Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico / Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure

Introducción: La terapia con cánula nasal de alto flujo (CNAF) se ha introducido recientemente en el tratamiento del fallo respiratorio agudo (FRA), siendo una técnica segura, confortable y eficaz que logra revertir la hipoxemia en estos pacientes. Es necesario disponer de herramientas que nos permitan detectar precozmente el fallo de este tipo de tratamiento para evitar el incremento de la mortalidad que puede conllevar. El objetivo primario de este estudio ha sido analizar el impacto que la frecuencia respiratoria (FR), la saturación periférica de oxígeno (SpO2), la fracción inspirada de oxígeno (FiO2) y el índice ROX (IROX=[SpO2/FiO2]/FR) tienen sobre el éxito de la CNAF en los pacientes con FRA hipoxémico. Los objetivos secundarios han sido analizar la estancia y la mortalidad en la UCI y la necesidad de ventilación mecánica (VM). Material y métodos Se trata de un estudio retrospectivo efectuado en una UCI polivalente del Hospital Comarcal de Montilla (Córdoba). Se incluyeron los pacientes tratados con CNAF por FRA hipoxémico desde enero de 2016 hasta enero de 2018.ResultadosDesde enero de 2016 hasta enero de 2018 se trataron 27 pacientes con FRA, de los cuales 19 (70,37%) presentaban FRA hipoxémico. De estos, 15 (78,95%) respondieron bien al tratamiento y 4 (21,05%) fracasaron. A las 2h de tratamiento la FR demostró ser el mejor predictor (área bajo la curva ROC [AUROC] 0,858; IC95%: 0,63-1,05; p=0,035). La FiO2 y el IROX fueron buenos predictores a las 8h de tratamiento (FiO2: AUROC 0,95; IC95%: 0,85-1,04; p=0,007, e IROX: AUROC 0,967; IC95%: 0,886-1,047; p=0,005). El mejor punto de corte de la FR a la segunda hora fue de 29 respiraciones/min (sensibilidad 75%, especificidad 87%). El mejor punto de corte de la FiO2 a las 8h de tratamiento fue de 0,59 (75% sensibilidad, 93% especificidad). El mejor punto de corte para IROX a las 8h de tratamiento fue de 5,98 (sensibilidad 100%, especificidad 75%). ... (AU)

Background: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV).MethodsA retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included.ResultsOut of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). ... (AU)

Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. / Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico.

BACKGROUND: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV). METHODS: A retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included. RESULTS: Out of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). CONCLUSIONS: RR after two hours of treatment, and FiO2 and ROXI after 8hours of treatment, were the best predictors of success of HFNC. RR<29rpm, FiO2<0.59 and ROXI>5.98 were associated with a lesser risk of MV.

Ambrosio Paré. Aportaciones a la cirugía / Ambroise Paré. Contributions to surgery

A Ambrosio Paré se le considera por muchos el padre de la cirugía moderna. Sin estudios académicos y actuando como barberocirujano participó en numerosas guerras, lo que le permitió adquirir amplios conocimientos y experiencia en el tratamiento de las heridas. Por otro lado llego a ser el cirujano y medico de cámara de nobles y de cuatro Reyes de Francia. Realizó múltiples aportaciones en numerosos campos del conocimiento sobre diversos temas, destacando el tratamiento de las heridas y amputaciones, realizando aportaciones en el diseño de material quirúrgico y prótesis de extremidades. En el campo vascular se podría destacar la sugerencia de la etiología de los aneurismas por la sífilis, la hemostasia de los vasos sanguíneos, la ligadura de los vasos en las amputaciones y el diseño de pinzas para la prensión de los conductos vasculares. Su obra ha quedado plasmada en numerosos documentos, en especial libros que ha servido para la trasmisión de sus aportaciones durante décadas y más bien siglos

Ambroise Paré is considered by many the father of modern surgery. Without academic studies and acting as a barber-surgeon he participated in numerous wars, which allowed him to acquire extensive knowledge and experience in the treatment of wounds. On the other hand he became the surgeon and chamber doctor of nobles and four Kings of France. He made multiple contributions in numerous fields of knowledge on various topics, highlighting the treatment of wounds and amputations, made contributions with the design of surgical material and limb prostheses. In the vascular field, the suggestion of the etiology of aneurysms due to syphilis, the hemostasis of blood vessels, the ligation of vessels in amputations and the design of forceps for blood vessel grasping could be highlighted. His work has been reflected in numerous documents, especially books that have served to transmit their contributions for decades and centuries

Traumatismos Vasculares del miembro superior / Upper-Extremity vascualr injuries

Los traumatismos de los vasos del miembro superior, en nuestro medio no es una patología muy frecuente. Sin embargo lesiones fundamentalmente iatrogénicas provocadas por los abordajes vasculares de los vasos fundamentalmente para las técnicas de monitorización de los procedimientos terapéuticos o técnicas que precisan este tipo de acceso y muy especialmente para el tratamiento de la patología coronaria, junto con otros traumatismos relacionados con los accidentes de tráficos, laborales y domésticos ha hecho que la incidencia se haya incrementado, aumentando la relevancia de este tipo de afecciones. Se analizan en el trabajo como revisión, aspectos muy variados, que van desde la etiología, etiopatogénica, clínica, diagnostico y las modalidades del tratamiento (AU)

Trauma to the vessels of the upper limb in our environment is not a very common disease. However iatrogenic injuries mainly by vascular vessel approaches techniques primarily for monitoring of therapeutic procedures or techniques that require such access and especially for the treatment of coronary disease, together with other related injuries, accidents of traffic, and domestic labor has made the incidence has increased, increasing the relevance of these types of conditions. Are analyzed at work and revision varied aspects, ranging from the etiology, etiopathogenic, clinical, diagnostic and treatment modalities (AU)

Tumor del cuerpo carotídeo en paciente joven / Carotid body tumour in young patient

Se presenta por los autores un caso de tumor carotídeo desarrollado en una joven. Se realiza una revisión sobre el manejo de este tipo de patología y se discute las características del caso con la información disponible en la bibliografía

The authors present a case of Carotid body tumor in a young women. A review of carotid body tumour management is made and have the discussion with the characteristics of the case in comparition of the information of the bibliography

Alteraciones en la onda P300 en el lóbulo occipital en pacientes depresivos / Alterations of P300 wave in occipital lobe in depressive patients

Introducción. El objetivo de este trabajo es valorar las alteraciones neurofuncionales en pacientes depresivos, analizando la actividad neurofisiológica de la onda P300 en áreas occipitales bilaterales durante tareas cognitivas de atención visual y memoria visual. Método. El estudio se realizó con un grupo de 40 sujetos, de los cuales 21 sujetos formaban el grupo control y 19 el grupo depresivo. La estimulación visual se realizó mediante el sistema Cognistin (ATI). El sujeto se sitúa a un metro de la pantalla y permanece sentado, a ser posible, sin estímulos visuales externos. A todos los sujetos se les aplicaron dos tareas diferentes: paradigma oddball visual y tarea de memoria visual. Resultados. Existe un retraso en la latencia de la onda P300 de forma global, tanto en la tarea de discriminación visual como en la tarea de memoria, en los pacientes depresivos en las áreas occipitales. Hemos encontrado una correlación negativa entre la amplitud P300 y gravedad de la depresión, de tal manera que a mayor amplitud del componente P300, menor gravedad de la depresión y viceversa. El tiempo de reacción en la tarea de discriminación visual es el que se correlaciona de manera estadísticamente significativa con la gravedad de la depresión, a mayor tiempo de reacción mayor gravedad de la misma. Conclusiones. Las conclusiones de este estudio ponen de manifiesto la existencia de alteraciones neurofuncionales en el lóbulo occipital durante una prueba de discriminación y memoria visual en pacientes depresivos

Introduction. The objective of this work is to assess neurofunctional alterations in patients with depression, analyzing the neurophysiological activity of P300 wave in bilateral occipital areas during visual attention and visual memory cognitive tasks. Method. The study was made up of a group of 40 individuals, 21 in the control group and 19 in the group with depression. Visual stimulation was made by means of Cognistin system (ATI). The person is placed at one meter from the screen and remains seated, with no external visual stimulus if possible. All individuals were subjected to two different tasks: visual «oddball» paradigm and visual memory. Results. A delay exists in latency of the P300 wave, in a global manner, both in visual task discrimination and memory task in patients with depression in the occipital areas. There is negative correlation between the P300 amplitude and severity of the depression, so that greater amplitude in the P300 component implies reduced severity of depression and vice versa. The reaction time in visual discrimination task correlates significantly with severity of depression; greater reaction time reveals greater severity in the depression. Conclusions. The conclusions of this study reveal neurofunctional alterations in the occipital lobe during visual discrimination and memory task in patients with depression

Alterations of P300 wave in occipital lobe in depressive patients.

INTRODUCTION: The objective of this work is to assess neurofunctional alterations in patients with depression, analyzing the neurophysiological activity of P300 wave in bilateral occipital areas during visual attention and visual memory cognitive tasks. METHOD: The study was made up of a group of 40 individuals, 21 in the control group and 19 in the group with depression. Visual stimulation was made by means of Cognistin system (ATI). The person is placed at one meter from the screen and remains seated, with no external visual stimulus if possible. All individuals were subjected to two different tasks: visual <> paradigm and visual memory. RESULTS: A delay exists in latency of the P300 wave, in a global manner, both in visual task discrimination and memory task in patients with depression in the occipital areas. There is negative correlation between the P300 amplitude and severity of the depression, so that greater amplitude in the P300 component implies reduced severity of depression and vice versa. The reaction time in visual discrimination task correlates significantly with severity of depression; greater reaction time reveals greater severity in the depression. CONCLUSIONS: The conclusions of this study reveal neurofunctional alterations in the occipital lobe during visual discrimination and memory task in patients with depression.

Formation of cyclopentadienyl and ruthenacyclopentadienyl derivatives through ynenyl-diyne and ynenyl-alkyne couplings onto a triruthenium cluster core.

The compound [Ru3(mu-H)(mu3-eta2-ampy)(CO)9] (1; Hampy =2-amino-6-methylpyridine) reacts with diynes RC4R in THF at reflux temperature to give the ynenyl derivatives [Ru3(mu3-eta2-ampy)(mu-eta3-RC...CC-CHR)(mu-CO)2-(CO)6] (2: R=CH2OPh; 3: R=Ph). These products contain a 1,4-disubstituted butynen-3-yl ligand attached to two ruthenium atoms. The compound [Ru3(mu-eta2-ampy)[mu3-eta6-PhCC5(C...CPh)-HPh2](CO)7] (4), which contains an eta5-cyclopentadienyl ring and a bridging carbene fragment, has also been obtained from the reaction of 1 with diphenylbutadiyne. This compound arises from a remarkable [3+2] cycloaddition reaction of a preformed 1,4-diphenylbutynen-4-yl ligand with a triple bond of a second diphenylbutadiyne molecule. The reactivity of the ynenyl derivatives 2 and 3 with diynes and alkynes has been studied. In all cases, compounds of the general formula [Ru3(mu-eta2-ampy)[mu3-eta5-C(=CHR)C=CRCR1=CR2](CO)7] (5-17) have been obtained. They all contain a ruthenacyclopentadienyl fragment formed by coupling of the coordinated ynenyl ligand of 2 (R = CH2OPh) or 3 (R = Ph) with a triple bond of the new reagent (the CR1=CR2 fragment results from the incoming diyne or alkyne reagent). While most of the products derived from 2 have the alkenyl C=CHR fragment with a Z configuration (R cis to Ru), all the compounds obtained from 3 have this fragment with an E configuration. Except 2 and 3, all the cluster complexes described in this article have a five-electron donor ampy ligand attached to only two metal atoms, a coordination mode unprecedented in cluster chemistry.

Preliminary studies of analgesic and anti-inflammatory properties of Opuntia dillenii aqueous extract.

Opuntia dillenii (Ker-Gawl) Haw is a cactus that belongs to the family Opuntiae. Lyophilized aqueous extract of the fruits of the plant, used in Canarian traditional medicine for gastrointestinal and bronchial troubles, was evaluated for analgesic and anti-inflammatory properties in rats and mice. The Opuntia dillenii extract (100-400 mg/kg, i.p.) inhibited, in a dose-related manner, carrageenan-induced paw edema in rats. A dose-dependent action was obtained against chemical (writhing test) and thermic (hot plate test) stimuli, respectively, with doses of 50 and 100 mg/kg.

Opportunities for cost reduction in diabetic retinopathy treatment: case study from Mexico.

A study was performed in order to explore the costs of treating diabetic retinopathy at a large eye hospital in Mexico with a view to identifying opportunities for improving efficiency. Clinical records of a random sample of 69 diabetic patients were reviewed for data on each patient's background, medical history, and treatment; and the costs of all resources utilized in each type of procedure provided were documented and priced. The resulting data on clinical costs was complemented by data on the private costs of treatment (medical fees, accommodation costs, transportation costs, and lost wages) that were gathered from patient interviews. The study found that the patients, who were generally poor, shouldered a substantial economic burden associated with treatment at the hospital; however, less than half this burden was in the form of fees. The rest involved other out-of-pocket expenditures on food, travel, and accommodation (45% of the total) and lost wages (10% of the total). Suggestions for reducing various of these costs without endangering treatment quality are presented. These include suggestions for reducing waiting time; reducing the number of patient visits required by increasing the strength of individual laser treatments, completing more procedures in a single visit, and reviewing hospital policy on fluoroangiograms; and increasing the chances for early and effective treatment by educating at-risk relatives accompanying the patients about the need for early treatment.

Stanozolol and danazol, unlike natural androgens, interact with the low affinity glucocorticoid-binding sites from male rat liver microsomes.

Some 17 alpha-alkylated androgens used as anabolic agents, such as stanozolol (ST) and danazol (DA), have specific effects on the liver that are not exerted by testosterone. This gives rise to the possibility that a steroid-binding protein, other than the androgen receptor, could modulate the intracellular actions of these agents. Male rat liver microsomes contain a homogeneous population of [3H]dexamethasone ([3H]DEX)-binding sites which we have denominated low affinity glucocorticoid-binding sites (LAGS). Because glucocorticoids, progestagens, and the synthetic estrogen ethynyl estradiol compete with [3H]DEX for binding to the LAGS, we aimed to study the possible interactions between androgens and the LAGS. To investigate whether several androgens had the capability of interacting with the LAGS, we performed competition experiments. The LAGS had no affinity for testosterone or methyltrienolone (R1881). However, some 17 alpha-alkylated androgens (DA (IC50, 116 nM) > ST >> fluoxymesterone > mestaline > methandriol >> methandrostenolone > methyltestosterone) were able to compete with [3H]DEX binding to liver microsomes. ST and DA were potent inhibitors of [3H]DEX binding to liver microsomes. They decreased both the affinity and the number of [3H]DEX-binding sites, increased the dissociation rate of [3H]DEX from the LAGS, and provoked a time- and dose-dependent inactivation of the [3H]DEX-binding site. These results strongly suggest that ST and DA exert a negative allosteric modulation on [3H]DEX binding to the LAGS. The in vivo administration of ST (but not other androgens) to male rats provoked a time- and dose-dependent decrease in the LAGS level. Full recovery of the LAGS concentration required at least 8 h and was blocked by protein synthesis inhibitors. Such results suggest that ST irreversibly inactivates the [3H]DEX-binding site in vivo as it does in vitro. Taken together, these observations are indicative of an irreversible interaction between some 17 alpha-alkylated androgens and the LAGS both in vitro and in vivo and suggest that ST may be an important pharmacological tool that can be used in the elucidation of the molecular structure of the LAGS. These results also mean that the LAGS are a steroid-binding entity able to distinguish between natural androgens and 17 alpha-alkylated testosterone derivatives used as anabolic agents.