[Fiber morphometry of the external intercostal muscle. Comparison of dominant and nondominant sides in patients with severe COPD]. / Morfometría fibrilar del músculo intercostal externo. Comparación entre los lados dominante y no dominante en pacientes con EPOC severa.

The general morphometric characteristics of the external intercostal muscle (EIM) of patients with chronic respiratory disease have been well described. Because this muscle is highly accessible, it can provide an ideal model for longitudinal studies using consecutive biopsies of both sides. Whether or not the EIM fiber phenotype is homogeneous on dominant (D) and non dominant (ND) sides is unknown, however. To evaluate possible structural differences in right and left EIM in patients with COPD, eight patients (63 +/- 7 years of age) were enrolled. Lung function, respiratory muscle power, general muscle power and nutritional state were evaluated. Biopsies of the fifth EIM were taken from both sides. Specimens were processed in parallel manner to determine conventional morphometry (hematoxylin-eosin staining), including minimum diameter (Dm) and fiber area (Ar) in cross sections. Fibers were typed by ATPase (at pH 4.2, 4.6 and 9.4) and NADH-TR staining. Nutrition was normal in all patients. All patients had severe COPD (FEV1 27 +/- 7% of reference, limits 13 to 38% of reference) with air entrapment (RV 163 +/- 36% of reference, limits 181 to 276% of reference). None of the patients showed respiratory insufficiency at rest (PaO2 72 +/- 7 mmHg). Peripheral musculoskeletal power measured by manual dynamometer showed no significant right-left differences: D 29 +/- 2 and ND 28 +/- 3 dynes. Morphometric study of 16 muscle specimens showed no significant differences between fiber size on D and ND sides. DmD was 47 +/- 10 microns and ArD, was 2,595 +/- 1,249 microns2. DmD was 49 +/- 9 microns and ArD was 2,636 +/- 953 microns2. Likewise, no significant differences were found between D and ND fiber types: type ID 51 +/- 4% and type IID 49 +/- 5% versus type IND 52 +/- 4% and type IIND 48 +/- 4%. EIM on N and ND sides is homogeneous at the fifth intercostal space. This finding, along with the scarcely invasive nature of the technique for collecting specimens leads us to suggest that longitudinal studies might be performed on the structural effects of various pharmacological or physical treatments followed by COPD patients

[Metabolic activity of the external intercostal muscle of patients with COPD]. / Actividad metabólica del músculo intercostal externo en pacientes con EPOC.

INTRODUCTION: The external intercostal muscle is a relevant contributor to ventilatory work in situations of overloading. Like other respiratory muscles, the external intercostal muscle seems to undergo a process of structural remodeling to adapt to a situation of functional disadvantage. However, findings from published studies of morphology have differed to a certain degree. On the one hand, the proportion of fibers involved in anaerobic metabolism increases; on the other hand, the number of capillaries also increases, an occurrence that would facilitate aerobic metabolism. OBJECTIVE: This study was designed to analyze the activity of several key enzymes involved in the principal metabolic pathways in the external intercostal muscles of patients with COPD. METHODOLOGY: We studied 6 patients with COPD (65 +/- 8 years, BMI 23 +/- 3 kg/m2, FEV1 51 +/- 9% ref, RV 184 +/- 38% ref, PaO2 81 +/- 10 mmHg) and 6 control subjects matched for age and anthropometric variables but with normal lung function. External intercostal muscle samples were taken from each patient (fifth intercostal space, non-dominant side). The samples were treated by conventional spectrophotometry to determine enzyme activity as follows: citrate synthase (CS, Krebs cycle), phosphofructokinase (PFK, by common glycolysis), lactate dehydrogenase (LDH, anaerobic glycolysis) and creatine phosphokinase (CPK, use of energy reserves). RESULTS: Patients with COPD showed greater PFK enzyme activity (93 +/- 25 versus 44 +/- 9 micromol/min/g of fresh weight; p = 0.001) and LDH (308 +/- 42 versus 231 +/- 29 micromol/min/g; p < 0.01) than did control subjects. However, CS and CPK activity was similar in both groups (82 +/- 31 versus 90 +/- 20 micromol/min/g and 4017 +/- 1734 versus 3048 +/- 464 micromol/min/g, respectively), although the latter displayed noteworthy dispersion of values among COPD patients, with levels in some patients being three-fold greater than in controls. RV was directly related to glycolytic enzyme activity (with PFK, r = 0.716, p < 0.01; with LDH r = 0.697, p < 0.05) and PFK and LDH also correlated with each other (r = 0.737, p < 0.01). CONCLUSIONS: Based on the enzyme activity studied, oxidative activity seems to be conserved in the external intercostal muscle of patients with COPD. Activity in the glycolytic pathway seems to increase and the increase is proportional to the severity of COPD. These findings are probably the expression of a combination of adaptive structural factors.

[Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome]. / Factores predictivos de infección por el virus de la gripe H1N1 2009 en pacientes con síndrome gripal.

INTRODUCTION: Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity. MATERIAL AND METHODS: A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus. RESULTS: Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P= 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5[12] mg/dL, P= 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P= 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab. CONCLUSIONS: About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity.

Arthritis in Mediterranean spotted fever.

Although arthralgia is a common complaint in Mediterranean spotted fever, frank arthritis is very unusual. We report two cases of this condition during the course of Mediterranean spotted fever. Synovial fluid was inflammatory in both patients and the disease resolved after doxycycline therapy. Immunofluorescence test for Rickettsia conorii in synovial fluid was negative, suggesting a reactive arthritis.

Parálisis facial periférica bilateral idiopática en una paciente de 38 años / No disponible

No disponible

Estudio comparativo de salbutamol nebulizado en monoterapia o asociado a glucosa más insulina en el tratamiento de la hiperpotasemia / Nebulized salbutamol with or without glucose and insulin to treat hyperkalemia: a randomized controlled trial

Introducción: La hiperpotasemia es un trastorno potencialmente letal, que se detecta con relativa frecuencia en los servicios de urgencias. En su tratamiento se contemplan los beta2-adrenérgicos junto a otros tratamientos. El objetivo de este estudio es comparar la eficacia del salbutamol nebulizado con la combinación de salbutamol nebulizado asociado a insulina más glucosa en el tratamiento de la hiperpotasemia. Método: Estudio prospectivo y aleatorizado de los pacientes a los que se les detectó hiperpotasemia (K > 5,5 mEq/l). Se dividieron en dos grupos: monoterapia con salbutamol nebulizado o salbutamol nebulizado asociado a insulina más glucosa. Se añadió bicarbonato cuando existía alteración del equilibrio ácido-base. Se recogieron datos de filiación, antecedentes y medicación hipercalemiante. Se registró la reducción plasmática de potasio y el diagnóstico al alta. Se realizó una comparación entre grupos. Resultados: Se incluyó a 81 pacientes (40 en el grupo monoterapia). La media (..) (AU)

Background and objective: Hyperkalemia is a life-threatening condition that is detected fairly often in the hospital emergency department. Treating hyperkalemia with â2-adrenergic drugs in association with other agents has been recommended. This study aimed to compare the efficacy of nebulized salbutamol alone or in combination with insulin and glucose to treat hyperkalemia. Patients, material and methods: Prospective randomized controlled trial enrolling patients with hyperkalemia(potassium level >5.5 mEq/L). Patients were assigned to a monotherapy group (nebulized salbutamol alone) or a combined therapy group (salbutamol plus insulin and glucose). If acid-base imbalance was detected, sodium bicarbonate was also administered. We recorded patient characteristics, medical history, current medication that might cause high potassium concentrations, plasma potassium concentration, and discharge diagnosis. Variables were compared between groups. Results: Eighty-one patients (40 in the monotherapy group) were enrolled. The mean (SD) potassium concentration at (..) (AU)

Tuberculosis en población inmigrante: casos diagnosticados en urgencias según el lugar de procedencia / Tuberculosis in an immigrant population: emergency department diagnoses, analyzed by place of origin

Objetivo: El Hospital del Mar de Barcelona cubre un área de influencia (AI) de 350.000habitantes. En 2006, el 15,7% de esta población eran inmigrantes. El objetivo de este estudio es describir la distribución por países y zonas geográficas de los pacientes diagnosticados de tuberculosis en urgencias. Adicionalmente, se muestra el país y zona geográfica de procedencia de los inmigrantes censados en nuestra AI. Método: Se incluyeron los inmigrantes diagnosticados de tuberculosis durante 2006 y2007. Los datos poblacionales se obtuvieron del padrón municipal. Para cada país y zona geográfica se evaluó el porcentaje que representaba respecto a la población inmigrante censada (PIC), y el porcentaje respecto al total de tuberculosis en inmigrantes diagnosticados en urgencias (PTU). Se calculó el índice PTU/PIC para evaluar los casos de tuberculosis ajustados según los datos poblacionales. Resultados: El número de inmigrantes censados en 2006 fue de 54.057. Las nacionalidades más frecuentes fueron la pakistaní (14,1%) y la ecuatoriana (10,1%) y las zonas geográficas fueron Latinoamérica (38,3%) y Europa Occidental (19,2%). Se diagnosticaron60 casos de tuberculosis en inmigrantes, y fueron más frecuentes los casos procedentes de Pakistán (26,7%), seguidos de Bolivia (15%), Europa del Este (11,7%) y África del Norte (8,3%). Las mayores puntuaciones PTU/PIC correspondieron a Bolivia, Pakistán, Europa del Este y Asia Central. Conclusiones: La mayoría de los nuevos casos de tuberculosis en inmigrantes visitados en urgencias corresponden a pacientes originarios de Pakistán y de Latinoamérica, pero el mayor índice PTU/PIC se observa en los procedentes de Bolivia y Europa del Este (AU)

Objectives: Hospital de Mar in Barcelona serves a population of 350 000 inhabitants. In 2006, 15.7% of this population consisted of immigrants to Spain. The aim of this study was to describe the distribution by country and geographic region of immigrant patients diagnosed with tuberculosis in the emergency department. Additionally, we show the countries and geographic regions of origin of all immigrants identified by the census as residing in the area the hospital serves. Methods: The study included immigrants diagnosed with tuberculosis in 2006 and 2007. Population data were obtained from municipal census records. By country and region of origin, we analyzed the number of immigrants with tuberculosis, calculating percentages of the overall immigrant population recorded in the census (PIPC) and of the total number of immigrants diagnosed with this disease in the emergency department (PTED). The ratio between the two percentages (PTED/PIPC) was calculated to create an index reflecting the number of tuberculosis cases adjusted for population data. Results: A total of 54 057 immigrants were identified in the 2006 census. The largest national groups were those from Pakistan (14.1%) and Ecuador (10.1%). The largest regional groups were those from Latin America (38.3%) and Western Europe (19.2%). Sixty cases of tuberculosis were diagnosed in immigrants. Most of these patients came from Pakistan(26.7%) and Bolivia (15%). Attending to geographic region, patients from Eastern Europe (11.7%) and those from North Africa (8.3%) were the most frequently diagnosed. The highest PTED/PIPC indexes corresponded to Bolivia, Pakistan, Eastern Europe, and Central Asia. Conclusions: Most new cases of tuberculosis in immigrants diagnosed in the emergency department were found in patients from Pakistan and Latin America, but the highest PTED/PIPC indices were those for Bolivia and Eastern Europe (AU)

Actividad metabólica del músculo intercostal externo en pacientes con EPOC / Metabolic activity of the external intercostal muscle of patients with COPD

INTRODUCCIÓN: El músculo intercostal externo (IE) contribuye de forma relevante al esfuerzo ventilatorio en situaciones de sobrecarga. Como otros músculos respiratorios, el IE parece participar en un proceso de remodelación estructural, para adaptarse a una situación funcional desventajosa. Sin embargo, los estudios morfológicos publicados ofrecen resultados hasta cierto punto divergentes. Por un lado, aumenta la proporción de fibras de metabolismo anaerobio, mientras que por otro se incrementa el número de capilares, lo que facilitaría el uso de un metabolismo de tipo aerobio.OBJETIVO: Este estudio se diseñó para analizar la actividad de diferentes enzimas clave, correspondientes a las principales vías metabólicas, en el IE de pacientes con enfermedad pulmonar obstructiva crónica (EPOC).METODOLOGÍA: Se estudiaron 6 pacientes con EPOC (65 ñ 8 años; índice de masa corporal [IMC]: 23 ñ 3 kg/m2; FEV1: 51 ñ 9 por ciento ref., volumen residual [RV: 184 ñ 38 por ciento ref.; PaO2: 81 ñ 100 mmHg) y 6 sujetos control, apareados por edad y características antropométricas, pero con función pulmonar normal. En todos ellos se procedió a la toma de muestras del IE (quinto espacio intercostal, lado no dominante), que fueron procesadas para la determinación de las siguientes actividades enzimáticas por espectrofotometría convencional: citratosintetasa (CS, ciclo de Krebs), fosfofructocinasa (PFK, vía glucolítica común), lactodeshidrogenasa (LDH, glucólisis anaerobia) y creatinfosfocinasa (CPK, uso de reservas energéticas).RESULTADOS: Los pacientes con EPOC presentaron mayor actividad de las enzimas PFK (93 ñ 25 frente a 44 ñ 9 µmol/min/g de peso en fresco; p = 0,001) y LDH (308 ñ 42 ante 231 ñ 29 µmol/min/g; p < 0,01) que los sujetos control. Por el contrario, las actividades de CS y CPK fueron similares (82 ñ 31 frente a 90 ñ 20 µmol/min/g, y 4.017 ñ 1.734 ante 3.048 ñ 464 µmol/min/g, respectivamente), aunque la segunda presentaba una dispersión muy notable de valores en los pacientes con EPOC, que en algunos casos triplicaban a los de los controles. El RV se correlacionó directamente con la actividad de las enzimas glucolíticas (con PFK, r = 0,716, p < 0,01; con LDH, r = 0,697, p < 0,05), que también se correlacionaban entre sí (r = 0,737, p < 0,01).CONCLUSIONES: A tenor de las actividades enzimáticas estudiadas, la actividad oxidativa parece conservada en el IE de sujetos con EPOC. Por su parte, la actividad de la vía glicolítica parece hallarse aumentada, y este aumento es proporcional a la gravedad de la EPOC. Estos resultados son probablemente la expresión del efecto combinado de diversos factores estructurales de carácter adaptativo. (AU)