Actualización en ventilación de alta frecuencia oscilatoria en pacientes pediátricos con insuficiencia respiratoria aguda / Ventilation update high oscillatory frequency in pediatric patients with Severe respiratory insufficiency

Recientemente un grupo de expertos estableció la definición del síndrome de dificultad respiratoria aguda en niños y las recomendaciones relativas a su tratamiento. La ventilación de alta frecuencia oscilatoria es considerada por este consenso como una alternativa válida a la ventilación mecánica convencional en pacientes con este síndrome e hipoxemia resistente. La incorporación de la ventilación de alta frecuencia oscilatoria en el ámbito clínico data de la década de 1970, su utilización se sustenta en que este modo ventilatorio respeta los objetivos fisiológicos de reclutamiento y protección pulmonar. La literatura alberga numerosas publicaciones referidas a la ventilación de alta frecuencia oscilatoria en niños con síndrome de dificultad respiratoria aguda y su comparación con la ventilación mecánica convencional, la mayoría de los trabajos con diseños limitados, a excepción de dos estudios controlados y aleatorizados que objetivan menor daño inducido y menor enfermedad pulmonar crónica en los pacientes tratados con ventilación de alta frecuencia oscilatoria. A la luz de la evidencia analizada, esta ventilación en pacientes con síndrome de dificultad respiratoria aguda pediátrico sería una terapia aceptable ante el fracaso de las medidas convencionales(AU)

Recently, a group of experts established the definition of pediatric acute respiratory distress syndrome and the recommendations regarding its treatment. High-frequency oscillatory ventilation is considered by this consensus as a valid alternative to conventional mechanical ventilation in children with acute respiratory distress syndrome and refractory hypoxemia. There are numerous publications about high-frequency oscillatory ventilation in pediatric patients with this syndrome and its comparison with the conventional mechanical ventilation, most of the studies with limited designs, except for two randomized controlled studies that reported less induced injury and less chronic lung disease in patients treated with high-frequency oscillatory ventilation. Incorporation of this type of ventilation in the clinical setting dates back to the 70s, its use is supported by the fact that this ventilation mode respects the physiological aims of recruitment and lung protection. In light of the analyzed evidence, high-frequency oscillatory ventilation in children with acute respiratory distress syndrome would be an acceptable therapy when conventional measures fail.(AU)

Exhaled nitric oxide in children with asthma and sinusitis.

Exhaled nitric oxide (FE(NO)) is a surrogate marker of eosinophilic airway inflammation. The measurement of this gas can be easily performed in children and the result is immediately available. Because of these characteristics, measurement of FE(NO) is slowly becoming part of the routine clinical evaluation of an asthmatic patient. FE(NO) measurement may have a role both in the diagnosis of asthma and as a guide in therapy algorithms. For example when FE(NO) levels are persistently normal and the asthmatic child is asymptomatic, the steroid therapy may be decreased or even stopped. In patients with acute or chronic rhinosinusitis the levels of nasal nitric oxide (nNO) are significantly decreased, while they rise up after a course of antibiotics. The measurement of nasal NO has been proposed as a functional test to evaluate sinus ventilation. Nasal NO is significantly reduced also in primary ciliary dyskinesia and can be used as a screening tool to identify patients affected by this condition.

3-Nitrotyrosine, a marker of nitrosative stress, is increased in breath condensate of allergic asthmatic children.

BACKGROUND: Asthmatic patients have high exhaled nitric oxide (NO) levels. NO-mediated inflammatory actions are mainly due to NO conversion into reactive nitrogen species, which can lead to nitrotyrosine formation. The aim of this study was to assess 3-nitrotyrosine (3-NT) levels in exhaled breath condensate (EBC) of asthmatic and healthy children and to investigate whether there is any relationship with exhaled NO (FE(NO)) and lung function. METHODS: The study included 20 asthmatic children (10 steroid-naive with intermittent asthma, 10 steroid-treated with unstable persistent asthma) and 18 healthy controls. They underwent FE(NO) measurement, EBC collection and spirometry. 3-NT was measured by a new liquid chromatography-tandem mass spectrometry (LC-MS/MS) method in isotopic dilution. RESULTS: The median EBC concentration of 3-NT (expressed as nitrotyrosine/tyrosine ratio x 100) in asthmatic children was fivefold higher than in healthy subjects [0.23% (0.12-0.32) vs 0.04% (0.02-0.06), P < 0.001] with no difference between steroid-naive and unstable steroid-treated asthmatic patients. FE(NO) levels were higher in asthmatic [44.6 ppb (36.0-66.0)] than in healthy children [7.5 ppb (6.0-8.8), P < 0.001]. No correlation was found among 3-NT, FE(NO) and lung function parameters. CONCLUSION: Nitrotyrosine is high in EBC of asthmatic children and could be considered as a noninvasive marker of nitrosative events in the airways.

[Some concepts about the treatment of the depressive episode in bipolar disorder]. / Algunos conceptos en torno al tratamiento del episodio depresivo en el trastorno bipolar.

A frequent clinical mistake is to diagnose a Depressive Episode of the Bipolar Disorder as a Unipolar Depression. This, generally, has iatrogenic consequences for the patient. In this article the approaches are revised for a correct diagnosis and also an algorithm for an appropriate treatment is suggested.

Problemas actuales respecto del diagnóstico y tratamiento del Trastorno Bipolar en nuestro medio: experiencia y opinión de los usuarios / Experience and opinion related to the diagnosis and treatment of patients with bipolar disorders

El objetivo de este estudio fue investigar la experiencia y la opinión de los pacientes afectados por Trastorno Bipolar en cuanto al diagnóstico y tratamiento de su enfermedad. Se relevó una encuesta anónima entre personas con diagnóstico de Trastorno Bipolar.... involucró a 100 pacientes.78 reportaron haber sido diagnosticados de otra manera a lo largo de su tratamiento. El error diagnóstico más frecuente fue el de Esquizofrenia. Este diagnóstico incorrecto se correlacionó positivamente con la presencia de síntomas psicóticos, los cuales fueron verificados en el 83 por ciento de la muestra...La mayoría de los encuestados calificaron como positivo el haber sido informados de su diagnóstico