Reduced thrombin activatable fibrinolysis inhibitor and enhanced proinflammatory cytokines in acute coronary syndrome.

OBJECTIVE: A study was made of the changes in the serum levels of thrombin activatable fibrinolysis inhibitor (TAFI), proinflammatory cytokines and acute phase proteins in the acute stage of acute coronary syndrome (ACS), in order to explore the possibility of using TAFI as a biomarker for ACS risk assessment. METHODS: A total of 211 patients with ACS were enrolled, and healthy subjects were used as controls. Blood samples were taken within 24h after admission. Serum TAFI levels were determined by immunoturbidimetry. Serum levels of interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA). Procalcitonin (PCT) and C-reactive protein (CRP) levels were measured by gold-immunochromatographic assay. RESULTS: Serum TAFI levels in ACS patients were significantly decreased versus the controls. The IL-1ß, IL-6, TNF-α, PCT and CRP levels were markedly higher in the ACS patients than in the controls. Correlation analysis revealed a strong negative correlation between TAFI concentration and the IL-1ß, IL-6, TNF-а, PCT and CRP levels in ACS patients and in controls. Multivariate logistic regression analysis suggested decreased serum TAFI to be an independent risk factor for ACS (OR 9.459; 95% CI 2.306-38.793; P=0.002). The area under the receiver operating characteristic (ROC) curve for TAFI was 0.872 (95% CI 0.787-0.909; P<0.001). The optimum TAFI cutoff point for the prediction of ACS was 24µg/ml, with a sensitivity of 75.83% and a specificity of 72.57%. CONCLUSION: These findings suggest that TAFI can be useful as a potential biomarker for ACS risk assessment.

Clinical factors associated with success of proportional assist ventilation in the acute phase of critical illness: pilot study.

REASON: Proportional assist ventilation plus (PAV+) applies pressure depending on the patient's inspiratory effort, automatically adjusting flow and volume assist to changes in respiratory mechanics. We aimed to assess the clinical factors associated with the success of PAV+ as first-line support in the acute phase of critical illness. METHODS: A prospective cohort study was carried out. Mechanically ventilated patients>24h were switched from assist-control ventilation to PAV+ as soon as they regained spontaneous breathing activity. PAV+ was set to deliver the highest assistance. We compared patients in whom PAV+ succeeded versus those in whom it failed. RESULTS: PAV+ succeeded in 12 (63%) patients, but failed in 7 (37%) due to tachypnea (n=4), hypercapnia (n=2), and metabolic acidosis (n=1), but without statistical significance. Both groups had similar clinical parameters. On the day of inclusion, total work of breathing per breath was lower in the successful PAV+ group (WOBTOT: 0.95 [0.8-1.35] vs. 1.6 [1.4-1.8] J/L; P<.007). The area under the ROC curve was 0.89 ± 0.08 for WOBTOT. The best cut-off for predicting PAV+ success was WOBTOT<1.4 J/L (sensitivity: 1 [0.7-1], specificity: 0.6 [0.4-0.6], PPV: 0.7 [0.5-0.7], and NPV: 1 [0.6-1]). CONCLUSION: PAV+ proved feasible as first-line ventilatory support in 63% of the patients, mostly in individuals without extreme derangements in WOBTOT. Tachypnea and hypercapnia were the clinical factors associated with failure, though statistical significance was not reached.

Importance of blood pressure monitoring in the acute phase of stroke. An update.

INTRODUCTION: The evaluation of blood pressure (BP) is essential in the acute phase of stroke. Although ambulatory blood pressure monitoring (ABPM) is a validated method for BP control, there are few studies assessing the usefulness of ABPM in the acute phase of stroke. DEVELOPMENT: A systematic review was carried out according to the PRISMA criteria in the PubMed/Medline and Scopus databases. Those articles that analysed the use of ABPM in the first days after suffering a stroke from 1992 to 2022 were selected. Those articles focused on the post-acute or sequelae phase of the stroke, with a sample size of less than 20 and those where the primary objective was different from the defined one. A total of 28 articles were included. CONCLUSIONS: The use of ABPM in patients with recent stroke demonstrates that the normal circadian profile of BP is altered in more than two-thirds of patients and that this will be fundamentally conditioned by the haemodynamic changes that occur on autoregulation of cerebral blood flow, the type of stroke or the response to treatment. Furthermore, these changes in BP have prognostic implications and are correlated with functional status, stroke recurrence and mortality, among others. However, although they continue to be a growing area of research, new studies are needed to clarify the real role of this technique in patients with acute stroke.

[Management of acute ischemic stroke]. / Abordaje y tratamiento del ictus isquémico en la fase aguda.

Ischemic stroke is a serious neurological condition that requires urgent attention. As a time-dependent disease, acute stroke management must be coordinated and effective to provide the best treatment as early as possible. The treatment of the acute phase of ischemic stroke includes general measures to ensure patient hemodynamic stability, the use of reperfusion therapies (intravenous thrombolytics and mechanical thrombectomy), improving cerebral protection by monitoring the homeostasis of certain variables as blood pressure, glycemia, temperature, or oxygenation, as well as preventing cerebral and systemic complications. Also, it is necessary an early planning of comprehensive rehabilitation. To prevent early recurrences, control of vascular risk factors and antithrombotic treatment is recommended. The management of patients with acute ischemic stroke aims to reverse initial symptoms, to prevent further brain damage, improve functional outcomes and avoid ischemic recurrences.

Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism.

INTRODUCTION: D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. PATIENTS AND METHODS: Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. RESULTS: Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. CONCLUSION: It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.

Analysis of hypothermia through the acute phase in major burns patients: Nursing care. / Análisis de la hipotermia durante la fase aguda del paciente gran quemado: cuidados enfermeros.

Major burns patients usually present hypothermia after suffering a thermal burn, due to exposure during the accident, cooling of the burn and transfer. There are methods of reheating to avoid this heat loss, where nursing care is key. OBJECTIVE: To analyse the constant temperature presented by large burns patients on admission to the Burns Unit and their progression over the first 72hours. METHOD: Retrospective cross-sectional descriptive observational study of patients with thermal burns affecting more than 15% of body surface area, from December 2010 to May 2018. By reviewing databases and clinical records, demographic data, qualitative variables (origin of burn, previous pathologies, mechanical ventilation and ABSI and BOBI scales) and quantitative variables (burn depth and extension, temperature at admission and taken every 8hours for 72hours). Absolute, relative frequencies and the statistics of the quantitative variables were analysed. The study was verified by statistical tests according to the variables and contingency tables. A logistic regression model was developed expressed in a ROC curve. RESULTS: Of the 57 patients included, 79.2% developed hypothermia on admission. They presented burns over 34.56%±16.64 of their body surface, with 28.04%±17.49 being deep burns. Mortality during the stay was 29.8%. The presence of hypothermia during the acute phase was statistically related to death during stay in the unit (p=.033). It was observed that hypothermia is directly related to the extent of the burn (p=.003). CONCLUSIONS: Due to the presence of hypothermia on admission, and to the fact that the average temperature does not exceed 36°C until at least 16hours after the burn, nurses must know and promptly administer adequate reheating measures to improve chances of survival in major burns.

Serum Levels of Alpha1-antitrypsin and Their Relationship With COPD in the General Spanish Population.

BACKGROUND: Low plasma level of alpha1-antitrypsin (AAT) is an established risk factor for early-onset chronic obstructive lung disease (COPD). However, less attention is given to the levels of AAT in the general population. METHODS: This is a part of a multicentre, population-based study conducted at 11 sites throughout Spain. Plasma levels of AAT were available for 837 persons with a mean (SD) age of 58.05 (11.3) years: 328-smokers, 272-ex-smokers and 237 non-smokers. Out of 837, 303 (36.2%) had a diagnosis of COPD, 222 (26.5%) had respiratory symptoms but no COPD, and 312 (37.3%) were healthy controls. RESULTS: In the whole cohort, the mean level of plasma AAT was 1.51 (0.47)g/L. Levels were higher in COPD patients [1.55 (0.45)g/L] and individuals with respiratory symptoms [1.57 (0.47)g/L] than in controls [1.43 (0.47)g/L], p<0.001, a finding which persisted after correction for age and CRP. Plasma AAT levels were negatively associated with FEV1/FVC ratio, after adjustment for age, sex, smoking status, CRP, TNFα, fibrinogen and albumin. The risk for COPD was significantly associated with higher AAT levels in univariate and multivariate models, with odds ratios of 1.8 and 1.5, respectively. In the univariate and multivariate models smoking status, gender, and CRP levels were also associated with COPD probability, demonstrating that they act independently. CONCLUSION: Increased circulating levels of AAT, similarly to CRP and other markers of systemic inflammation, is an important feature of COPD. Our results highlight a complex interrelationship between levels of AAT and health of respiratory system.

Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology. / Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

Caracterización clínica y epidemiológica de la enfermedad pulmonar obstructiva crónica / Clinical and epidemiological characterization of chronic obstructive pulmonary disease

Objetivo: caracterizar clínica y epidemiológicamente a los pacientes con enfermedad pulmonar obstructiva crónica. Métodos: estudio descriptivo retrospectivo trasversal, que incluyó pacientes adultos con diagnóstico de enfermedad pulmonar obstructiva crónica en un hospital universitario de Medellín. Material y métodos: la fuente de información fue secundaria a través de historias clínicas, el análisis se realizó en el programa Jamovi, empleando un análisis univariado. Resultados y discusión: se incluyeron 552 pacientes, la edad mediana fue 76 años con predominio del sexo femenino (56.7%). Respecto a la exposición a sustancias tóxicas respiratorias importantes en el desarrollo de la enfermedad, 24.1% consumían cigarrillo y 23% exposición a biomasa. Al momento del ingreso hospitalario 17.9% fueron clasificados con disnea grado IV; 74.1% recibió beta-agonistas de corta acción y antimuscarínicos de corta acción 60%; 11.6% requirió ingreso a las unidades de cuidados intensivos o especiales y 7.8% fallecieron durante la hospitalización. Conclusiones: se evidencia subdiagnóstico espirométrico de la enfermedad que puede estar relacionado con las limitaciones económicas, tecnológicas y de recurso humano capacitado, lo cual afecta el adecuado diagnóstico y manejo de la enfermedad, así como impacta la calidad de vida de los pacientes.

Objective: clinical and epidemiological characterization of patients with chronic obstructive pulmonary disease (COPD). Methods: a retrospective, cross-sectional, descriptive study, which included adult patients with a diagnosis of COPD in a university hospital in Medellín. Data sources were secondary, based on medical records. The Jamovi program was used to perform a univariate analysis. Results and discussion: 552 patients were included. Median age was 76 years with a female predominance (56.7%). Regarding exposure to major respiratory toxic substances implicated in the development of the disease, 24.1% were tobacco smokers and 23% were exposed to biomass smoke. At the time of hospital admission,17.9% were classified as having grade 4 dyspnea; 74.1% received short acting beta-agonists and 60% short-acting antimuscarinics,11.6% required intensive care unit or special care unit admission, and 7.8% died in hospital. Conclusions: under-diagnosis of COPD by spirometry may be related to economic, technological, and trained human resource limitations, which affect adequate diagnosis and management of the disease, as well as patient ́s quality of life.

Haptoglobin and its association with naturally occurring diseases in Holstein heifer calves / [Haptoglobina e sua associação com doenças ocorridas naturalmente em bezerras da raça Holandesa]

The present study evaluated the use of haptoglobin (Hp) as an indicator of health and performance in 166 Holstein heifer calves reared in an intensive production system. Calves were evaluated at D6-9; D10-13; D20-23; D35-38 and D65-68, corresponding to the days of life. The absence or presence of diseases was evaluated by physical examination and classification of scores. The performance parameters evaluated were body weight, height at withers and hind width. Hp was measured by spectrophotometric technique. The highest prevalence of diarrhea (59.4%; 98/165) was observed in D10-13, bovine respiratory disease (BRD) was on D35-38 (25.8%; 42/163), and umbilical inflammations in D6-D9 (7.8%; 13/166). Highest values of Hp were observed in animals with diarrhea (P=0.02), and umbilical inflammation (P=0.057), in comparison with the group of healthy calves. A significant negative correlation was observed between Hp and performance index. This protein presented an important relation with diarrhea and performance of the calves, opening perspectives on its utilization as a biomarker of diseases.(AU)

O presente estudo avaliou o uso da haptoglobina (Hp) como indicadora de sanidade e desempenho em 166 bezerras Holandesas criadas em um sistema de produção intensivo. As bezerras foram avaliadas nos momentos D6-9; D10-13; D20-23; D35-38 e D65-68, sendo estes correspondentes aos dias de vida. A ausência ou a presença de doenças foi avaliada por meio do exame físico e da classificação por escores. Os parâmetros de desempenho avaliados foram peso corporal, altura de cernelha e largura de garupa. A Hp foi mensurada por técnica espectrofotométrica. A maior prevalência de diarreia (59,4%; 98/165) foi observada em D10-13, doença respiratória bovina (DRB) ocorreu em D35-38 (25,8%; 42/163) e inflamações umbilicais em D6-D9 (7,8%; 13/166). O valor de Hp foi maior nos animais que apresentaram diarreia (P=0,02) e inflamações umbilicais (P=0,057), em comparação ao grupo de bezerras saudáveis. Houve correlação negativa significativa entre a Hp e os índices de desempenho. Essa proteína apresentou uma importante relação com a diarreia e com o desempenho das bezerras, abrindo perspectivas sobre a sua utilização como biomarcadora de doenças.(AU)