Saliva in the Diagnosis of COVID-19: A Review and New Research Directions.

This review presents literature that highlights saliva's utility as a biofluid in the diagnosis and monitoring of COVID-19. A systematic search was performed in 5 electronic databases (PubMed, Embase, LILACS, Scopus, and Web of Science). Studies were eligible for inclusion if they assessed the potential diagnostic value and/or other discriminatory properties of biological markers in the saliva of patients with COVID-19. As of July 22, 2020, a total of 28 studies have investigated the presence of SARS-CoV-2 RNA in saliva. Several of those studies confirmed reliable detection of SARS-CoV-2 in the saliva of patients with COVID-19. Saliva offered sensitivity and specificity for SARS-CoV-2 detection comparable to that of the current standard of nasopharyngeal and throat swabs. However, the utility of saliva in diagnosing COVID-19 infection remains understudied. Clinical studies with larger patient populations that measure recordings at different stages during the disease are still necessary to confirm the accuracy of COVID-19 diagnosis with saliva. Nevertheless, the utility of saliva as a diagnostic tool opens the possibility of using rapid and less invasive diagnostic strategies by targeting bioanalytes rather than the pathogen.

Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women.

Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection.Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR).Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39-2.29; PR: 1.76, 95% CI: 1.38-2.23; and PR: 2.07, 95% CI: 1.64-2.61, respectively) and the adjusted model.Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration / Respostas de enzimas antioxidantes, pigmentos fotossintéticos e carboidratos em Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) micropropagadas, sob déficit hídrico ex vitro e após reidratação

In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.

Neste estudo, foram avaliadas as atividades de enzimas antioxidantes, pigmentos fotossintéticos, conteúdo de prolina e carboidratos em Pitcairnia encholirioides sob déficit hídrico em condições ex vitro. Os resultados mostraram que as plantas sob estresse hídrico progressivo, previamente cultivadas in vitro em meio de cultura suplementado com 30 g L-1 de sacarose e GA3 acumularam mais prolina e aumentaram a atividade da peroxidase (POD) e os teores de pigmentos fotossintéticos e carboidratos. Para plantas previamente cultivadas in vitro com 15 g L-1 de sacarose e ANA, não foram encontradas diferenças nos conteúdos de prolina e houve reduções nas atividades da peroxidase (POD), catalase (CAT) e polifenoloxidase (PPO), e no conteúdo de carboidratos, com o progresso do déficit hídrico ex vitro. Após a reidratação, as plantas apresentaram recuperação fisiológica, com atividades enzimáticas e conteúdo de metabólitos semelhantes aos encontrados nos controles não sujeitos à desidratação, independentemente das condições de cultivo in vitro. Estes resultados mostram que P. encholirioides micropropagada tem alta tolerância à desidratação uma vez em condições ex vitro, o que pode garantir a sobrevivência de plantas provenientes da cultura de tecidos quando transferidas para seu ambiente natural, enfatizando a importância desta biotecnologia para a propagação de espécies ameaçadas.

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration / Respostas de enzimas antioxidantes, pigmentos fotossintéticos e carboidratos em Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) micropropagadas, sob déficit hídrico ex vitro e após reidratação

Abstract In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.

Resumo Neste estudo, foram avaliadas as atividades de enzimas antioxidantes, pigmentos fotossintéticos, conteúdo de prolina e carboidratos em Pitcairnia encholirioides sob déficit hídrico em condições ex vitro. Os resultados mostraram que as plantas sob estresse hídrico progressivo, previamente cultivadas in vitro em meio de cultura suplementado com 30 g L-1 de sacarose e GA3 acumularam mais prolina e aumentaram a atividade da peroxidase (POD) e os teores de pigmentos fotossintéticos e carboidratos. Para plantas previamente cultivadas in vitro com 15 g L-1 de sacarose e ANA, não foram encontradas diferenças nos conteúdos de prolina e houve reduções nas atividades da peroxidase (POD), catalase (CAT) e polifenoloxidase (PPO), e no conteúdo de carboidratos, com o progresso do déficit hídrico ex vitro. Após a reidratação, as plantas apresentaram recuperação fisiológica, com atividades enzimáticas e conteúdo de metabólitos semelhantes aos encontrados nos controles não sujeitos à desidratação, independentemente das condições de cultivo in vitro. Estes resultados mostram que P. encholirioides micropropagada tem alta tolerância à desidratação uma vez em condições ex vitro, o que pode garantir a sobrevivência de plantas provenientes da cultura de tecidos quando transferidas para seu ambiente natural, enfatizando a importância desta biotecnologia para a propagação de espécies ameaçadas.

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration.

In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration / Respostas de enzimas antioxidantes, pigmentos fotossintéticos e carboidratos em Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) micropropagadas, sob déficit hídrico ex vitro e após reidratação

In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.(AU)

Neste estudo, foram avaliadas as atividades de enzimas antioxidantes, pigmentos fotossintéticos, conteúdo de prolina e carboidratos em Pitcairnia encholirioides sob déficit hídrico em condições ex vitro. Os resultados mostraram que as plantas sob estresse hídrico progressivo, previamente cultivadas in vitro em meio de cultura suplementado com 30 g L-1 de sacarose e GA3 acumularam mais prolina e aumentaram a atividade da peroxidase (POD) e os teores de pigmentos fotossintéticos e carboidratos. Para plantas previamente cultivadas in vitro com 15 g L-1 de sacarose e ANA, não foram encontradas diferenças nos conteúdos de prolina e houve reduções nas atividades da peroxidase (POD), catalase (CAT) e polifenoloxidase (PPO), e no conteúdo de carboidratos, com o progresso do déficit hídrico ex vitro. Após a reidratação, as plantas apresentaram recuperação fisiológica, com atividades enzimáticas e conteúdo de metabólitos semelhantes aos encontrados nos controles não sujeitos à desidratação, independentemente das condições de cultivo in vitro. Estes resultados mostram que P. encholirioides micropropagada tem alta tolerância à desidratação uma vez em condições ex vitro, o que pode garantir a sobrevivência de plantas provenientes da cultura de tecidos quando transferidas para seu ambiente natural, enfatizando a importância desta biotecnologia para a propagação de espécies ameaçadas.(AU)

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration

Abstract In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.

Resumo Neste estudo, foram avaliadas as atividades de enzimas antioxidantes, pigmentos fotossintéticos, conteúdo de prolina e carboidratos em Pitcairnia encholirioides sob déficit hídrico em condições ex vitro. Os resultados mostraram que as plantas sob estresse hídrico progressivo, previamente cultivadas in vitro em meio de cultura suplementado com 30 g L-1 de sacarose e GA3 acumularam mais prolina e aumentaram a atividade da peroxidase (POD) e os teores de pigmentos fotossintéticos e carboidratos. Para plantas previamente cultivadas in vitro com 15 g L-1 de sacarose e ANA, não foram encontradas diferenças nos conteúdos de prolina e houve reduções nas atividades da peroxidase (POD), catalase (CAT) e polifenoloxidase (PPO), e no conteúdo de carboidratos, com o progresso do déficit hídrico ex vitro. Após a reidratação, as plantas apresentaram recuperação fisiológica, com atividades enzimáticas e conteúdo de metabólitos semelhantes aos encontrados nos controles não sujeitos à desidratação, independentemente das condições de cultivo in vitro. Estes resultados mostram que P. encholirioides micropropagada tem alta tolerância à desidratação uma vez em condições ex vitro, o que pode garantir a sobrevivência de plantas provenientes da cultura de tecidos quando transferidas para seu ambiente natural, enfatizando a importância desta biotecnologia para a propagação de espécies ameaçadas.

Responses of antioxidant enzymes, photosynthetic pigments and carbohydrates in micropropagated Pitcairnia encholirioides L.B. Sm. (Bromeliaceae) under ex vitro water deficit and after rehydration

Abstract In this study, the activities of antioxidant enzymes, photosynthetic pigments, proline and carbohydrate contents in Pitcairnia encholirioides under ex vitro conditions of water deficit were evaluated. Results show that plants under progressive water stress, previously in vitro cultured in media supplemented with 30 g L-1 sucrose and GA3, accumulated more proline and increased peroxidase (POD) activity and the contents of photosynthetic pigments and carbohydrates. For plants previously in vitro cultured with 15 g L-1 sucrose and NAA, no differences were found for proline content and there were reductions in activities of peroxidase (POD), catalase (CAT) and poliphenoloxidase (PPO), and in contents of carbohydrates, with progress of ex vitro water deficit. After rehydration, plants showed physiological recovery, with enzymatic activities and contents of metabolites similar to those found in the controls not submitted to dehydration, regardless of the previous in vitro culture conditions. These results show that micropropagated P. encholirioides has high tolerance to dehydration once in ex vitro conditions, which can ensure the survival of plants from tissue culture when transferred to its natural environment, emphasizing the importance of such biotechnology for the propagation of endangered species.

Resumo Neste estudo, foram avaliadas as atividades de enzimas antioxidantes, pigmentos fotossintéticos, conteúdo de prolina e carboidratos em Pitcairnia encholirioides sob déficit hídrico em condições ex vitro. Os resultados mostraram que as plantas sob estresse hídrico progressivo, previamente cultivadas in vitro em meio de cultura suplementado com 30 g L-1 de sacarose e GA3 acumularam mais prolina e aumentaram a atividade da peroxidase (POD) e os teores de pigmentos fotossintéticos e carboidratos. Para plantas previamente cultivadas in vitro com 15 g L-1 de sacarose e ANA, não foram encontradas diferenças nos conteúdos de prolina e houve reduções nas atividades da peroxidase (POD), catalase (CAT) e polifenoloxidase (PPO), e no conteúdo de carboidratos, com o progresso do déficit hídrico ex vitro. Após a reidratação, as plantas apresentaram recuperação fisiológica, com atividades enzimáticas e conteúdo de metabólitos semelhantes aos encontrados nos controles não sujeitos à desidratação, independentemente das condições de cultivo in vitro. Estes resultados mostram que P. encholirioides micropropagada tem alta tolerância à desidratação uma vez em condições ex vitro, o que pode garantir a sobrevivência de plantas provenientes da cultura de tecidos quando transferidas para seu ambiente natural, enfatizando a importância desta biotecnologia para a propagação de espécies ameaçadas.

Efectos de la injuria renal isquémica aguda en la disfunción extrarenal: estudio experimental aleatorizado / Acute kidney injury and extrarenal organ dysfunction: a randomized experimental study

Introducción: La insuficiencia renal aguda (IRA) es una enfermedad grave y causante de disfunciones de órganos distantes que incrementan su mortalidad. Objetivo: Identificar disfunción hemodinámica y respiratoria gatillada por IRA en un modelo pediátrico animal de isquemia-reperfusión renal. Método: Doce cerdos anestesiados (11,9 +/- 1,0 kg). En seis animales se indujo lesión renal bilateral por isquemia-reperfusión: 45 min de isquemia y 240 min de reperfusión, mientras que los seis animales restantes fueron grupo control. En condiciones basales y posterior a lesión renal se realizó monitorización hemodinámica convencional y termodilución transpulmonar. Paralelamente se midió gasometría arterial y análisis de mecánica pulmonar. Resultados: Hubo un incremento de la precarga volumétrica en 29 por ciento (221 +/- 22 ml/m² vs 286 +/- 16 ml/m², p = 0,04) y de la presión arterial media en 58 por ciento (71 +/- 6 mmHg vs 112 +/- 17 mmHg, p = 0,04) respecto a controles, sin cambios en frecuencia cardíaca, presión venosa central ni gasto cardíaco. Además ocurrió un aumento del agua extravascular pulmonar en 86 por ciento (7,6 +/- 0,6 ml/kg vs 14,1 +/- 1,4 ml/kg, p = 0,02), sin cambios en intercambio gaseoso ni mecánica pulmonar. Simultáneamente hubo un leve deterioro de la creatinina sérica (1,12 +/- 0,07 mg/dL vs 1,45 +/- 0,10 mg/dL, p = 0,03). Discusión: En este modelo experimental se pudo apreciar el desarrollo temprano de disfunción hemodinámica y pulmonar. Se evidenció un aumento de la precarga volumétrica y de la presión arterial, asociado a un incremento substancial del agua extravascular pulmonar. Creemos que es fundamental monitorizar de forma seriada la función hemodinámica y respiratoria en sujetos con una lesión renal aguda, aún sin una IRA urémica.

Background: Acute kidney injury (AKI) is a serious disease that can cause distant organ injuries and is associated with high mortality rates. Objective: To identify the hemodynamic and respiratory dysfunction triggered by AKI, in an animal model of renal ischemia-reperfusion. Method: Twelve anesthetized juvenile pigs (11.9 +/- 1.0 kg). Six animals underwent ischemia/reperfusion-induced AKI: 45 min of ischemia and 240 minutes of reperfusion, while the remaining six animals were the control group. In basal conditions and after AKI, a conventional hemodynamic monitoring and transpulmonary thermodilution were performed. At the same time, arterial blood gases and lung mechanics were measured. Results: There was a 29 percent increase in volumetric preload (221 +/- 22 ml/m² vs 286 +/- 16 ml/m², p = 0.04) and a 58 percent mean arterial pressure increase (71 +/- 6 mmHg vs 112 +/- 17 mmHg, p = 0.04) compared to controls, without changes in heart rate, central venous pressure and cardiac output. In addition, an increase of 86 percent in extravascular lung water (7.6 +/- 0.6 ml/kg vs 14.1 +/- 1.4 ml/ kg, p = 0.02) was reported, without changes in gas exchange and lung mechanics. Simultaneously, a slight increase in serum creatinine (1.12 +/- 0.07 mg/dl vs 1.45 +/- 0.10 mg/dl, p = 0.03) was described. Discussion: An early development of hemodynamic and pulmonary dysfunction was observed in this experimental reperfusion model. An increase in volumetric preload and blood pressure associated with a substantial increase in the extravascular lung water were also reported. It is essential serially monitor the hemodynamic and respiratory functions in AKI, including nonuremic subjects.

Enfermedad injerto contra huésped asociada a transfusión / Graft versus hot disease associated to transfusion

Background: Transfusion-associated graft versus host disease (AT-GVDH) is produced by an aggressive host inmune response secondary to the incorporation and proliferation of T lymphocytes in blood products. AT-GVDH affects immunocompromised patients with cellular immune dysfunction, but also immunocompetent persons with certain genetic characteristics. It presents as an acute syndrome that involves skin, gastrointestinal tract, liver and bone marrow. The use of irradiated blood products represents the only therapeutic choice. Objective: To describe a severe and rarely diagnosed pathological condition associated to frequent clinical practice. Case-report: A 6 months-old child with a severe combined immunodeficiency (pathology with high risk of AT-GVDH) who developed this disease after a filtered red blood cell transfusion. Conclusions: The AT-GVDH is an uncommon iatrogenic and highly lethal complication related to the use of blood products. It implies high degree of clinical suspicion because underlying pathologies of risk may be unknown. The therapy is poor, being prevention the only available alternative. It is fundamental to know the risks and complications in using blood products, in order to determine correctly their indications.

Introducción: La Enfermedad Injerto Contra Huésped asociada a Transfusiones (EICH-AT) se produce por una respuesta inadecuada y autodestructiva del organismo frente a la incorporación y proliferación de linfocitos T presentes en los hemoderivados. Afecta fundamentalmente a pacientes inmunosuprimidos de predominio celular, aunque también a inmunocompetentes con determinadas características genéticas. Se manifiesta como un síndrome agudo que compromete piel, hígado, tracto gastrointestinal y médula ósea, confundible al inicio con enfermedades banales frecuentes. Actualmente la prevención, mediante el uso de hemoderivados irradiados representa la única medida terapéutica demostrada. Objetivo: Presentar una entidad patológica grave y poco reconocida asociada a una práctica clínica habitual. Caso clínico: Lactante de 6!4 meses portadora de una Inmunodeficiencia Combinada Severa que posterior a una transfusión de glóbulos rojos filtrados desarrolló esta enfermedad. Conclusiones: La EICH-AT es una complicación iatrogénica infrecuente, altamente letal y potencialmente prevenible relacionada a la administración de hemoderivados. Requiere un alto grado de sospecha clínica, mas aun en menores de 1 año en quienes pueden desconocerse patologías de riesgo subyacentes.

Albúmina en el paciente crítico: ¿mito o realidad terapéutica?: [revisión] / Albumin in the critically ill patient: myth or real therapeutics?: [review]

Under normal conditions, the plasmatic oncotic pressure is determined mainly by albumin. Numerous trials in critically ill patients have showed that hypoalbuminemia is associated to poor outcome. So, the administration of exogenous albumin is an attractive therapeutic strategy, widely spread in different clinical scenes. Nevertheless, its use has been questioned in the last period and up to date there is no clear evidence of the real effectiveness and/or utility. This article reviews the physiological and pathophysiological concepts that would justify the use of synthetic albumin. According to current literature, discussion about the rationality of its use in different pathological situations exists, trying to outline those clinical conditions that could or could not benefit with its administration. Certainly, clinical guidelines with recommendations about the benefits and indications of this therapy are required. Hypoalbuminemia in the critically ill patient is produced principally by redistribution, secondary to changes in capillary permeability: "transcapillary leakage". The crucial interrelation between osmotic plasmatic pressure and albumin concentration in healthy individuals is lost in several critical conditions. Agreements on indications for use of albumin have not been achieved, since in different clinical context (resuscitation, sepsis, post-surgical, burns, nephrotic syndrome, ARDS) there are no significant advantages in morbidity and mortality of critically ill patients, compared to other cristalloids or synthetic colloids used. It is extremely important to develop clinical guidelines with recommendations on benefits and indications for the use of albumin in critically ill patients.

La albúmina es la principal determinante de la presión oncótica plasmática. La reducción de sus niveles séricos se asociaría a malos resultados clínicos, fundamentalmente, en la población de pacientes críticos, por lo cual su administración exógena resulta una estrategia terapéutica atractiva y ampliamente difundida. Su uso, sin embargo, ha sido cuestionado en el último tiempo, no existiendo a la fecha una clara evidencia de su real eficacia y/o utilidad. Objetivo: Revisar los conceptos fisiológicos y fisiopatológicos que subyacen al uso de albúmina sintética y evaluar la racionalidad de su utilización en distintas situaciones patológicas, intentando perfilar las condiciones clínicas que pudieran o no beneficiarse de su administración. La hipoalbuminemia en el paciente crítico está dada principalmente por un fenómeno de redistribución, secundario a cambios en la permeabilidad capilar (escape transcapilar), y la correlación entre presión osmótica plasmática y concentración de albúmina en individuos sanos, se pierde en condiciones críticas. A pesar de la literatura existente, no se han logrado acuerdos sobre las indicaciones para el uso de albúmina, ya que en los distintos contextos clínicos revisados, (resucitación, sepsis, post quirúrgicos, quemados, síndrome nefrótico, SDRA), no aparecen ventajas significativas en la morbimortalidad al compararla con el uso de cristaloides u otros coloides sintéticos, sin dejar de mencionar además el costo económico que representa su uso. Se requieren guías clínicas de consenso, basadas en la evidencia, que establezcan recomendaciones acerca de los beneficios e indicaciones de esta herramienta terapéutica, que por ahora aparece con indicaciones muy limitadas en los pacientes críticos.

Fetal atrioventricular valve junction in normal fetuses and in fetuses with complete atrioventricular septal defect assessed by 4D volume rendering.

OBJECTIVES: To assess the feasibility and clinical potential of 4D volume rendering of the atrioventricular (AV) valve junction, to standardize the acquisition method, and to display the AV valve junction morphology in normal fetuses and in those with a complete atrioventricular septal defect (AVSD). METHODS: We performed sonography in 40 normal fetuses and 10 fetuses with complete AVSD, and volume datasets were acquired from apical and lateral four-chamber views. The render box was placed systematically. First, it included the AV valves, with the reference dot at the level of the crux of the heart. Then, it included the papillary muscles, with the reference dot in the interventricular septum at the level of the distal opening of the tricuspid valve leaflet. RESULTS: Volume acquisition and rendering were technically possible in all cases. Volume rendering of the left ventricle showed the position of the anterolateral and posteromedial papillary muscles in 36/40 normal fetuses (90%). At the level of the right ventricle, the septal, anterior and posterior papillary muscles were visualized in 33/40 normal fetuses (82%). In cases of complete AVSD, the AV valve has five leaflets, with anterosuperior and posteroinferior bridging leaflets straddling the septa. The morphology of the anterosuperior bridging leaflets and the abnormal position of the papillary muscles could be displayed in all cases. CONCLUSIONS: Our study suggests that some of the components of the AV junction can be reconstructed easily from sonographic volumes acquired from an apical or lateral four-chamber view. This new technique may have a role in obtaining views that are not easily accessible by standard sonography, enabling a rapid complementary assessment of normal and abnormal intracardiac anatomy.

Timolipoma mediastínico: caso clínico / Mediastinal thymolipoma: a clinical case

Se presenta un caso de timolipoma mediastínico en un paciente de 14 años portador de asma bronquial, pesquisado durante el control de una crisis bronquial obstructiva. El diagnóstico de este tumor fue planteado por las imágenes en la Rx de tórax y por la tomografía axial computarizada (TAC) previo a su extirpación quirúrgica. No hubo síntomas atribuibles a este tumor, como tampoco disminución en los volúmenes pulmonares a pesar de la gran masa que contenía el tórax. Al extirparlo se comprobó un peso de 1200 g y el estudio histológico confirmó la sospecha planteada por la característica en la Rx y TAC de tórax