C-reactive protein: clinical and epidemiological perspectives.

An important etiopathogenic component of cardiovascular disease is atherosclerosis, with inflammation being an essential event in the pathophysiology of all clinical pictures it comprises. In recent years, several molecules implicated in this process have been studied in order to assess cardiovascular risk in both primary and secondary prevention. C-reactive protein is a plasmatic protein of the pentraxin family and an acute phase reactant, very useful as a general inflammation marker. Currently, it is one of the most profoundly researched molecules in the cardiovascular field, yet its clinical applicability regarding cardiovascular risk remains an object of discussion, considered by some as a simple marker and by others as a true risk factor. In this sense, numerous studies propose its utilization as a predictor of cardiovascular risk through the use of high-sensitivity quantification methods for the detection of values <1 mg/L, following strict international guidelines. Increasing interest in these clinical findings has led to the creation of modified score systems including C-reactive protein concentrations, in order to enhance risk scores commonly used in clinical practice and offer improved care to patients with cardiovascular disease, which remains the first cause of mortality at the worldwide, national, and regional scenarios.

Epidemiologic Behavior and Estimation of an Optimal Cut-Off Point for Homeostasis Model Assessment-2 Insulin Resistance: A Report from a Venezuelan Population.

Background. Mathematical models such as Homeostasis Model Assessment have gained popularity in the evaluation of insulin resistance (IR). The purpose of this study was to estimate the optimal cut-off point for Homeostasis Model Assessment-2 Insulin Resistance (HOMA2-IR) in an adult population of Maracaibo, Venezuela. Methods. Descriptive, cross-sectional study with randomized, multistaged sampling included 2,026 adult individuals. IR was evaluated through HOMA2-IR calculation in 602 metabolically healthy individuals. For cut-off point estimation, two approaches were applied: HOMA2-IR percentile distribution and construction of ROC curves using sensitivity and specificity for selection. Results. HOMA2-IR arithmetic mean for the general population was 2.21 ± 1.42, with 2.18 ± 1.37 for women and 2.23 ± 1.47 for men (P = 0.466). When calculating HOMA2-IR for the healthy reference population, the resulting p75 was 2.00. Using ROC curves, the selected cut-off point was 1.95, with an area under the curve of 0.801, sensibility of 75.3%, and specificity of 72.8%. Conclusions. We propose an optimal cut-off point of 2.00 for HOMA2-IR, offering high sensitivity and specificity, sufficient for proper assessment of IR in the adult population of our city, Maracaibo. The determination of population-specific cut-off points is needed to evaluate risk for public health problems, such as obesity and metabolic syndrome.

C-Reactive Protein: An In-Depth Look into Structure, Function, and Regulation.

Cardiovascular disease is the leading cause of morbidity and mortality in the adult population worldwide, with atherosclerosis being its key pathophysiologic component. Atherosclerosis possesses a fundamental chronic inflammatory aspect, and the involvement of numerous inflammatory molecules has been studied in this scenario, particularly C-reactive protein (CRP). CRP is a plasma protein with strong phylogenetic conservation and high resistance to proteolysis, predominantly synthesized in the liver in response to proinflammatory cytokines, especially IL-6, IL-1ß, and TNF. CRP may intervene in atherosclerosis by directly activating the complement system and inducing apoptosis, vascular cell activation, monocyte recruitment, lipid accumulation, and thrombosis, among other actions. Moreover, CRP can dissociate in peripheral tissue-including atheromatous plaques-from its native pentameric form into a monomeric form, which may also be synthesized de novo in extrahepatic sites. Each form exhibits distinct affinities for ligands and receptors, and exerts different effects in the progression of atherosclerosis. In view of epidemiologic evidence associating high CRP levels with cardiovascular risk-reflecting the biologic impact it bears on atherosclerosis-measurement of serum levels of high-sensitivity CRP has been proposed as a tool for assessment of cardiovascular risk.

Variations of lipoprotein(a) levels in the metabolic syndrome: a report from the Maracaibo City Metabolic Syndrome Prevalence Study.

BACKGROUND: Lipoprotein(a) [Lp(a)] is a known risk factor for cardiovascular disease, yet its influence on metabolic syndrome (MS) is still controversial. The purpose of this study was to assess the impact generated by this diagnosis in serum Lp(a) concentrations. MATERIALS AND METHODS: A total of 1807 subjects of both genders (55.3% women and 44.7% men) belonging to the Maracaibo City Metabolic Syndrome Prevalence Study were evaluated. Results were expressed as Mean ± SD, determining differences through Student's t-test and One-Way ANOVA test. Multiple logistic regression models were utilized for analyzing factors associated with elevated serum Lp(a) levels and MS. Total cholesterol and LDL-C were corrected according to Lp(a)-Cholesterol when necessary. RESULTS: No differences were found in Lp(a) values between genders; P = 0,292. The association between MS and the classification of Lp(a) was statistically significant (χ (2) = 28.33; P < 0,0001), with greater levels in subjects with this diagnosis. In the univariate analysis, subjects with each of the separate diagnostic criteria showed higher serum Lp(a) concentrations, except for hyperglycemia. CONCLUSIONS: Lp(a) values exhibit important variations regarding MS and each of its components. Impaired fasting glucose appeared as a protecting factor against elevated Lp(a) concentrations, whereas its association with LDL-C and hs-CRP suggests a potential pro-inflammatory role.

Hipertensión endocraneana benigna en un niño intoxicado por plomo / Benign endocraneal hypertension in a lead intoxicated child

Se expone el caso clínico de un escolar de 5 años de edad, que un mes antes de su ingreso presentaba alteraciones neuroconductuales, cefalea y síntomas generales, además de ser tratado ambulatoriamente a causa de anemia carencial. Ingresó en la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil Sur Docente de Santiago de Cuba con hipertensión endocraneana benigna y evolutivamente se le diagnosticó una intoxicación plúmbica, al manipularse sustancias que contenían plomo en su medio familiar, el cual penetró en su organismo por vías oral e inhalatoria. Ese hallazgo constituyó el punto de partida para la confirmación de otros afectados por el citado metal en su entorno comunitario(AU)

The case report of a 5 year-old school child who a month before beginning school had neurobehavioral alterations, migraine and general symptoms is presented. He had been treated in the out-patient department due to lacking anemia. He was admitted to the Intensive Care Pediatric Unit from the Southern Teaching Children Hospital in Santiago de Cuba with benign endocraneal hypertension and during the clinical course he was diagnosed a lead intoxication,when substances that contained lead were manipulated in his house , which penetrated his organism through oral and inhalatory routes. This finding constituted the starting point for the confirmation of other members of his community affected by the mentioned metal(AU)

Hipertensión endocraneana benigna en un niño intoxicado por plomo / Benign endocraneal hypertension in a lead intoxicated child

Se expone el caso clínico de un escolar de 5 años de edad, que un mes antes de su ingreso presentaba alteraciones neuroconductuales, cefalea y síntomas generales, además de ser tratado ambulatoriamente a causa de anemia carencial. Ingresó en la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil Sur Docente de Santiago de Cuba con hipertensión endocraneana benigna y evolutivamente se le diagnosticó una intoxicación plúmbica, al manipularse sustancias que contenían plomo en su medio familiar, el cual penetró en su organismo por vías oral e inhalatoria. Ese hallazgo constituyó el punto de partida para la confirmación de otros afectados por el citado metal en su entorno comunitario.

The case report of a 5 year-old school child who a month before beginning school had neurobehavioral alterations, migraine and general symptoms is presented. He had been treated in the out-patient department due to lacking anemia. He was admitted to the Intensive Care Pediatric Unit from the Southern Teaching Children Hospital in Santiago de Cuba with benign endocraneal hypertension and during the clinical course he was diagnosed a lead intoxication,when substances that contained lead were manipulated in his house , which penetrated his organism through oral and inhalatory routes. This finding constituted the starting point for the confirmation of other members of his community affected by the mentioned metal.

Fundamentos epidemiológicos, fisiopatológicos y clínicos de la sepsis en la población infantil / Epidemiological, pathophysiological and clinical fundamentals of sepsis in children

A pesar de las numerosas investigaciones realizadas en torno a la sepsis, la morbilidad y mortalidad elevadas por su causa revelan un insuficiente conocimiento al respecto, que impide en muchos casos identificar oportunamente sus manifestaciones clínicas y pone en riesgo la supervivencia de los niños hospitalizados; razón por la cual se impone aumentar y actualizar el volumen de información que posee el personal de la salud encargado de atender a la población infantil ingresada en instituciones sanitarias pediátricas. Para ello se revisaron los resultados de discusiones médicas en conferencias de consensos internacionales, donde se debatió acerca de importantes aspectos epidemiológicos, fisiopatológicos y clínicos relacionados con el asunto, siempre con el propósito de disminuir la incidencia de ese factor de riesgo(AU)

Despite the numerous researches on sepsis, the high morbidity and mortality because of it reveal a lack of knowledge about it, which prevents in many cases timely identification of its clinical manifestations and threatens the survival of hospitalized children; reason why it should be increased and updated the volume of information that the people in charge of health care for children admitted to pediatric health institutions have. With this purpose the results of medical discussions on international consensus conferences were reviewed, where important epidemiological, pathophysiological and clinical aspects related to the subject were discussed, always with the aim of reducing the incidence of this risk factor(AU)

Fundamentos epidemiológicos, fisiopatológicos y clínicos de la sepsis en la población infantil: [revisión] / Epidemiological, pathophysiological and clinical fundamentals of sepsis in children: [review]

A pesar de las numerosas investigaciones realizadas en torno a la sepsis, la morbilidad y mortalidad elevadas por su causa revelan un insuficiente conocimiento al respecto, que impide en muchos casos identificar oportunamente sus manifestaciones clínicas y pone en riesgo la supervivencia de los niños hospitalizados; razón por la cual se impone aumentar y actualizar el volumen de información que posee el personal de la salud encargado de atender a la población infantil ingresada en instituciones sanitarias pediátricas. Para ello se revisaron los resultados de discusiones médicas en conferencias de consensos internacionales, donde se debatió acerca de importantes aspectos epidemiológicos, fisiopatológicos y clínicos relacionados con el asunto, siempre con el propósito de disminuir la incidencia de ese factor de riesgo.

Despite the numerous researches on sepsis, the high morbidity and mortality because of it reveal a lack of knowledge about it, which prevents in many cases timely identification of its clinical manifestations and threatens the survival of hospitalized children; reason why it should be increased and updated the volume of information that the people in charge of health care for children admitted to pediatric health institutions have. With this purpose the results of medical discussions on international consensus conferences were reviewed, where important epidemiological, pathophysiological and clinical aspects related to the subject were discussed, always with the aim of reducing the incidence of this risk factor.

Aspectos epidemiológicos y clínicos de la sepsis en niños ingresados en unidades de cuidados intensivos / Clinical and epidemiologic aspects of sepsis in children admitted in intensive care units

Se realizó un estudio descriptivo y transversal de una muestra de 134 pacientes, de 171 en total, que presentaron algún estadio del síndrome de respuesta inflamatoria sistémica al ingreso o durante su permanencia en las unidades de cuidados intensivos pediátricos de los 2 hospitales infantiles docentes ubicados en el municipio de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2009, con vista a determinar algunos aspectos clínicos y epidemiológicos en la casuística (edades, desnutrición, enfermedades crónicas asociadas, insuficiencia multiorgánica y otros). El ingreso directo a través del Cuerpo de Guardia y el predominio de infecciones respiratorias estuvieron vinculados con septicemias de mayor gravedad. El estado de choque séptico fue la causa de muerte en todos los fallecidos(AU)

A descriptive and cross-sectional study of a sample of 134 patients, of 171 in total that presented some stage of the syndrome of systemic inflammatory response when admitted or during their stay in the pediatric intensive care units of the 2 teaching children hospitals located in the municipality of Santiago de Cuba was carried out, from January, 2007 to December, 2009, aimed at determining some clinical and epidemiologic aspects in the case material (ages, malnutrition, associated chronic diseases, multiorganic failure and others). The direct admission through the emergency room and the prevalence of breathing infections were linked to more serious septicemias. The state of septic shock was the cause of death in all deaths(AU)

Aspectos epidemiológicos y clínicos de la sepsis en niños ingresados en unidades de cuidados intensivos / Clinical and epidemiologic aspects of sepsis in children admitted in intensive care units

Se realizó un estudio descriptivo y transversal de una muestra de 134 pacientes, de 171 en total, que presentaron algún estadio del síndrome de respuesta inflamatoria sistémica al ingreso o durante su permanencia en las unidades de cuidados intensivos pediátricos de los 2 hospitales infantiles docentes ubicados en el municipio de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2009, con vista a determinar algunos aspectos clínicos y epidemiológicos en la casuística (edades, desnutrición, enfermedades crónicas asociadas, insuficiencia multiorgánica y otros). El ingreso directo a través del Cuerpo de Guardia y el predominio de infecciones respiratorias estuvieron vinculados con septicemias de mayor gravedad. El estado de choque séptico fue la causa de muerte en todos los fallecidos.

A descriptive and cross-sectional study of a sample of 134 patients, of 171 in total that presented some stage of the syndrome of systemic inflammatory response when admitted or during their stay in the pediatric intensive care units of the 2 teaching children hospitals located in the municipality of Santiago de Cuba was carried out, from January, 2007 to December, 2009, aimed at determining some clinical and epidemiologic aspects in the case material (ages, malnutrition, associated chronic diseases, multiorganic failure and others). The direct admission through the emergency room and the prevalence of breathing infections were linked to more serious septicemias. The state of septic shock was the cause of death in all deaths.