La humidificación activa en ventilación mecánica no se asocia con un aumento de complicaciones infecciosas respiratorias en un estudio cuasi-experimental pre-postintervención / Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study

Objetivo Existen controversias sobre la influencia del sistema de humidificación en la incidencia de infecciones respiratorias asociadas a la ventilación mecánica invasiva (VMI). Nuestro objetivo fue evaluar las diferencias en la incidencia de neumonía y traqueobronquitis asociadas a la ventilación mecánica (NAV y TAV respectivamente) con humidificación pasiva y activa. Diseño Estudio retrospectivo cuasi-experimental de tipo pre-postintervención. Ámbito UCI polivalente de 14 camas. Pacientes Se incluyeron todos los pacientes conectados a la VMI durante>48horas durante los años 2014 y 2016. Intervenciones Durante el año 2014 se empleaba humidificación pasiva con un intercambiador calor-humedad (HME) y, durante 2016, humidificación activa (HH) con calentamiento de la tubuladura inspiratoria. Se establecieron medidas idénticas para la prevención de NAV (proyecto Neumonía Zero). Variables de interés principales Se estimaron tasas de incidencia NAV y TAV por 1.000 días de VMI en ambos grupos y se valoraron diferencias estadísticamente significativas mediante regresión Poisson. Resultados Se incluyeron 287 pacientes (116 con HME y 171 con HH). La densidad de incidencia de NAV por 1.000 días de VMI fue de 5,68 en el grupo de HME y 5,80 en el grupo de HH (p=ns). La densidad de incidencia de TAV fue 3,41 y 3,26 casos por 1.000 días de VMI con HME y HH respectivamente (p=ns). Se identificó como factor de riesgo de NAV la duración de la VMI. Conclusiones En nuestro estudio la humidificación activa en pacientes ventilados durante>48horas no se asoció con un aumento de las complicaciones infecciosas respiratorias. (AU)

Objective There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. Design A retrospective pre-post quasi-experimental study was carried out. Setting A polyvalent ICU with 14 beds. Patients All patients connected to IMV for>48hours during 2014 and 2016 were included. Interventions During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). Main outcome measures The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. Results A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. Conclusions In our population, active humidification in patients ventilated for>48hours was not associated to an increase in respiratory infectious complications. (AU)

Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study.

OBJECTIVE: There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. DESIGN: A retrospective pre-post quasi-experimental study was carried out. SETTING: A polyvalent ICU with 14 beds. PATIENTS: All patients connected to IMV for >48h during 2014 and 2016 were included. INTERVENTIONS: During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). MAIN OUTCOME MEASURES: The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. RESULTS: A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. CONCLUSIONS: In our population, active humidification in patients ventilated for >48h was not associated to an increase in respiratory infectious complications.

La monitorización capnográfica en la parada cardiaca extrahospitalaria / Capnography for monitoring response to care after out-of-hospital cardiac arrest

Objetivo: Analizar la eficacia de la monitorización capnográfica en la parada cardiorrespiratoria(PCR) extrahospitalaria, mediante la determinación de la capacidad de la capnografía y la capnometría para confirmar la intubación endotraqueal, la detección precoz de la recuperación de circulación espontánea mediante capnometría y el valor pronóstico de la capnometría sobre la capacidad de recuperación del paciente.Método: Estudio descriptivo preliminar del estudio prospectivo en curso realizado con los 30 primeros casos de PCR no traumática en pacientes mayores de edad atendidos por siete unidades móviles de emergencia del SUMMA 112 durante el año 2008. Se recogieron datos clínicos evolutivos y de la monitorización capnográfica. Resultados: De los 30 pacientes (70% varones, 64,5 ± 16,3 años), en 28 casos se observó capnograma tras el primer intento de intubación y en los dos restantes, la ausencia de capnograma se debió a la intubación esofágica. En ambos se obtuvo capnograma al segundo intento, y confirmó así la correcta intubación (valores predictivos positivo y negativo del100%). No se observó diferencia en los valores de end-tidal CO2 (ETCO2) obtenidos tras el primer intento de intubación en presencia o ausencia de capnograma. De los ocho pacientes recuperados, en cinco de ellos (62,5%) se observó un incremento significativo del ETCO2 anterioral cambio en la monitorización electrocardiográfica y a la detección de pulso carotídeo (p < 0,05). Finalmente, se observó que los valores de ETCO2 al final de la reanimación cardiopulmonar(RCP) fueron significativamente mayores en los pacientes recuperados (33,5 ±12,7 mmHg) que en los fallecidos (15,3 ± 11,1 mmHg; p < 0,01), y fueron mayores de 20 mmHg en todos los pacientes recuperados, tanto a los 20 minutos (..) (AU)

Objective: To analyze the usefulness of capnography to monitor patients after out-of-hospital cardiorespiratory arrest, interms of the ability of capnography to confirm tracheal intubation and the ability of capnometry to promptly detect return of spontaneous circulation and predict patient recovery. Methods: Preliminary description of the first 30 cases in a prospective study of out-of-hospital cardiorespiratory arrest inelderly non-trauma patients attended by the 7 ambulance units of the SUMMA 112 emergency service in Madrid, Spain,in 2008. Clinical, evolutive and capnographic data were recorded. Results: Seventy percent of the 30 patients were men. The mean (SD) age was 64.5 (16.3) years. A capnogram was observed after the first intubation attempt in 28 cases. In the remaining 2 cases, the absence of a capnogram indicatedes ophageal intubation; correct intubation was accomplished and confirmed on the second try (positive and negativepredictive values, 100%). However, no differences were observed between end-tidal carbon dioxide partial pressure(PETCO2) in the absence or presence of a capnogram with the first and second attempts at intubation. Eight patients recovered. In 5 of them (62.5%), a significant increase in PETCO2 was observed before the change in the electrocardiographic signal and before detection of a carotid pulse (P<.05). Finally, PETCO2 values after cardiopulmonary resuscitation (CPR) were significantly higher in the patients who recovered (33.5 [12.7] mm Hg) than in those who died(15.3 [11.1] mm Hg) (P<.01). After 20 minutes of CPR, PETCO2 was more than 20 mm Hg in all patients who recovered.Conclusions: Capnography monitoring in responding to out-of-hospital cardiorespiratory arrest is useful for confirming correct placement of the endotracheal tube, as indicated by the presence of a capnogram. Capnometry offers the first sign of return of spontaneous circulation in some cases and can be used to predict the success of prolonged CPR (AU)

Determination of major human cytochrome P450s activities in 96-well plates using liquid chromatography tandem mass spectrometry.

At the early stage of drug discovery, thousands of new chemical entities (NCEs) may be screened before a single candidate can be identified for development. Evaluation of the effect of NCEs on human CYP450 enzyme activities is a key issue in pharmaceutical development as it may explain inter-subject variability, drug-drug interactions, non-linear pharmacokinetics and toxic effects. A liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method has been developed for the fast and routine analysis of major human CYP450s enzyme activities (CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4) in primary hepatocyte cell cultures. The high sensitivity and selectivity of mass spectrometry has allowed traditional assays to be minimized, thus enabling the use of 96-well plate format which markedly reduced the number of hepatocytes needed for each cytochrome CYP450 activity measurement, a fact that is particularly critical concerning human hepatocytes.

Perfil del paciente con hipotiroidismo subclínico en atención primaria / Profile of patients with sub-clinical hypothyroidism in primary care

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Accidente cerebrovascular en una paciente joven. Papel del foramen oval permeable / Cerebrovascular accident in a young female. Role of the patent foramen ovale

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[Esophageal obstruction caused by dietary fiber from Plantago ovata, a complication preventable by adequate information]. / Obstrucción esofágica por la fibra dietética Plantago ovata, una complicación prevenible mediante la información.

INTRODUCTION: Plantago ovata (PO) is widely used as a dietary fiber in the treatment of constipation. A case of esophageal obstruction due to PO is presented. Other published cases are reviewed, and possible risk factors and prevention are discussed. CASE REPORT: A 41-year-old woman felt chest pain and regurgitation immediately after swallowing a tablespoonful of PO in granules. She kept the granules in her mouth for a few seconds before swallowing them with 250 ml of water. Flexible endoscopy revealed a brown-black consistent mass blocking the inferior esophagus. A mild hiatus hernia was subsequently discovered. DISCUSSION: All the cases found through an unlimited Medline search using key words Plantago, Psyllium, mucilage, bezoars and esophagus, were taking PO in granules. Most of the cases took the granules with insufficient liquid, and some had previous obstructive esophageal disease. PO in powder probably presents a lower risk of esophageal obstruction.

Oxidative stress induced by tert-butyl hydroperoxide causes vasoconstriction in the aorta from hypertensive and aged rats: role of cyclooxygenase-2 isoform.

We analyzed the mechanisms involved in the effect of tert-butyl hydroperoxide (t-BOOH) in isolated aortic rings with and without endothelium from normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) at 6, 18, and 24 months of age. t-BOOH (1 microM-10 mM) induced concentration-dependent contractions that were scarcely modified by aging and potentiated in SHR and by endothelium removal. The nitric oxide synthase and prostacyclin synthase inhibitors N(G)-nitro-L-arginine methyl ester (100 microM) and tranylcypromine (100 microM), respectively, increased both basal tone and the t-BOOH-induced contractions in intact segments from WKY, with these effects not observed in SHR. Indomethacin (10 microM), a nonspecific cyclooxygenase inhibitor, and SQ 29,548 (10 microM), a prostaglandin H(2)/thromboxane A(2) receptor blocker, abolished the t-BOOH-induced vasoconstriction, independent of age and hypertension. In both strains, these contractile responses were unaltered by the thromboxane synthase inhibitor imidazole (10 microM). The cyclooxygenase-2 inhibitor NS-398 (10 microM) abolished or markedly reduced the t-BOOH-induced contractions in segments with or without endothelium, respectively. In addition, expression of cyclooxygenase-2 protein was detected in aorta from WKY and SHR in either basal condition or after stimulation with t-BOOH. These results suggest that (1) t-BOOH-induced vasoconstriction in the aorta from WKY and SHR is essentially mediated by cyclooxygenase-2 metabolites, different from thromboxane-A(2), probably prostaglandin-H(2), and/or isoprostanes; (2) aging scarcely modifies, whereas endothelium negatively modulates, these contractions in both strains; and (3) nitric oxide and prostacyclin exert a negative modulator role on the t-BOOH-induced vasoconstriction in WKY, with this modulator role lost in SHR.

[Multicystic renal dysplasia and Wilms tumor]. / Displasia renal multiquística y tumor de Wilms.

We review a case of multicystic right dysplasia containing nodular renal blastema in a 3-year-old girl with left Wilms tumor. In relation to this finding the management of the asymptomatic multicystic dysplastic kidney in discussed.

Monoclonal gammopathy associated with crescentic glomerulonephritis and antimyeloperoxidase antibodies.

A 68-year-old male patient suffering from dizziness, gait instability, deafness, and visual loss showed proteinuria, hematuria, reduced creatinine clearance, and a monoclonal IgA lambda component. Renal biopsy revealed crescentic glomerulonephritis. Serum antibodies against myeloperoxidase were identified. These antibodies were IgG, not related to the IgA monoclonal component. This clinical description adds new information to the spectrum of diseases associated with glomerulonephritis and antimyeloperoxidase antibodies and illustrates that a monoclonal component cannot be directly implicated in the pathogenesis of a vasculitic process associated with antineutrophil cytoplasm antibodies.

Ultrastructure of the pineal cells of the homing pigeon Columba livia and magnetic fields (first trials).

The homing pigeon Columba livia was exposed to uniform 60 Hz AC magnetic fields, generated by Helmholtz coils with an intensity of 200 mG for 48 hrs. The microscopic studies performed revealed that only some of the pineal cells (between 20 and 30%) seemed to respond to the magnetic stimulation, and showed different ultrastructural morphological changes; the most striking effect was an apparent increase of apocrine secretion to the luminal spaces in the epiphyseal epithelium of this avian species.

[Xanthogranulomatous pyelonephritis in childhood: analysis of 4 cases]. / Pielonefritis xantogranulomatosa en la infancia: análisis de cuatro casos.

A critical retrospective evaluation of four cases of xanthogranulomatous pyelonephritis (XPG) treated between 1966 and 1980. Incidence was 1.93%. Age range was from 1.5 and 24 months. Interval since first symptoms to diagnosis was between one and 14 months. Clinical presentation was nonspecific in two and urinary symptoms in the rest, abdominal mass present in all, the fourth had an onset similar to an acute leucosis. There were was a grossly dilated pelvis and calices in two patients and nonfunctioning kidney in the others, one with multiple calculi. Ureteral stenosis was present in two and three showed a vesiureteral reflux grade IV. Urinculture yielded E. coli and Proteus mirabilis. In all cases diagnosis was confirmed by macro and microscopic examination. Nephrectomy was effectively cure in all four children. All patients are well at the end of follow-up, between one and four years.