulating drugs 90% and loop diurectics 85%). Conclusions: Patients with HF are predominantly male, with younger ages than those reported in the literature. Cardiovascular diseases are the most frequent underlying pathologies. The electrocardiographic and echocardiographic findings are consistent with previous studies. The treatment of choice in our center is the recommended by the practice guidelines(AU)
