RESUMO
Objective: Clinical practice guidelines suggest performing an electrocardiogram (EKG) in patients with chest pain within the first 10 minutes in the emergency department, warning about subdiagnosis in women. Possible differences based on sex were analyzed. Method: An observational and retrospective study in an Emergency Department, with adult patients admitted to the Chest Pain Unit in 2021. Results: There were 1,469 patients, of whom 774 were men (52.7%). The men were younger (60 vs. 65 years), were less overweight (17.18 vs. 22.16%), and had more previous admissions to the Coronary Unit (12 vs. 7%), compared to women. No gender differences were observed in EKG performance (91 vs. 90%), EKG time (median 4.1 vs. 4.5 minutes), or delay in care attention (median 25 vs. 26 minutes). In terms of healthcare resources, men underwent more biomarkers: troponins (63 vs. 55%; odds ratio [OR]: 1.35; 95% confidence interval [95%CI]: 1.10-1.67) and creatine phosphokinase (24.8 vs. 19.1%), received more aspirin (6.7 vs. 3.1%), nitrates/nitrites (6 vs. 3%), and hospitalization (17.18 vs. 10.50%; OR: 1.76; 95%CI; 1.30-2.40). Of 206 hospitalized, 112 had a final diagnosis of acute coronary syndrome (54%), more men than women (81 vs. 31). There were no significant differences in revascularization time, medication schedule at discharge, hospital stay, or mortality. Conclusions: Gender did not affect precordial pain care, diagnosis, and treatment times, highlighting the quality of hospital care.
Objetivo: Las guías de práctica clínica sugieren realizar electrocardiograma (ECG) en pacientes con dolor precordial dentro de los primeros 10 minutos en urgencias, advirtiendo sobre el subdiagnóstico en mujeres. Se analizaron las posibles diferencias en función del sexo. Método. Método: Estudio observacional y retrospectivo en una central de emergencias de adultos, con pacientes ingresados a la unidad de dolor torácico durante 2021. Resultados: Hubo 1,469 pacientes, de los cuales 774 eran hombres (52.7%). Los hombres eran más jóvenes (60 vs. 65 años), tenían menos sobrepeso (17.18 vs. 22.16%) y más ingresos previos en unidad coronaria (12 vs. 7%). No se observaron diferencias de género en la realización de ECG (91 vs. 90%), tiempo para el ECG (mediana 4.1 vs. 4.5 minutos) o tiempo de demora en atención (mediana 25 vs. 26 minutos). En términos de recursos sanitarios, los hombres se sometieron más a biomarcadores: troponinas (63 vs. 55%; odds ratio [OR]: 1.35; intervalo de confianza del 95% [IC95%]: 1.10-1.67) y creatina fosfocinasa (24.8 vs. 19.1%), recibieron más aspirina (6.7 vs. 3.1%), nitratos/nitritos (6 vs. 3%), y hospitalización (17.18 vs. 10.50%; OR: 1.76; IC95%: 1.30-2.40). De 206 internados, 112 tuvieron diagnóstico final de síndrome coronario agudo (54%), más hombres que mujeres (81 vs. 31). No hubo diferencias significativas en tiempos de revascularización, esquema de medicación al alta, tiempo de estadía ni en mortalidad hospitalaria. Conclusiones: El género no afectó a los tiempos de atención, diagnóstico y tratamiento del dolor precordial, destacando la calidad de atención hospitalaria.
RESUMO
Crosstalk between the lung and the kidney is based on the similarities that these organs share. This is why different diseases that affect one organ can have repercussions on the other. Patients with acute kidney injury can present complications such as pulmonary edema and require mechanical ventilation in respiratory failure. This interaction occurs due to the increase in systemic immune mediators that cause inflammatory reactions, oxidative stress, and an increase in vascular permeability in the lung. With regard to lung-induced renal damage, the kidney can also be affected by chemical mediators, which are translocated into the bloodstream. Moreover, the kidneys are extremely sensitive to oxygen changes which can cause them to lose their autoregulation mechanism. In patients with acute lung injury (ALI), oxygen supply is decreased causing renal hypoxia. Besides, hypercapnia generated by ALI causes vasoconstriction in the renal vascular network and activation of the renal angiotensin aldosterone system. ALI not only can cause renal injury, but also worsening chronic obstructive pulmonary disease and obstructive sleep apnea. In conclusion, kidney-lung crosstalk is commonly present in certain pathological states, and knowing its characteristics is crucial for managing the complications which may arise from this vicious circle.
