Mortalidad en pacientes hospitalizados por COVID-19 durante la primera ola en una institución de tercer nivel de Neuquén / Mortality in Patients Hospitalized for COVID-19 during the First Wave in a Tertiary Care Institution in Neuquén

Introducción: En diciembre de 2019, se detectó un brote de enfermedad por un nuevo coronavirus que evolucionó en pandemia con severa morbilidad respiratoria y mortali- dad. Los sistemas sanitarios debieron enfrentar una cantidad inesperada de pacientes con insuficiencia respiratoria. En Argentina, las medidas de cuarentena y control sani - tario retrasaron el primer pico de la pandemia y ofrecieron tiempo para preparar el sis- tema de salud con infraestructura, personal y protocolos basados en la mejor evidencia disponible en el momento. En una institución de tercer nivel de Neuquén, Argentina, se desarrolló un protocolo de atención para enfrentar la pandemia adaptado con la evo- lución de la mejor evidencia y evaluaciones periódicas de la mortalidad hospitalaria. Métodos: Estudio de cohorte observacional para evaluar la evolución de pacientes con COVID-19 con los protocolos asistenciales por la mortalidad hospitalaria global y al día 28 en la Clínica Pasteur de Neuquén en 2020. Resultados: Este informe describe los 501 pacientes diagnosticados hasta el 31 de di- ciembre de 2020. La mortalidad general fue del 16,6% (83/501) y del 12,2% (61/501) al día 28 de admisión. En los 139 (27,7%) pacientes con ventilación mecánica, la mortali- dad general y a los 28 días fue de 37,4% (52/139) y 28,1% (38/139) fallecieron, respec- tivamente. Los factores de riesgo identificados fueron edad, comorbilidades y altos re- querimientos de oxígeno al ingreso. Conclusión: La mortalidad observada en los pacientes hospitalizados en nuestra insti- tución en la primera ola de la pandemia COVID-19 fue similar a los informes internacio- nales y menor que la publicada en Argentina para el mismo período.

Introduction: In December 2019, an outbreak of disease due to a new coronavirus was detected that evolved into a pandemic with severe respiratory morbidity and mortality. Health systems had to face an unexpected number of patients with respiratory failure. In Argentina, quarantine and health control measures delayed the first peak of the pan - demic and offered time to prepare the health system with infrastructure, personnel and protocols based on the best evidence available at the time. In a third level institution of Neuquén, Argentina, a care protocol was developed to confront the pandemic adapted by evolving best evidence and periodic evaluations of hospital mortality. Methods: Observational cohort study to evaluate the evolution of patients hospitalized for COVID-19 with care protocols in terms of overall hospital mortality and at day 28 at the Pasteur Clinic in Neuquén in 2020. Results: This report describes the 501 patients diagnosed until December 31, 2020. Mortality was 16.6% (83/501) and 12.2% (61/501) on day 28 of admission. Among the 139 (27.7%) patients with mechanical ventilation, overall mortality and at 28 days it was 37.4% (52/139) and 28.1% (38/139), respectively. The risk factors identified were age, comorbidities and high oxygen requirements on admission. Conclusion: The mortality observed in patients hospitalized in our institution during the first wave of COVID-19 pandemic was similar to international reports and lower than other publications in Argentina for the same period.

Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

COVID-19 knowledge, attitudes, and practices among health care workers in Latin America.

OBJECTIVE: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. METHODS: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. RESULTS: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. CONCLUSIONS: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.

COVID-19 knowledge, attitudes, and practices among health care workers in Latin America / Conhecimento, atitudes e práticas em relação à COVID-19 entre profissionais de saúde na América Latina

ABSTRACT Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.

RESUMO Objetivo: Avaliar o conhecimento, atitudes e práticas em relação à COVID-19 entre profissionais de saúde atuantes em países da América Latina durante o primeiro surto da pandemia. Métodos: Estudo multinacional transversal com uso de questionário on-line autoaplicável. A versão final do questionário foi composta por 40 perguntas, organizadas em cinco seções: características demográficas e profissionais; conhecimento sobre COVID-19; atitudes em relação à COVID-19; práticas relacionadas à COVID-19; e recursos institucionais. Resultados: O estudo envolveu 251 profissionais de saúde de 19 países da América Latina que aceitaram participar. Em nossa amostra, 77% dos profissionais de saúde participaram de algum tipo de treinamento institucional sobre COVID-19 e 43% tiveram baixa pontuação de conhecimento sobre COVID-19. O conhecimento sobre COVID-19 apresentou associação com o tipo de instituição de saúde (pública/privada), disponibilidade de treinamento institucional e fontes de informação. Receio de não prestar atendimento adequado foi relatado por 60% dos participantes. As estratégias ventilatórias mais utilizadas foram ventilação mecânica protetora, manobras de recrutamento alveolar e posição prona, e o uso de medicamentos para tratar a COVID-19 foi baseado principalmente em protocolos institucionais. Conclusões: Neste estudo multinacional na América Latina, quase metade da amostra teve baixa pontuação de conhecimento sobre COVID-19 e o nível de conhecimento apresentou associação com o tipo de instituição, participação em treinamento institucional e fontes de informação. Os profissionais de saúde consideravam a COVID-19 muito relevante, e mais da metade tinha receio de não prestar atendimento adequado aos pacientes.

Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL-1 for mepolizumab and above 400 cells·µL-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL-1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

[Prevalence of asthma at risk symptoms in adolescents exposed to volcanic ash, in two Patagonian cities]. / Prevalencia de síntomas de riesgo asma en adolescentes expuestos a ceniza volcánica, en dos ciudades de la Patagonia.

Objective: Evaluate the prevalence of asthma risk in subject of 13-14 years old that were exposed to volcanic ash. One year after the eruption of the Calbuco Volcano and in 2 cities with different degrees of exposure. Methods: Cross-sectional study was developed in subjects of 13-14 years old of two Patagonian cities: San Carlos de Bariloche and Cipolletti. The ISAAC questionnaire and video questionnaire was applied to determine asthma risk. Demographic and perception of exposure variables were assessed. Results: 511 subjects were surveyed in both cities. The prevalence of asthma at risk symptoms was higher in Bariloche 14% compared to Cipolletti 10%, but this difference was not statistically significant (p=0.32). A significant increase in the perception of volcanic ash exposure was reported 14% in Bariloche city vs. 6% in Cipolletti city, p<0.05. Conclusions: After 18 months of volcanic eruption with respiratory ash exposure and the lack of respiratory symptoms difference between two cities with different degree of exposure, this factor may not contribute to have a clinical impact in respiratory health.

Objetivo: Evaluar la prevalencia de riesgo de asma en adolescentes expuestos a ceniza volcánica a un año de la erupción del Volcán Calbuco, en 2 ciudades con diferentes grado de afectación. Métodologia: Estudio de Corte Transversal, en adolescentes de 13-14 años en dos ciudades con diferente grado de exposición a ceniza volcánica: San Carlos de Bariloche y Cipolletti. Se aplicó cuestionario y video-cuestionario ISAAC para determinar riesgo de asma. Las variables demográficas y percepción de exposición, se obtuvieron por cuestionario previo a la aplicación de metodología ISAAC. Resultados: Se encuestaron 511 sujetos en total. Se reportó prevalencia de síntomas de riesgo de asma en Bariloche resultó de 14% comparado con Cipolletti que reportó 10% (p=0.32). Se informó mayor exposición a ceniza volcánica en la ciudad de Bariloche vs. Cipolletti; 14% y 6% respectivamente con p<0.05. Conclusiones: La falta diferencia estadisticamente significativa respecto a la prevalencia de sintomas de riesgo de asma entre ambas poblaciones con diferente nivel de exposición y tras 18 meses de la erupción volcánica mas exposición respiratoria a ceniza volcánica, pareciera no presentar impacto clínico en la salud respiratoria.

Impacto respiratorio de la exposición aguda a las cenizas volcánicas en la Patagonia Argentina: un estudio transversal / Respiratory impact of acute exposure to volcanic ash in Argentine Patagonia: a cross-sectional study

Antecedentes: Las personas expuestas a cenizas volcánicas presentan incremento de los síntomas respiratorios. La duración de la exposición, las características y concentración de la ceniza son determinantes en el impacto sobre la salud respiratoria. Objetivos: Describir la prevalencia de sibilancias en el último año en la población adulta expuesta a la caída de ceniza volcánica en dos ciudades con diferente nivel de exposición. Secundariamente describir la prevalencia de síntomas oculares y respiratorios en esas poblaciones. Materiales y métodos: Se realizó estudio de corte transversal cinco días después de la erupción del volcán Calbuco, en dos ciudades patagónicas con diferente nivel de exposición (alta y baja exposición). La prevalencia de sibilancias, síntomas respiratorios y oculares, se evaluaron mediante la encuesta telefónica por sistema interactivo de voz. Resultados: La prevalencia de sibilancias fue similar en las ciudades de baja y alta exposición (30.2% vs. 31.0%; p: 0.82). Los síntomas respiratorios y los síntomas oculares fueron 32% y 57% respectivamente (p: NS). Conclusión: Luego de la erupción del volcán Calbuco, una alta proporción de la población expuesta reportó sibilancias, síntomas respiratorios y oculares. No se demostraron diferencias entre las ciudades analizadas. La prevalencia de sibilancias fue mayor en estas ciudades que la reportada a nivel nacional. Síntomas respiratorios, prevalencia de sibilancias en adultos mayor a lo reportado por a nivel nacional.

Impact on the Respiratory Airways of Acute Exposure to Volcanic Ash in the Patagonia: Cross-Sectional Study

History: People exposed to volcanic ash show increased respiratory symptoms. The duration of exposure, the characteristics and ash concentration are determinants of the impact on respiratory health. Objectives: To describe the prevalence of wheezing over the past year within the adult population exposed to volcanic ash spilling in two cities with different levels of exposure. Secondarily, to describe the prevalence of ocular and respiratory symptoms in those populations. Materials and methods: A cross-sectional study was conducted five days after the eruption of the Calbuco volcano in two Patagonian cities with different levels of exposure (high and low levels of exposure). The prevalence of wheezing and respiratory and ocular symptoms was evaluated by means of telephone surveys conducted through an interactive voice response system. Results: The prevalence of wheezing was similar both in cities with low and with high levels of exposure (30.2% vs. 31.0%; p: 0.82). The respiratory and ocular symptoms were 32% and 57%, respectively (p: NS). Conclusion: After the eruption of the Calbuco volcano, a high proportion of the exposed population showed wheezing and respiratory and ocular symptoms. No differences were shown between the analyzed cities. The prevalence of wheezing in these cities was higher than that reported on the national level. The respiratory symptoms and the prevalence of wheezing in adults were higher than those reported on the national level.

Longitudinal association of adiposity with wheezing and atopy at 22 years: the 1993 Birth Cohort, Pelotas, Brazil.

PURPOSE: Asthma is a highly prevalent noncommunicable lung disease. The aim of this study was to evaluate the longitudinal association of obesity/adiposity with wheezing and atopy. METHODS: The population of the study was composed of participants from the 1993 Pelotas (Brazil) Birth Cohort. The following outcome variables were measured at 22 years: wheezing in the last 12 months, wheezing with atopy, wheezing without atopy, only atopy, and persistent wheezing at 18 and 22 years. Exposure variables were obesity body mass index, percent fat mass (FM), and fat mass index, which were obtained by precise methods (BOD POD and dual-energy X-ray absorptiometry [DXA]). Crude and adjusted logistic and multinomial logistic regressions were used in the analyses. RESULTS: The prevalence of wheezing (with and without atopy), wheezing without atopy, only atopy, and persistent wheezing were 10.6%, 3.9%, 30.9%, and 4.0%, respectively. To be obese or to belong to the highest tertile of obesity/adiposity at two follow-ups showed a cumulative and positive association with wheezing in the adjusted analysis; for atopy there was no significant association. The odds ratio (OR) for wheezing according to the percentage of total FM measured by DXA in the highest tertile at both follow-ups was 1.58 (95% CI: 1.14-2.20) against an OR of 1.16 (95% CI: 0.92-1.47) for atopy. Persistent wheezing was also associated with adiposity, but without statistical significance. CONCLUSIONS: We found a positive longitudinal association between several measures of adiposity and wheezing at 22 years old. The effect was higher for cumulative adiposity; the results for atopy were not consistent.

Lung Disease Associated With Marijuana Use. / Patología pulmonar asociada al consumo de marihuana.

Marijuana is the most widely usedillegal drug in the world, with a prevalence of 2.5%-5%, and the second most commonly smoked substance after tobacco. The components of smoke from combustion of marijuana are similar to those produced by the combustion of tobacco, but they differ in terms of psychoactive components and use. Inhalation of cannabis smoke affects the respiratory tract, so the available evidence must be updated in order to provide pulmonologists with the latest scientific information. In this article, we review the impact of cannabis consumption on the lungs, taking into account that the respiratory route is the most popular route of cannabis consumption.

Prevalencia de síntomas de asma en niños expuestos a ceniza volcánica / Asthma Prevalence among Children Exposed to Volcanic Ashes

Introducción: Las erupciones volcánicas tienen diversos impactos sobre la salud de la población expuesta y el sistema respiratorio es uno de los más afectados debido a la inhalación de los productos volatilizados. Estudios experimentales en ratones demostraron que la exposición crónica a ceniza volcánica de la erupción del complejo Puyehue-Caulle se asoció con respuesta inflamatoria de la vía aérea. A la fecha, no se ha reportado el impacto sobre la salud respiratoria de los niños expuestos a este evento. Objetivo: Determinar la prevalencia de síntomas de asma en niños 2 años después de la erupción del complejo Puyehue-Caulle. Materiales y Métodos: Se realizó un estudio de corte transversal en niños de 13 y 14 años asistentes a 11 colegios secundarios de la Ciudad de San Carlos de Bariloche, Rio Negro. Se encuestaron usando los cuestionarios ISAAC, y se realizaron mediciones de espirometría y monóxido de carbono en aire espirado a cada uno de los sujetos. Resultados: Se encuestaron 303 sujetos, 56% fueron varones y 47% asistían a escuelas del sector público. El 12,8 % reportaron ser fumadores activos. El cuestionario ISAAC más video-cuestionario reportó 27% de sibilancias alguna vez en la vida y 14% de sibilancias en el último año. El análisis de las espirometrías mostró 1% de la muestra con patrón obstructivo. Conclusiones: En una muestra de niños residentes de una ciudad con alto nivel de exposición a ceniza volcánica se observó una alta prevalencia de síntomas de asma, los mismos fueron significativamente más prevalentes que en estudio previo realizado en esa ciudad.

Background: Volcanic eruptions have different health impacts on exposed population and the respiratory system is one of the most affected due to the inhalation of volatilized products. Experimental studies in guinea pigs showed that chronic exposure to volcanic ash from the eruption of the Puyehue-Caulle complex is associated with inflammatory airway response. To date, it has not been reported respiratory health impact of children exposed to this. Objective: To determine children´s asthma symptoms prevalence 2 years after Puyehue-Caulle complex´s eruption. Methods: Cross-sectional study was conducted among 13 and 14 years old children attending 11 secondary schools in San Carlos de Bariloche City, Rio Negro. They were surveyed with ISAAC´s questionnaires and spirometry and carbon monoxide in exhaled air measurements were performed to each subject. Results: 303 subjects were surveyed, 56% were male and 47% belonged to public schools. 12,8% were active tobacco smokers, 27% had wheezing sometime in the life and 14% had wheezes in the last year (based on ISAAC questionnaire). Only 1% of the spirometry had airway obstruction. Conclusions: The prevalence of last year asthma symptoms increased compared with a previous study.

Frecuencia y caracterización de tabaquismo en pacientes internados con patología respiratoria: estudio multicéntrico en hospitales de Buenos Aires / Frequence and characteristics of smoking patients admitted with respiratory pathology: a multicenter survey in Buenos Aires Hospitals

Introducción: Actualmente en Argentina no hay información sobre la prevalencia de tabaquismo en pacientes internados por enfermedad respiratoria. El objetivo de este estudio es determinar la prevalencia de tabaquismo y evaluar las características de la adicción a la nicotina en pacientes internados por patología respiratoria. Materiales y métodos: Estudio de corte transversal en 9 Hospitales de Buenos Aires. Se encuestaron pacientes cuyo motivo de ingreso fueron enfermedades respiratorias. Las variables estudiadas fueron reporte de consumo de tabaco (fumador actual, ex fumador, nunca fumador), dependencia mediante test de Fagerstrõm (TF), abstinencia mediante Minessota Nicotine Withdrawal Scale (MNWS); y motivación para dejar defumar mediante test de Richmond. Se evaluó la implementación del consejo breve y del tratamiento farmacológico.Resultados: Se encuestaron 376 pacientes, la edad media fue de 53 ± 16 años; el 54.5% eran varones. La prevalencia de fumadores actuales fue 30.3 % (IC:25.8-35.3). Los pacientes fumadores actuales presentaron TF promedio de 4.59 ± 2.9 puntos (dependencia moderada) y MNWS promedio de 1.14 ± 0.85 puntos (abstinencia leve). El 79.7% presentaba motivación moderada a alta para dejar de fumar. El 77% (IC:64.5-86.8%) de los fumadores actuales recibió consejo breve, pero solo 10.2% (IC:3.8-20.8) recibió tratamiento farmacológico.Conclusiones: La prevalencia de tabaquismo es similar a la reportada en la población general de Argentina. Los pacientes fumadores actuales presentan dependencia a la nicotina moderada y síndrome de abstinencia leve; con motivación moderada a alta para dejar de fumar durante la internación. La mayoría recibió consejo breve pero notratamiento farmacológico.

Background: Nowadays Argentina has no data about the prevalence of tobacco smoking about patients hospitalized for respiratory diseases. The objectives of this study are to establish the prevalence of the tobacco smoking habit and to assess the features of nicotine addiction in these patients. Methods: We designed a cross-sectional study with the participation of 9 Buenos Aires Hospitals. We surveyed patients who were hospitalized for respiratory diseases. The survey included the tobacco smoking habit, nicotine dependence with Fagerstrõm test (FT), nicotine abstinence with Minessota Nicotine Withdrawal Scale (MNWS) andmotivation to quit with Richmond´s test. We also assessed the implementation of brief advice and pharmacological treatment for tobacco use cessation. Results: 376 patients were surveyed, the mean age was 53 ±16 years and 54.5% were male. Prevalence ofactive tobacco smokers was 30.3% (IC: 25.8-35.3). The mean FT was 4.59 ± 2.9 points (moderate dependence) and the MNWS mean was 1.14 ± 0.85 points (mild abstinence). The majority (79.7%) had moderate to high motivation to quit smoking. Despite77% (IC: 64.5-86.8%) of active tobacco smokers received a brief advice, only 10.2% (IC: 3.8-20.8) were prescribed pharmacological treatment for tobacco use cessation. Conclusion: The prevalence of tobacco smoking in patients who were hospitalized forrespiratory diseases is similar to the prevalence in the general population of Argentina. Active tobacco smokers who are hospitalized for respiratory diseases have moderate nicotine dependence, mild withdrawal symptoms and moderate to high motivation to quit the smoking habit. Most patients received a brief advice but no pharmacologicaltreatment for tobacco use cessation.

Qué deben saber los cardiólogos del tratamiento farmacológico para dejar de fumar? / What cardiologists should be aware of pharmacotherapy for smoking cessation?

El consumo de tabaco constituye el principal factor de riesgo reversible en la enfermedad cardiovascular isquémica y dejar de fumar rápidamente disminuye el riesgo de eventos cardiovasculares y de muerte por esta causa. Las intervenciones conductuales han demostrado ser efectivas para dejar de fumar, y si a ello se suman fármacos, al menos se duplican las tasas de abstinencia medidas al año. Los fármacos con efectividad demostrada son la terapia de reemplazo nicotínico en todas sus formas farmacéuticas, el bupropión y la vareniclina. Estos fármacos han sido estudiados en pacientes con enfermedad cardiovascular estable y tienen similar efectividad que en la población general y un adecuado margen de seguridad, por lo que se recomienda su prescripción junto a la terapia conductual. No hay evidencia de mayor efectividad al asociar diferentes fármacos ni tampoco de diferentes perfiles de seguridad. La relación riesgo-beneficio de los posibles riesgos psiquiátricos y cardiovasculares reportados y los beneficios de abandonar el consumo benefician ampliamente el uso de estos fármacos en las indicaciones recomendadas.

Trombólisis con activador plasmático del plasminógeno en un modelo de trombosis de la arteria carótida en conejos, con cloruro férrico / Thrombolysis with plasminogen plasmatic activator in a rabbit model: carotid artery thrombosis with ferric chloride

Objetivo: El objetivo del presente trabajo fue analizar los resultados obtenidos de la actividad y la eficacia fibrinolítica de una nueva fracción proteica del plasma humano denominada activador plasmático del plasminógeno (APP) en un modelo experimental de trombosis carotídea en conejos. Material y métodos: Se realizó un estudio experimental, prospectivo, aleatorizado, doble ciego, en una muestra de 13 conejos New Zeland blancos. Para la formación del trombo se procedió a aislar la arteria carótida primitiva y en un sector de ella se realizó una trombosis, envolviendo una tira de papel de filtro impregnada en cloruro férrico (FeCl) al 70 por ciento alrededor del extremo distal del segmento arterial disecado. Se evaluó y se registró en forma secuencial el flujo sanguíneo arterial carotídeo pretrombosis, a los 10, 20, 30 y 35 minutos mediante eco-Doppler contínuo vascular. Comprobada la trombosis se iniciaba la fibrinólisis. Siete conejos fueron asignados al grupo A y se intentó reperfundir el flujo mediante dosis: 0,42 ± 0,25 mg; rango: 0,2-0,8 mg. Los 6 restantes conformaron el grupo B y fueron infundidos con placebo. Se evaluó el flujo a los 10, 20 y 30 minutos posteriores a la fibrinólisis en ambos grupos. Resultados: El eco-Doppler mostró reperfusión del flujo arterial carotídeo en el 100 por ciento de los conejos (7/7) del grupo A tratados con APP. En el grupo B, la reperfusión fue nula (0/6) (p = 0,002). Ningún conejo evidenció trastornos hemorrágicos sistémicos secundarios. Conclusiones: La trombosis arterial carotídea con FeCl en este modelo experimental en conejos resultó ser un método sencillo y económico para la evaluación de drogas fibrinolíticas. El APP demostró eficacia y seguridad en la fibrinólisis local y la reperfusión de la trombosis arterial, en comparación con el grupo tratado con placebo.