Miocardiopatía posterior a intoxicación con monóxido de carbono. A propósito de un caso / Cardiomyopathy after carbon monoxide poisoning. About a case

La intoxicación por monóxido de carbono constituye una de las principales causas de muerte por envenenamiento en la Argentina, presentando múltiples vías de toxicidad: hipoxia anémica por formación de carboxi-hemoglobina, desplazamiento de la curva de disociación de la oxihemoglobina hacia la izquierda y la unión a proteínas intracelulares, entre otras. Los órganos dianas que más frecuentemente se afectan son el sistema nervioso central y el cardiovascular. Las afecciones cardíacas descritas son arritmias, infarto de miocardio y edema pulmonar. Se describe a su vez la miocardiopatía inducida por monóxido de carbono con diferentes grados de disfunción ventricular.Se presenta un paciente con intoxicación con monóxido de carbono con desarrollo de cardiomiopatía similar al síndrome de Tako-Tsubo, con compromiso moderado de la función del ventrículo izquierdo con restitución ad-integrum

Carbon monoxide poisoning constitutes one of the main causes of death due to poisoning in Argentina, presenting multiple toxicity pathways: anemic hypoxia due to carboxy-hemoglobin formation, displacement of the oxyhemoglobin dissociation curve to the left and the union to intracellular proteins, among others. The target organs that are most frequently affected are the central nervous system and the cardiovascular system. The heart conditions described are arrhythmias, myocardial infarction and pulmonary edema. Carbon monoxide-induced cardiomyopathy with different degrees of ventricular dysfunction is described. A patient with carbon monoxide poisoning with development of cardiomyopathy similar to Tako-Tsubo syndrome is presented, with moderate compromise of left ventricular function with ad-integrum restitution

Factores de riesgo de mortalidad de los pacientes ancianos en cuidados intensivos sin limitación del esfuerzo de tratamiento / Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort

OBJETIVO: Determinar factores pronóstico para mortalidad en los pacientes ancianos que se internan en unidades de cuidados intensivos (UCI) por enfermedad crítica aguda. DISEÑO: Estudio de cohorte prospectiva. Ámbito: Unidad de Terapia Intensiva polivalente en Hospital Universitario en Argentina. Pacientes o participantes: Se incluyeron 249 pacientes mayores de 65años que ingresaron en forma consecutiva a la UCI con requerimiento de asistencia ventilatoria mecánica durante más de 48h entre enero de 2011 y diciembre de 2012. Fueron excluidos pacientes con enfermedad neurológica degenerativa, limitación de esfuerzos terapéuticos y ventilación mecánica crónica. Variables de interés principales: Se registró la mortalidad hospitalaria, la carga de comorbilidad (índice de Charlson), APACHEII y estado previo a la enfermedad aguda: estado nutricional (valoración global subjetiva), funcionalidad (actividades de la vida diaria [AVD] o índice de Katz y Barthel), habilidades cognitivas (Short Informant Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) y calidad de vida (EQ-5D). RESULTADOS: La mortalidad hospitalaria fue del 52%. Por regresión logística, y después de ajustar por APACHEII y edad, resultaron variables independientes asociadas a mortalidad el sexo masculino, con un odds ratio (OR) de 2,46 (intervalo de confianza [IC] del 95%: 1,37-4,42), la desnutrición moderada (OR: 2,07, IC95%: 1,09-3,94), la desnutrición severa (OR: 2,20, IC95%: 1,06-4,59) y un AVD<6 (OR: 2,35, IC95%: 1,16-4,75). CONCLUSIONES: En nuestro estudio, la edad cronológica no resultó asociada a la mortalidad hospitalaria. Sin embargo, la pérdida de la independencia funcional (evaluada por AVD) y la desnutrición mostraron ser factores pronóstico. Conocer estos datos desde el ingreso por enfermedad crítica sería de utilidad a la hora de tomar decisiones relevantes respecto a la intensidad del tratamiento a instituir

OUTCOME: To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness. Design: A prospective cohort study was carried out. Setting: A polyvalent Intensive Care Unit at a University Hospital in Argentina. Patients or participants: We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48hours, between January 2011 and December 2012. Patients with degenerative neurological disease, limitation of therapeutic effort or on chronic mechanical ventilation were excluded. Principal variables of interest: In-hospital mortality, comorbidity (Charlson index), APACHEII score, and pre-acute illness status were recorded: nutritional status (subjective global assessment), functionality (activities of daily living [ADL] and Barthel index), cognitive abilities (Short Reporting Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) and quality of life (EQ-5D). Results: The in-hospital mortality rate was 52%. Logistic regression analysis, after adjusting for APACHEII score and age, identified the following independent variables associated to mortality: male gender (OR: 2.46, 95%CI: 1.37-4.42), moderate malnutrition (OR: 2.07, 95%CI: 1.09-3.94), severe malnutrition (OR: 2.20, 95%CI: 1.06-4.59), and ADL<6 (OR: 2.35, 95%CI: 1.16-4.75). Conclusions: In our study, chronological age was not associated to in-hospital mortality. However, loss of functional independence (assessed by ADL) and malnourishment were shown to be strong prognostic factors; knowing these baseline characteristics from ICU admission would be useful when making decisions regarding the intensity of treatment

Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort. / Factores de riesgo de mortalidad de los pacientes ancianos en cuidados intensivos sin limitación del esfuerzo de tratamiento.

OUTCOME: To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness. DESIGN: A prospective cohort study was carried out. SETTING: A polyvalent Intensive Care Unit at a University Hospital in Argentina. PATIENTS OR PARTICIPANTS: We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48hours, between January 2011 and December 2012. Patients with degenerative neurological disease, limitation of therapeutic effort or on chronic mechanical ventilation were excluded. PRINCIPAL VARIABLES OF INTEREST: In-hospital mortality, comorbidity (Charlson index), APACHEII score, and pre-acute illness status were recorded: nutritional status (subjective global assessment), functionality (activities of daily living [ADL] and Barthel index), cognitive abilities (Short Reporting Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) and quality of life (EQ-5D). RESULTS: The in-hospital mortality rate was 52%. Logistic regression analysis, after adjusting for APACHEII score and age, identified the following independent variables associated to mortality: male gender (OR: 2.46, 95%CI: 1.37-4.42), moderate malnutrition (OR: 2.07, 95%CI: 1.09-3.94), severe malnutrition (OR: 2.20, 95%CI: 1.06-4.59), and ADL<6 (OR: 2.35, 95%CI: 1.16-4.75). CONCLUSIONS: In our study, chronological age was not associated to in-hospital mortality. However, loss of functional independence (assessed by ADL) and malnourishment were shown to be strong prognostic factors; knowing these baseline characteristics from ICU admission would be useful when making decisions regarding the intensity of treatment.

Imaging mass spectrometry (IMS) of cortical lipids from preclinical to severe stages of Alzheimer's disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disease affecting millions of patients worldwide. Previous studies have demonstrated alterations in the lipid composition of lipid extracts from plasma and brain samples of AD patients. However, there is no consensus regarding the qualitative and quantitative changes of lipids in brains from AD patients. In addition, the recent developments in imaging mass spectrometry methods are leading to a new stage in the in situ analysis of lipid species in brain tissue slices from human postmortem samples. The present study uses the matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS), permitting the direct anatomical analysis of lipids in postmortem brain sections from AD patients, which are compared with the intensity of the lipid signal in samples from matched subjects with no neurological diseases. The frontal cortex samples from AD patients were classified in three groups based on Braak's histochemical criteria, ranging from non-cognitively impaired patients to those severely affected. The main results indicate a depletion of different sulfatide lipid species from the earliest stages of the disease in both white and gray matter areas of the frontal cortex. Therefore, the decrease in sulfatides in cortical areas could be considered as a marker of the disease, but may also indicate neurochemical modifications related to the pathogenesis of the disease. This article is part of a Special Issue entitled: Membrane Lipid Therapy: Drugs Targeting Biomembranes edited by Pablo V. Escribá.

Lipid mapping of the rat brain for models of disease.

Lipids not only constitute the primary component of cellular membranes and contribute to metabolism but also serve as intracellular signaling molecules and bind to specific membrane receptors to control cell proliferation, growth and convey neuroprotection. Over the last several decades, the development of new analytical techniques, such as imaging mass spectrometry (IMS), has contributed to our understanding of their involvement in physiological and pathological conditions. IMS allows researchers to obtain a wide range of information about the spatial distribution and abundance of the different lipid molecules that is crucial to understand brain functions. The primary aim of this study was to map the spatial distribution of different lipid species in the rat central nervous system (CNS) using IMS to find a possible relationship between anatomical localization and physiology. The data obtained were subsequently applied to a model of neurological disease, the 192IgG-saporin lesion model of memory impairment. The results were obtained using a LTQ-Orbitrap XL mass spectrometer in positive and negative ionization modes and analyzed by ImageQuest and MSIReader software. A total of 176 different molecules were recorded based on the specific localization of their intensities. However, only 34 lipid species in negative mode and 51 in positive were assigned to known molecules with an error of 5ppm. These molecules were grouped by different lipid families, resulting in: Phosphatidylcholines (PC): PC (34: 1)+K+ and PC (32: 0)+K+ distributed primarily in gray matter, and PC (36: 1)+K+ and PC (38: 1)+Na+ distributed in white matter. Phosphatidic acid (PA): PA (38: 3)+K+ in white matter, and PA (38: 5)+K+ in gray matter and brain ventricles. Phosphoinositol (PI): PI (18: 0/20: 4)-H+ in gray matter, and PI (O-30: 1) or PI (P-30: 0)-H+ in white matter. Phosphatidylserines (PS): PS (34: 1)-H+ in gray matter, and PS (38: 1)-H+ in white matter. Sphingomyelin (SM) SM (d18: 1/16: 0)-H+ in ventricles and SM (d18: 1/18: 0)-H+ in gray matter. Sulfatides (ST): ST (d18: 1/24: 1)-H+ in white matter. The specific distribution of different lipids supports their involvement not only in structural and metabolic functions but also as intracellular effectors or specific receptor ligands and/or precursors. Moreover, the specific localization in the CNS described here will enable us to analyze lipid distribution to identify their physiological conditions in rat models of neurodegenerative pathologies, such as Alzheimer's disease. This article is part of a Special Issue entitled: Membrane Lipid Therapy: Drugs Targeting Biomembranes edited by Pablo V. Escribá.

Lanzamiento de un programa de ECMO en un hospital universitario de la Argentina / Launching a program of ECMO in a hospital University of Argentina

El objetivo de este trabajo es describir el proceso para implementar un programa de ECMO en un hospital universitario de Buenos Aires, y transmitir los resultados a los tres años. Se realizó un análisis retrospectivo de 27 pacientes con ECMO desde enero de 2011: once pacientes con síndrome de dificultad respiratoria aguda y 16 postrasplante de pulmón con hipoxemia. La mediana de la edad era de 43 años (rango intercuartil 23-53); la mediana del puntaje APACHE II fue de 19 (rango intercuartil 14-21), la mediana de la PaFi, 100 (rango intercuartil 78-121) y la tasa de mortalidad, del 29%. Estos programas son factibles en la región con el entrenamiento adecuado.(AU)

The aim of this paper is to describe the process to implement an ECMO program at a university hospital in Buenos Aires, and to transmit the results after three years. A retrospective analysis of 27 patients with ECMO from January 2011 was performed, this includes patients with acute respiratory distress syndrome (n=11) and lung transplantation with hypoxemia (n=16). Patients had a median age of 43 years (IQR: 23-53), with a median APACHE II score of 19 (IQR: 14-21), a median PAFI of 100 (IQR: 78-121) and the mortality rate was 29%. These programs are feasible in the region with the right training.(AU)

Trends in prostate cancer survival in Spain: results from population-based cancer registries

INTRODUCTION: The aim of this study is to analyse the evolution of the survival of patients diagnosed with prostate cancer during the period 1995-2003. MATERIAL AND METHODS: This is a population survival study of incident cases of prostate cancer in four Spanish areas: Basque Country, Girona, Murcia and Navarra. We calculated the relative survival (RS) at 5 years and its 95% confidence intervals using a cohort analysis and adjusted for age. To assess the trend in survival between the periods (1995-1999 and 2000-2003) a Poisson regression model was used, adjusting for age, region and period, obtaining the relative risk of death. RESULTS: The number of patients diagnosed during the 1995- 1999 period was 6493 and 8331 in the period 2000-03. The RS at 5 years adjusted for age increased significantly, from 75.3% (95% CI 73.3-77.2) in the period 1995-99 to 85% (95% CI 83.4-86.4) in the period 2000-03. CONCLUSION: In Spain the survival of patients with prostate cancer has increased significantly from 1999 to 2003, probably due to the advancement in diagnosis produced by the opportunistic screening of prostate-specific antigen (PSA). Differences in the dissemination and use of the PSA level could explain the observed geographic differences in the increase of survival. It would be necessary to carry out studies to quantify the produced overdiagnosis by screening with PSA in prostate cancer (AU)

[Incidence rate trends for colorectal cancer in Navarre (North of Spain) in the 1990-2005 period]. / Tendencias en las tasas de incidencia de cáncer colorrectal en Navarra en el periodo 1990-2005.

BACKGROUND: In Spain, an increase in the incidence of colorectal cancer (CRC) has been observed in both sexes in recent years, probably due to an improved diagnostic, the westernization of dietary habits, and worse obesity levels, among others factors. In this work, the CRC incidence rate trends in different health areas in Navarre (northern Spain) are studied during the 1990-2005 period. METHODS: An estimated incidence trend curve for each health area and the corresponding confidence bands were obtained for each gender using P-spline models. RESULTS: These results show an increasing trend of CRC in most of the areas in both sexes, being less pronounced in women than in men. In the central area of Pamplona (the capital) a decreasing trend has been observed for men during the period studied. CONCLUSIONS: Primary prevention is the best strategy to change the increasing trend observed in most areas of the province of Navarre. However, a healthy lifestyle has long-term results, so it is important to have an early detection program that would serve as a short-term prevention strategy.

Hipotermia en el tratamiento del traumatismo de cráneo grave. Caso clínico y revisión de la literatura / Hypothermia in the treatment of skull trauma serious. Clinical case and review of literature

El tratamiento de la hipotermia comenzó hace más de cuatro décadas, pero en los últimos años, su uso cobró más relevancia, por lo que se realizaron múltiples estudios. Lamentablemente, los resultados son controvertidos en el tratamiento de la hipertensión intracraneal secundaria al trauma. Presentamos a un paciente con traumatismo de cráneo grave e hipertensión intracraneal resistente, en el que se utilizó la hipotermia controlada, con buena respuesta.(AU)

Treatment of hypothermia started more than four decades ago. But in recent years its use became more relevant, and multiple studies were performed. Results are controversial in the treatment of intracranial hypertension in trauma. We present a patient with severe cranial trauma and refractory intracranial hypertension, treated with controlled hypothermia, with a good response.(AU)

[Measuring Kt by ionic dialysance is a useful tool for assessing dialysis dose in critical patients]. / La determinación del Kt por dialisancia iónica es una herramienta útil para la evaluación de la dosis de diálisis en pacientes críticos.

AIM: To evaluate the Kt assessed through ionic dializance (KtOCM) in UCI patients undergoing renal replacement therapy for acute kidney injury, comparing the results with those obtained through the urea removal rate method determined by dialyzate collection (Kturea). MATERIAL AND METHODS: 18 adult UCI staying individuals suffering from renal replacement therapy requiring oliguric acute kidney injury were included in this study. RRT consisted in intermittent or extended hemodialysis performed through a Fresenius 4008E dialysis machine equipped with an on-line clearance monitor (OCM Fresenius). The KtOCM results were provided automatically. The Spearman correlation test was used to assess the relationship between the two exploratory methods and the Student s t test to compare the results obtained by the KtOCM and the Kturea. RESULTS: 35 treatments were analyzed. There were not statistically significant differences between the results form the KtOCM and the Kturea (34.9 +/- 10.69 vs 32.78 +/- 11.31, p = NS). A remarkable association was find between both methods (r = 0.87; 95CI, 0.76-0.94; p < 0.001). CONCLUSIONS: The assessment of Kt through ionic dialyzance is a simple method to estimate the dose of dialysis in critically ill patients and is and useful tool to monitor and adjust the RRT in real time according to a target dose.

La determinación del Kt por dialisancia iónica es una herramienta útil para la evaluación de la dosisde diálisis en pacientes críticos / Measuring Kt by ionic dialysance is a useful tool for assessing dialysis dose in critical patients

Objetivo: Evaluar la determinación de Kt (KtOCM) por dialisancia iónica en los pacientes sometidos a terapia de reemplazo renal (TRR) por insuficiencia renal aguda (IRA) atendidos en una unidad de cuidados intensivos (UCI), comparándola con el Kt obtenido mediante el cálculo del índice de remoción de urea obtenido por recogida del dializado (Kturea). Materiales y métodos: Se incluyeron 18 pacientes adultos, con IRA oligúrica ingresados en la UCI, con requerimiento de TRR, tratados con hemodiálisis intermitente y/o diálisis extendida. Las TRR fueron realizadas con equipos Fresenius 4008E equipados con un monitor de aclaramiento «on-line» (OCM Fresenius). La determinación de KtOCM fue realizada automáticamente por el monitor. Se efectuaron la correlación y la comparación entre KtOCM y Kturea utilizando el análisis de correlación de Spearman y el test de la t, respectivamente. Resultados: Sobre 35 tratamientos efectuados, la media de KtOCM no fue estadísticamente diferente de la del Kturea (34,9 ± 10,69 frente a 32,78 ± 11,31; NS). Se obtuvo una importante correlación y una relación lineal significativa entre los dos métodos (r = 0,87; p <0,001; intervalo de confianza [IC] 95%, 0,76-0,94%). Conclusiones: La determinación del Kt por dialisancia iónica es un método simple para estimar la dosis de diálisis en pacientes críticos y es una herramienta útil para monitorizar y ajustar las TRR en tiempo real de acuerdo con una dosis objetivo (AU)

Aim: To evaluate the Kt assessed through ionic dializance (KtOCM) in UCI patients undergoing renal replacement therapy for acute kidney injury, comparing the results with those obtained through the urea removal rate method determined by dialyzate collection (Kturea). Material and methods: 18 adult UCI staying individuals suffering from renal replacement therapy requiring oliguric acute kidney injury were included in this study. RRT consisted in intermitent or extended hemodialysis performed through a Fresenius 4008E dialysis machine equiped with an on-line clearance monitor (OCM Fresenius). The KtOCM results were provided automatically. The Spearman correlation test was used to assess the relationship between the two exploratory methods and the Student´s t test to compare the results obtained by the KtOCM and the Kturea. Results: 35 treatments were analyzed. There were not statistically significant differences between the results form the KtOCM and the Kturea (34.9 ± 10.69 vs 32.78 ± 11.31, p = NS). A remarkable association was find between both methods (r = 0.87; 95CI, 0.76-0.94; p <0.001). Conclusions: The assessment of Kt through ionic dialyzance is a simple method to estimate the dose of dialysis in critically ill patients and is and useful tool to monitor and adjust the RRT in real time according to a target dose (AU)

Balance hídrico y uso de drogas vasoactivas como predictores de mortalidad en pacientes con lesión pulmonar aguda y síndrome de distress respiratorio agudo: Estudio multicéntrico / Water balance and drug use vasoactive as predictors of mortality in patients with acute lung injury and respiratory distress syndrome acute: Multicentric study

Introducción. Desde la década de 1990, la mortalidad por el síndrome de distress respiratorio agudo ha disminuido. Sin embargo, no hay datos concluyentes acerca de que una nueva estrategia sea responsable de esta evolución (p. ej., el manejo de los fluidos). Aún no se ha dilucidado cuál es la cantidad óptima de fluidos para tratar a estos pacientes. Clásicamente la discusión se basa en estrategias liberales o conservadoras. Objetivo. El objetivo principal fue conocer cómo impacta el balance de fluidos asociado con el uso de noradrenalina en la evolución. Materiales y métodos. Se llevó a cabo un estudio observacional en 87 pacientes con síndrome de distress respiratorio agudo entre agosto y diciembre de 2007, en tres hospitales universitarios. Se utilizó el protocolo de tratamiento estándar de las Unidades de Cuidados Intensivos permitiendo la expansión en forma liberal cuando se sospechaba hipovolemia no resuelta. Resultados. Se detectaron tres situaciones de mayor riesgo y mala evolución: a) la asociación de noradrenalina y balance positivo de fluidos <2500 ml en las primeras 24 h (OR: 5,4; IC95%: 2,1-13,9; p = 0,0004), b) la asociación de noradrenalina y balance acumulativo >5500 ml en las primeras 72 h (OR: 2,7; IC95%: 1,1-6,5; p = 0,032) y c) pacientes con puntaje APACHE II >21, noradrenalina y balance positivo <2500 ml en las primeras 24 h (OR: 8,4; IC95%: 1,8-39; p = 0,008). Conclusión. La utilización de noradrenalina y escaso fluido en estrategias de reanimación que intentan "proteger" al pulmón con lesión parece no ser adecuada, según este estudio observacional(AU)

Introduction. Recent studies have shown an important decline in mortality due to acute respiratory distress syndrome since 1990. However, to date, there is no definitive evidence to demonstrate that any mode of specific therapeutic approach (i.e., fluid management) make a difference in survival or other outcome measures. The optimal fluid management of acute lung injury is not established. Classically there are two arguments: the wet or dry strategy. Objective. The main goal was to know the impact on outcome of fluid balance and the use of noradrenaline as a vasoactive drug. Materials and methods. In this observational study, 87 ventilated patients with acute respiratory distress syndrome were included from August to December 2007 in three University Critical Care Units. A standard protocol of resuscitation was used, fluid intake was liberal only in hypovolemic patients. Results. Three categories of risk and poor outcome were detected: a) noradrenaline plus positive fluid balance <2500 mL in first day (OR: 5.4; IC95%: 2.1-13.9; p = 0.0004), b) noradrenaline plus a cumulative positive balance >550 mL in first 72 hours (OR: 2.7; IC95%: 1.1-6.5; p = 0.032), c) APACHE II >21 and noradrenaline plus positive fluid balance <2500 mL in the first day (OR: 8.4; IC95%: 1.8-39; p = 0.008). Conclusion. The use of noradrenaline and conservative resuscitation with fluid in critically ill patients with acute respiratory distress syndrome in order to minimize the risk of excessive fluid therapy was associated with poor outcome and higher mortality(AU)

Qué necesitan los pacientes de sus médicos / What do the patients need from their measurements

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Diagnóstico ambiental del Area Metropolitana de Buenos Aires sistema de información ambiental

Presenta una mirada a la situación ambiental de las megaciudades, y analiza el problema de la contaminación del aire y del agua en el Area Metropolitana de Buenos Aires. Además reseña las posibilidades de aplicación del GIS a los problemas ambientales

Meso-substituted cationic porphyrins of biological interest. Photophysical and physicochemical properties in solution and bound to liposomes.

A series of cationic porphyrins with 1-4 positive charges are studied: mono(N-methyl-4-pyridyl)triphenylporphine chloride [Mono], cis(N-methyl-4-pyridyl)diphenylporphine chloride [Cis], tri(N-methyl-4-pyridyl)monophenylporphine chloride [Tri] and tetra(N-methyl-4-pyridyl)porphine chloride [Tetra]. Their photophysical properties are measured in small unilamellar vesicles and compared with those in homogeneous solution. Liposomes of L-alpha-dimyristoyl-phosphatidylcholine (100 nm diameter) and L-alpha-dipalmitoyl-phosphatidylcholine (50 nm diameter) in phosphate-buffered saline (pH = 7.4) or D2O 0.15 M NaCl were used. The effect of the medium microheterogeinity is discussed. The triplet quantum yields in liposomes for all the porphyrins are about 0.7, similar to the value obtained for Tetra in aqueous media. The singlet molecular oxygen quantum yields for the hydrophilic compounds Tri and Tetra are greater than those of the hydrophobic ones, Mono and Cis. Also, association constants (KL) of the dyes to liposomes and their localization within the membranes are determined from fluorescence and fluorescence polarization measurements, respectively. KL values are in the range of 10(4)-10(5) M-1 for all the compounds, indicating that hydrophobic and coulombic interactions between porphyrins and liposomes are responsible for the dye association. Fluorescence polarization experiments indicate that Mono and Cis can penetrate into the lipidic phase, and that Tri and Tetra are located near the polar heads of the lipidic molecules.

Técnicas de diagnóstico de la neumonía asociada a la ventilación mecánica (NAV) en Argentina / Diagnostic procedures of the ventilator-associated pneumonia in Argentina

Introducción: El diagnóstico clínico de la NAV es dificultoso. Su frecuencia de presentación varía entre el 2 y el 67 por ciento. Esta variabilidad responde en parte a los diferentes criterios diagnósticos empleados y la falta de estadarización de las técnicas para la toma de muestrtas profundas. Objetivos: 1- Conocer la metodología aplicada en Argentina para realizar el diagnóstico etiológico de la NAV. 2- Conocer las características generales de los centros donde las UCIs desarrollan su actividad. Material y métodos: Se distribuyó a 240 UCIs de Argentina un cuestionario con 32 preguntas de opinión múltiple. Los resultados se cotejaron con las recomendaciones de la ACCP de 1992. Resultados: Respondieron 40 (16,6 por ciento) de las 240 UCIs. El 87,5 por ciento utiliza algún método diagnóstico. Las técnicas broncoscopías (FBC) se utilizan sistemáticamente en un 25 por ciento y ocasionalmente en un 60 por ciento, seguido del Aspirado Traqueal Simple (ATS) 25 por ciento y 27,5 por ciento y el Cualitativo (ATC) 15 por ciento y 32,5 por ciento respectivamente. Un 12,5 por ciento no utiliza ningún método. El 67,5 por ciento utiliza Lavado Broncoalveolar (LBA) el 32,5 por ciento Broncoaspirado (BAS) y 30 por ciento el Catéter Telescopado (CT). El neumonólogo (87,5 por ciento) fue quien efectuó la FBC (la misma persona en el 75 por ciento), en general (42,8 por ciento) con anestésicos locales y sin relajantes musculares (57,1 por ciento). Frecuentemente (64,7 por ciento) se aspiran secreciones o se realiza LBA (45,8 por ciento) antes del CT. En el 10 por ciento se obtienen secreciones de bronquio proximal y en el 60 por ciento se aspiran dichas secreciones antes del CT. El cepillo se corta en el lugar (85 por ciento) y se transporta en solución fisiológicas (100 por ciento) hasta el laboratorio en menos de 30 minutos (52,5 por ciento) donde se siembra con igual demora (80 por ciento). Un 57,5 por ciento realiza suspensión del ATB antes de tomar la muestra y un 20 por ciento no toma en cuenta los mismos. El Gram se efectúa sistemáticamente en el 54 por ciento de los casos mientras que la búsqueda de gérmenes intracelulares en el 51,4 por ciento. El 90 por ciento de la UCIs cuentan con infectólogo (If) y el 55 por ciento con equipo de control de infecciones...