Extra-cardiac management of cardiogenic shock in the intensive care unit.

Cardiogenic shock (CS) is a heterogeneous clinical syndrome characterized by low cardiac output leading to end-organ hypoperfusion. Organ dysoxia ranging from transient organ injury to irreversible organ failure and death occurs across all CS etiologies but differing by incidence and type. Herein, we review the recognition and management of respiratory, renal and hepatic failure complicating CS. We also discuss unmet needs in the CS care pathway and future research priorities for generating evidence-based best practices for the management of extra-cardiac sequelae. The complexity of CS admitted to the contemporary cardiac intensive care unit demands a workforce skilled to care for these extra-cardiac critical illness complications with an appreciation for how cardio-systemic interactions influence critical illness outcomes in afflicted patients.

Cervical Cancer Evades the Host Immune System Through the Inhibition of Type I Interferon and CXCL9 by LIF.

BACKGROUND: Cervical cancer (CC) is a viral-associated tumor caused by the infection with the human papilloma virus. CC is then an immunogenic cancer that expresses viral antigens. Despite being immunogenic, CC does not fully respond to immune checkpoint inhibitors (ICI). LIF is a crucial cytokine in embryo implantation, involved in maternal tolerance that acts as an immunomodulatory factor in cancer. LIF is expressed in CC and high levels of LIF is associated with poor prognosis in CC. METHODS: We evaluated the impact of LIF on the immune response to ICI using primary plasmocytoid dendritic cells (pDCs) and macrophage cultures, syngeneic animals and patient-derived models that recapitulate the human tumor microenvironment. RESULTS: We found that the viral proteins E6 and E7 induce the expression of LIF via the NFκB pathway. The secreted LIF can then repress type I interferon expressed in pDCs, and CXCL9 expressed in tumor associated macrophages. Blockade of LIF promotes the induction of type I interferon and CXCL9 inducing the tumor infiltration of CD8 T cell. This results in the sensitization of the tumor to ICI. Importantly, we observed that patients with CC expressing high levels of LIF tent to be resistant to ICI. CONCLUSION: Our data show that the HPV virus induces the expression of LIF to provide a selective advantage to the tumor cell by generating local immunosuppression via the repression of type I interferon and CXCL9. Combinatory treatment with blocking antibodies against LIF and ICI could be effective against CC expressing high levels of LIF.

Compromiso hepatoesplénico, un hallazgo inusual secundario a enfermedad por arañazo de gato: a propósito de un caso / Hepato-splenic involvement, an unusual finding secondary to cat-scratch disease: a clinical case

La infección por Bartonella henselae (BH) que causa la enfermedad por arañazo de gato puede cursar de manera asintomática, así como presentar manifestaciones locales y sistémicas. El objetivo de este caso es documentar que el compromiso hepatoesplénico es poco habitual en este tipo de infección y el tratamiento, que debe ser personalizado, aún genera controversia. Se presenta un caso de una paciente de 11 años con fiebre de origen de desconocido con hallazgos en tomografía y ecografía abdominal de abscesos hepatoesplénicos, y confirmación de infección por BH a través de métodos serológicos. Se realiza una revisión bibliográfica donde se evidencia la baja frecuencia de compromiso hepatoesplénico. De esta manera, la anamnesis y el examen físico son fundamentales para realizar un rápido diagnóstico y tratamiento

The infection by Bartonela henselae (BH), the cause of cat scratch disease, it could be asymptomatic or produce local and multisystem illness. The objective of this case report is to document that the hepato-splenic involvement is unusual in BH infection, and the treatment is discussed and individualized in each patient. This case is about an eleven-year girl who presented with findings in abdominal tomography and ultrasound of hepato-splenic abscesses, with later positive serology for BH. In this way, a bibliographic review is carried out to show the low prevalence and incidence of hepato-splenic involvement where the anamnesis and the physical examination are essential to make an early diagnosis and treatment.

Hallazgos electrocardiográficos en pacientes hipertensos del programa de vigilancia y control de la hipertensión arterial de ASSBASALUD ESE, Manizales, Colombia / Electrocardiographic findings in hypertensive patients of the hypertension surveillance and control program at ASSBASALUD ESE, Manizales, Colombia

Antecedentes. La hipertensión arterial sistémica es una enfermedad multifactorial que incluye la elevación de las cifras de tensión arterial, factores de riesgo cardiovascular e hipertrofia ventricular izquierda. Objetivo. Analizar los cambios electrocardiográficos en pacientes hipertensos inscritos en el programa de hipertensión arterial en ASSBASALUD Empresa Social del Estado, Manizales, Colombia, 2012. Materiales y métodos. Estudio poblacional de corte transversal. 102 pacientes. Variables electrocardiográficas analizadas: índices de Cornell, Sokolow Lyon y Macruz; cambios en la onda P y cambios en el eje. Se tomó electrocardiograma. Resultados. Edad promedio de 62 años. El 58,5% de los pacientes estudiados se clasificaron como pre-hipertensos, el 18,6% tenían frecuencia cardíaca superior a 100 latidos por minuto. Se encontraron cambios en la onda P en el 26,3%. En el 34% el eje estaba desviado. 64,6% tenían índice de Macruz anormal. 10,8% mostraron aumento en el voltaje del índice Sokolow-Lyon. En un 10,8% el voltaje de Cornell estaba elevado. En un 5,1% la fuerza terminal de onda P fue mayor a 40. Un 7,8% tenían bloqueos de rama derecha. En los pacientes con niveles altos de la presión arterial se encontró relación significativa con la elevación en los índices de Cornell (p=0,000) y de Sokolow-Lyon (p=0,016). Se encontró relación significativa entre los valores elevados de la presión arterial sistólica y los cambios en los índices de Cornell (p=0,010) y Sokolow-Lyon (p=0.001), los valores de la presión arterial diastólica se asociaron más a cambios en el Sokolow-Lyon (p=0,001). Conclusiones. Se confirma en esta población de hipertensos la asociación entre hipertensión arterial y cambios electrocardiográficos, especialmente en los índices de Cornell y de Sokolow-Lyon.

Background. Systemic blood pressure (HBP) is a multifactorial disease that includes elevated blood pressure levels, cardiovascular risk factors and left ventricular hypertrophy. Objective. To analyze the electrocardiographic changes in hypertensive patients enrolled in the hypertension surveillance and control program at ASSBASALUD ESE, Manizales, Colombia in 2012. Materials and methods. Cross-sectional study that involved 102 patients. The variables used were electrocardiogram indexes as Cornell, Sokolow Lyon, Macruz and P wave duration. It took a 12-lead electrocardiogram for each patient executed at ASBASALUD ESE, La Asunción. Results. The average age was 62 years, 58.5% were in the prehypertension range, also 18.6% had abnormal heart rate, 26.3% abnormal P wave duration, 34% abnormal cardiac axis, 64.6% abnormal Macruz index, 10.8% abnormal Sokolow-Lyon index, 10.8% abnormal Cornell index, 5.1% positive P-wave terminal force, 7.8% had right bundle branch block. The rank of hypertension showed significant relationship with the level of Cornell (p=0.000) and Sokolow-Lyon (p=0.016) indexes. A significant relationship between systolic blood pressure value and Cornell (p=0.010) and Sokolow-Lyon indexes were found (p=0.001), likewise diastolic blood pressure value and Sokolow-Lyon index value showed relationship (p=0.001). Conclusions. It is confirmed, in this population of hypertensive patients, that the indexes show variation according to level of hypertension, as well with the values of systolic and diastolic blood pressure are Cornell and Sokolow-Lyon indexes.