Estrategia invasiva precoz ajustada al riesgo en pacientes con síndrome coronario agudo sin elevación de segmento ST en Unidades de Cuidados Intensivos Cardiológicos / Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units

OBJETIVO: Las guías de práctica clínica recomiendan la estrategia invasiva precoz ajustada al riesgo (EIPAR) en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST). El objetivo fue analizar la aplicación de la EIPAR, sus condicionantes e impacto sobre el pronóstico en pacientes con SCASEST ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC). DISEÑO: Estudio de cohortes prospectivo. ÁMBITO: UCIC de 8 hospitales en Cataluña. PACIENTES: Pacientes consecutivos con SCASEST entre octubre del 2017 y marzo del 2018. El perfil de riesgo se definió mediante los criterios de la Sociedad Europea de Cardiología. INTERVENCIONES: Se definió como EIPAR la realización de coronariografía en las primeras 6 h en pacientes de muy alto riesgo o en 24 h en pacientes de alto riesgo. VARIABLES DE INTERÉS: Mortalidad/reingreso a los 6 meses. RESULTADOS: Se incluyó a 629 pacientes (edad media 66,6 años), 225 (35,9%) de muy alto riesgo y 392 (62,6%) de alto riesgo. La estrategia invasiva fue mayoritaria (96,2%). La EIPAR se aplicó en 284 pacientes (45,6%), especialmente pacientes más jóvenes, con menos comorbilidades. Estos pacientes presentaron menor estancia en UCIC y hospitalaria, así como menor incidencia de SCA, revascularizaciones y menor incidencia de muerte/reingreso a 6 meses. Tras ajustar por factores de confusión, la asociación entre adherencia y muerte/reingreso a 6 meses persistió de manera significativa (razón de riesgos: 0,66 [0,45-0,97] p = 0,035). CONCLUSIONES: La EIPAR se aplica en una minoría de SCASEST ingresados en UCIC, asociándose con una menor incidencia de eventos

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes

Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units. / Estrategia invasiva precoz ajustada al riesgo en pacientes con síndrome coronario agudo sin elevación de segmento ST en Unidades de Cuidados Intensivos Cardiológicos.

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.

Risk factors for lower airway bacterial colonization in chronic bronchitis.

The aim of this study was to determine the prevalence and risk factors for lower airway bacterial colonization (LABC) in stable chronic bronchitis (CB). Forty-one outpatients with CB were enrolled in the study (age 63.8+/-9.1 yrs (mean+/-SD); forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 62.8+/-11.2; current/former smokers 24/17). All patients had normal chest radiographs and an indication for performing fibreoptic bronchoscopy (pulmonary nodule, remote haemoptysis). The protected specimen brush (PSB) was used for bacterial sampling, and concentrations > or = 1,000 colony-forming units (cfu) x mL(-1) were considered positive for LABC. The repeatability of the procedure in CB was assessed in a random subsample of 18 subjects. A 72.2% quantitative agreement was found in the repeatability assessment of the PSB technique. Positive PSB cultures, obtained in 9 out of 41 (22%) patients, mainly yielded Haemophilus influenzae. The logistic regression model, used to determine which variables were related to colonization, showed that LABC was associated with current smoking (odds ratio (OR) 9.83, confidence interval (CI) 1.16-83.20) and low FVC (OR 0.73, CI 0.65-0.81). Age and FEV1 were not related to LABC. It was concluded that the prevalence of LABC in stable CB is high (22%), and current smoking is an important risk factor.

[The impact of bronchial colonization in the quality of life of patients with chronic, stable bronchitis]. / Impacto de la colonización bronquial en la calidad de vida del paciente con bronquitis crónica estable.

BACKGROUND: The aim of this study was to determine the impact of respiratory function and bacterial colonization of the lower airway on the quality of life of patients with chronic, stable bronchitis (CB). MATERIALS AND METHODS: A series of 41 patients with stable CB was studied (age: 63.8; standard deviation (SD) 9.1 years; FVC% 91.0 (18.9); FEV1% 74.6 (23.7); FEV1/FEC 62.8 (11.2) with normal thoracic radiography. Patients with previous diagnosis of bronchiectasia, bronchial asthma and/or positive bronchodilatory tests (> 15%) were not included in the study. Bacterial growth in a sputum sample of grade 4-5 of the Murray-Washington scale was considered diagnostic of bronchial colonization. Measurement of the quality of life was performed with the Nottingham Health Profile (NHP) and the St. George Respiratory Questionnaire (SGRQ). RESULTS: The patients presented a moderate alteration in their quality of life with scores over 25 in most of the dimensions of the NHP and the SGRQ. In 9 out of 41 cases (22%), the sputum cultures demonstrated bronchial colonization with the most frequently isolated bacterias being Haemophilus influenzae and Moraxella catarrhalis. Multivariate analysis performed with the quality of life as the dependent variable showed an association between FEV1/FEC1 and the SGRQ score (R2 = 0.18), and energy (R2 = 0.09) and physical mobility (R2 = 0.05) of NHP. CONCLUSIONS: Bronchial obstruction is the main determinant in the quality of life in patients with stable CB. Colonization of the lower airway is observed in 22% of the patients and also influences the quality of life of the patients but to a much lesser extent.

[Pancoast's syndrome secondary to neck metastasis with normal radiography of the thorax]. / Síndrome de Pancoast secundario a metástasis cervical con radiografía de tórax normal.

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Contraceptive agents from cycloaddition reactions of diarylcyclopropenones and diarylthiirene 1, 1-dioxides.

The potential for compounds with antifertility activity from the reactions of diphenylcyclopropernone (1) and 2, 3-diphenylthiirene 1, 1-dioxide (2) with enamines is described. In certain instances, a marked dissociation of antifertility from estrogenic activity was possible. Two series were studied extensively, one was stilbene amides (7) and the other stilbene amino ketones (8). The latter series (8) afforded several materials from which, on further biological work-up, was singled out compound 21 as a potent antifertility agent in rats and hamsters.

PIP: The antifertility activity from the reactions of diphenylcyclopropene (1) and 2,3-diphenylthiirene 1,1 dioxide (2) with enamines was investigated in laboratory rodents. A considerable dissociation of antifertility from estrogenic activity was observed in certain instances. Stilbene amides (7) and stilbene aminoketones (8) we re extensively studied. The stilbene aminoketone group provided several materials of which compound 21 was found to be a highly potent antifertility agent. The preparation of the materials is described.