The role of local inflammation in complications associated with intubation in pediatric patients: A narrative review.

Although the most important primary local inflammatory response factor to intubation is not yet clear, it is known that it may be directly attributed to the presence of trauma during intubation or the response of oral bacterial flora present in the trachea. It is known that prolonged intubation is associated with worse outcomes, but other underlying systemic issues, such as sepsis and trauma, are also associated with this result. Likewise, patients who require advanced airway management and excessive manipulation are more likely to experience complications. There are various inflammatory mediators that are generated during orotracheal intubation, many of which can be considered targets for therapies to help reduce inflammation caused by intubation. However, there is little evidence on the management of the inflammatory response induced by orotracheal intubation in pediatric patients. Therefore, the aim of this narrative review is to highlight the intubation associated complications that can arise from poorly controlled inflammation in intubated pediatric patients, review the proposed pathophysiology behind this, and discuss the current treatments that exist. Finally, taking into account the discussion on pathophysiology, we describe the current therapies being developed and future directions that can be taken in order to create more treatment options within this patient population.

Significado de la enfermedad, experiencias y expectativas de pacientes con mielofibrosis / Meaning of illness, experiences and expectations of patients with myelofibrosis

Fundamentos: La mielofibrosis es una enfermedad rara que afecta personas adultas especialmente sobre la cual no se encuentran estudios que investiguen el sentir del padecimiento en los pacientes o que aborden lo que ha representado esta enfermedad en la vida El trabajo buscó determinar el significado, las experiencias y las implicaciones que la mielofibrosis tiene en pacientes colombianos. Métodos: Estudio cualitativo de 10 pacientes con mielo fibrosis. Muestreo teórico intencionado. Técnica: entrevista a profundidad realizada por psicóloga clínica con cuestionario semiestructurado diseñado por los investigadores. Entre diciembre 2013 - enero 2014. Análisis de contenido con apoyo del software Atlas ti. Versión 7, licencia educativa multiusuario. Resultados: 7 hombres, 3 mujeres con edades entre 19-80 de varias regiones del país, con diagnostico entre 1-17 años. Edad mediana 63.5 años. Cinco con diagnóstico inicial de anemia, leucemia o hepatomegalia. Ninguno conocía previamente la enfermedad. Atribuyen la causa: cocinar con leña, manipulación de materiales en su trabajo, vida agitada sin buena alimentación o razones divinas. El padecimiento de mielofibrosis cambio las concepciones sobre la vida, sus expectativas, hábitos y costumbres. Tienen la convicción de vivir con apoyo del sistema de salud. La familia, la religión y los médicos se convierten en su apoyo. Conclusiones No conocían sobre enfermedad. Manifiestan emociones y sentimientos de incredulidad, angustia, tristeza, miedo entre otros y es la familia, la creencia en Dios y la cercanía y comprensión del médico la mejor red de apoyo. Su expectativa frente a la enfermedad es de esperanza

Background: Myelofibrosis is a rare disease on which no studies about the suffering of patients who have it have been conducted. this work seeks to determine the significance, the experiences and the implications that Myelofibrosis has in Colombian patients. Methods: This is a qualitative study method directed to Myelofibrosis diagnosed patients where theoretical intentional samples were collected. To such end, 10 interviews were conducted between December 2013 and January 2014 by a Clinical Psychologist with semi-structured questionnaires carefully designed by the researchers. The content analysis was developed with Atlas.ti® software support, multi-user educative license, version 7. Results: 7 male and 3 female patients between 19-80 years old from various regions of the country were enrolled whose illness had been diagnosed within the 1 and 17 years from the onset of symptoms. Five of the patients had an initial diagnosis of Anemia, Leukemia or Hepatomegaly. None of them knew about their disease previously. They attributed the cause to such symptoms to factors like cooking with firewood, the handling of materials at their work, busy life with poor eating habits or to spiritual reasons. Suffering from the illness has substantially changed the patients’ conceptions about life and therefore their expectations, habits, and customs. They have the conviction to continue living with the support of the health system and to overcome the disease. Family, religion, and doctors become their support. Conclusions: They did not know anything about the illness previous to the diagnosis. However, they express emotions and feelings of disbelief, anger, sadness, and fear among others and it is the family, the belief in God and the closeness and understanding of their doctors which constitutes their main support network. Hope is the only expectation he has towards the disease

Preventive effect of zaprinast and 3-isobutyl, 1-methylxanthine (phosphodiesterase inhibitors) on gastric injury induced by nonsteroidal antiinflammatory drugs in rats.

Cyclic GMP plays an important role in maintaining homeostasis in the gastric mucosa. NSAIDs damage the mucosa by mechanisms that may be mediated by alterations in the intragastric concentration of cyclic GMP. To test this hypothesis we studied the effects of the oral administration of acetylsalicylic acid (100, 300, and 500 mg/kg), piroxicam (5, 10, and 20 mg/kg) and sodium diclofenac (10, 25, 50, and 100 mg/kg), and of their interaction with zaprinast (5 mg/kg) and IBMX (10 mg/kg), on intragastric concentrations of cyclic GMP and the gastric erosive index in rats. All determinations were done 3 hr after the NSAID was given. All NSAIDs induced dose-dependent decreases in mucosal concentrations of cyclic GMP, which correlated inversely with the surface area showing mucosal injury. In contrast, cyclic GMP concentrations remained normal, and no intragastric damage was seen in rats given zaprinast (cyclic GMP-specific phosphodiesterase inhibitor) or IBMX (non-specific phosphodiesterase inhibitor) or in combination with NSAIDs. These findings are in line with the hypothesis that cyclic GMP is involved in the biochemical mechanisms of NSAID-induced gastric injury.

Mechanisms involved in protection afforded by L-arginine in ibuprofen-induced gastric damage: role of nitric oxide and prostaglandins.

L-Arginine (L-arg) exhibits multiple biological properties and plays an important role in the regulation of different functions in pathological conditions. Many of these effects could be achieved on this amino acid serving as a substrate for the enzyme nitric oxide synthase (NOS). At the gastrointestinal level, recent reports revealed its protective activities involving a hyperemic response increasing the gastric blood flow. The aim of this study was to characterize the relationship between NOS activity/expression and prostaglandin changes (PGs) in rats gastric mucosa, with L-arg associated resistance to the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (IBP). The protective effect of oral L-arg (100 mg/kg body wt), administerred together with IBP (100 mg/kg body wt, per os), was evident enough 90 min after drug administration, although a significant protection persisted for more than 6 hr. Pretreatment with N(G)-nitro-L-arginine (L-NNA) (40 mg/kg body wt, intraperitoneally), a competitive inhibitor of constitutive NOS, partly altered the protection afforded by the amino acid. In contrast, no changes could be observed after inducible NOS inhibition [aminoguanidine (AG) 50 mg/Kg body wt, intraperitoneally). L-arg, plus IBP, produced a significant increase of the cyclic GMP (cGMP) response in tissue samples from rat stomach, 90 min and 6 h after drug administration. iNOS activity and mRNA expression were higher in IBP-treated rats, and no differences were observed in inducible responses in the L-arg plus IBP group. No variations in the cNOS activity and expression were found among the different groups of animals assayed. The measurement of mucosal PGE2 content confirmed that biosynthesis of the eicosanoid is maintained by L-arg for over 90 min after IBP, while a total inhibition was observed 6 hr later. The mechanisms of the L-arg protective effect on the damaged induced by IBP could be explained by the different period after drug administration. The early phase is mediated by cyclooxygenase/prostaglandins pathway (COX/PGs) although NO liberated by cNOS and the guanylate cyclase/cGMP pathway could be also relevant. The later phase implicates inhibition of the iNOS/NO response.