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Data on demographic characteristics and therapeutic approaches in Latin American pulmonary arterial hypertension (PAH) patients are scarce. Pulmonary Hypertension Mexican registry (REMEHIP) is a multicenter Mexican registry of adult and pediatric patients, including prevalent and incident cases. Objective: assess clinical characteristics, treatment trends, and in-hospital outcomes. Inclusion: age >2 years, diagnosis of pulmonary hypertension (PH) (groups 1 and 4), right heart catheterization with mPAP ≥25 mmHg, PWP ≤ 15 mmHg, and PVR > 3 Wood unit (WU). We included 875 PH patients, 619 adults, 133 pediatric idiopathic PAH (IPAH), and 123 chronic thromboembolic pulmonary hypertension (CTEPH) patients. We enrolled 48.4% of the incident and 51.6% of the prevalent adult and pediatric patients. PAH adults: age 43 ± 15, females 81.9%, functional class (FC) (I/II) 66.5%, 6-min walk distance (6MWD) 378 ± 112 m, mPAP 57.3 ± 19.0 mmHg, confidence interval (CI) 3.3 ± 1.5 L/min/m2, PVR 12.0 ± 8.1 WU. PAH pediatrics: age 9 ± 5, females 51.1%, FC (I/II) 85.5%, 6MWD 376 ± 103 m, mPAP 49.7 ± 13.4 mmHg, CI 2.6 ± 0.9 L/min/m2, PVR 16.4 ± 13.5 WU. CTEPH: age 44 ± 17, females 56.1%, FC (I/II) 65.5%, 6MWD 369 ± 126 m, mPAP 49.7 ± 13.4 mmHg, CI 2.6 ± 0.9 L/min/m2, PVR 10.5 + 6.5 WU. When we analyzed the IPAH group separately, it sustained a high functional class I/II incidence. REMEHIP shows better functional class in young females with severe PAH than in American and European patients. Also, PAH pediatric patients had a better functional class than other registries. However, our registry also shows that our population's access to specific pharmacologic treatments is still far from optimal.
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BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. OBJECTIVE: This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. METHODS: An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. RESULTS: A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P<0.001), the timing of the PPI indication literature review (<5 years vs >5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. CONCLUSION: While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation. BACKGROUND: ⢠The study aims to evaluate physician prescribing patterns, assess their knowledge of proton pump inhibitors, and identify factors influencing their knowledge. BACKGROUND: ⢠An online survey of Latin American and Spanish physicians assessed proton pump inhibitor usage patterns and case-scenario responses, categorizing knowledge, and conducting subgroup analysis based on training, experience, specialty, and literature review timing. BACKGROUND: ⢠Thirty-eight percent of surveyed physicians commonly prescribed proton pump inhibitors, and among them, 80% were unfamiliar with deprescribing strategies, with 54.4% rarely reviewing ongoing indications. BACKGROUND: ⢠Sufficient knowledge was correlated with recent literature reviews and medical specialty affiliations.
Assuntos
Médicos , Inibidores da Bomba de Prótons , Humanos , Padrões de Prática Médica , Prescrições , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
ABSTRACT Background: Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. Objective: This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. Methods: An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. Results: A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P<0.001), the timing of the PPI indication literature review (<5 years vs >5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. Conclusion: While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation.
RESUMO Contexto: Os inibidores da bomba de prótons (IBPs) são amplamente prescritos em todo o mundo, muitas vezes resultando em seu uso excessivo. Consequentemente, é essencial identificar as prováveis causas desse uso excessivo para facilitar sua prescrição adequada. Objetivo: Este estudo tem como objetivo avaliar o padrão de prescrição dos médicos, seu conhecimento sobre IBPs e fatores que afetam seu conhecimento. Métodos: Uma pesquisa on-line foi conduzida entre médicos latino-americanos e espanhóis, coletando os seguintes dados: informações profissionais, padrões de uso de IBP, familiaridade com evidências publicadas e abordagem de manejo em três casos-cenários hipotéticos. O conhecimento dos participantes foi categorizado em suficiente ou insuficiente com base nos resultados dos cenários de caso. Posteriormente, a análise de subgrupos foi realizada com base no nível de formação do médico, anos de prática, especialidade e tempo desde a última revisão da literatura dos IBPs. Resultados: Um total de 371 médicos participaram da pesquisa. Trinta e oito por cento prescrevem frequentemente IBP, principalmente para fins profiláticos (57,9%). Oitenta por cento não estavam familiarizados com as estratégias de prescrição de IBP, e 54,4% raramente revisaram a indicação contínua de pacientes em uso de IBP. Sessenta e quatro por cento demonstraram conhecimento suficiente nos cenários-caso. Observou-se associação significativa entre o tipo de especialidade (médica vs cirúrgica: 69,4% vs 46,8%, P<0,001), o momento da revisão da literatura de indicação do IBP (<5 anos vs >5 anos: 71,4% vs 58,7%, P=0,010) e conhecimento suficiente. Conclusão: Embora a maioria dos participantes prescrevesse IBPs regularmente e para fins de profilaxia, no entanto, não estava familiarizada com estratégias de prescrição e raramente revisava as indicações em andamento. O conhecimento suficiente está correlacionado com revisões recentes da literatura e afiliação à especialidade médica.
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Gastric-acid suppressants are one of the most frequently used classes of drugs worldwide. Several studies about their overprescribing have been carried out in recent years. The aim of the study was to assess the appropriateness of these drugs at an internal medicine service of a tertiary hospital in Venezuela. A retrospective record review of patients admitted to the internal medicine service from January 2020 to February 2021 was performed. Data about indications for gastric-acid suppressants, the type used, and their continuation at discharge were collected. The prescribing was grouped into two categories, appropriate or inappropriate, according to current clinical guidelines. Of the 1203 patients who were newly prescribed gastric-acid suppressants in hospital during the study period, 993 (82.5%) had an inappropriate prescription. Prophylaxis of peptic ulcers in low-risk patients was the most frequent no evidence-based indication (20.24%). Seven hundred sixty-two patients were discharged on gastric-acid suppressants. Of these, 74.7% did not have an acceptable indication to continue this treatment on an outpatient basis. Many hospitalized patients in a Venezuelan academic tertiary healthcare center were given gastric acid suppressants not in accordance with the current clinical practice guidelines.
Los supresores del ácido gástrico son uno de los grupos farmacológicos más frecuentemente prescritos en todo el mundo. En los últimos años se han realizado varios estudios sobre su prescripción inadecuada. El objetivo del estudio fue evaluar la idoneidad de estos medicamentos en un servicio de medicina interna de un hospital de tercer nivel en Venezuela. Se realizó una revisión retrospectiva de historias medicas de pacientes ingresados en el servicio de medicina interna desde enero de 2020 hasta febrero de 2021. Se recogieron datos sobre indicaciones de supresores de ácido gástrico, tipo utilizado y su continuación al alta. La prescripción se agrupó en dos categorías, adecuada o inadecuada, según las guías clínicas vigentes. Entre los 1203 pacientes a los que se les prescribió recientemente supresores de ácido gástrico en el hospital durante el período de estudio, 993 (82,5%) tenían una prescripción inapropiada. La profilaxis de úlceras pépticas en pacientes de bajo riesgo fue la indicación no basada en evidencia más frecuente (20,24%). Setecientos sesenta y dos pacientes fueron dados de alta con supresores de ácido gástrico. De estos, el 74,7% no tenía una indicación apropiada para continuar este tratamiento de forma ambulatoria. Un alto número de pacientes hospitalizados en un centro asistencial de nivel terciario en Venezuela fueron prescritos con supresores de ácido gástrico que no se ajustaban a las guías de práctica clínica vigentes.
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En Guatemala, la producción del cultivo de papa se ve afectada por los nematodos Globodera rostochiensis y Globo-dera pallida. La capacidad de ambas especies para formar quistes complica su control y provoca el aumento de sus poblaciones. En Guatemala se reporta la presencia de ambas especies de nematodos por identificación morfológica, sin embargo, no se ha realizado una confirmación molecular. Este es el primer estudio para validar la presencia de ambas especies de nematodos por PCR múltiple y la determinación de la diversidad y estructura genética de las poblaciones utilizando marcadores moleculares. Se realizaron muestreos en cuatro departamentos productores de papa del país. La identificación por PCR se realizó con el cebador común ITS5 y los cebadores PITSr3 específico para G. rostochiensisy PITSp4 para G. pallida. La caracterización molecular se realizó con el marcador AFLP. Se confirmó la presencia de las dos especies de nematodos en los cuatro departamentos. Los índices de diversidad Shannon y heterocigosidad esperada revelaron mayor diversidad genética en G. rostochiensis (H = 0.311, He = 0.301) que en G. pallida (H = 0.035, He = 0.223). Los métodos NJ, DAPC y PCA exhibieron una débil estructura entre las poblaciones de ambas especies de nematodos. Los resultados sugieren un patrón de dispersión desde Quetzaltenango hacia el resto del país, atribuido a la comercialización de semilla contaminada con nematodos. Se sugiere promover programas de socialización sobre los beneficios del uso de semilla certificada, además de constantes monitoreos moleculares para un diagnóstico certero de ambas especies de nematodos.
In Guatemala, potato crop production is affected by the nematodes Globodera rostochiensis and Globodera pallida. The ability of both species to form cysts complicates their control and causes an increase in their populations. In Guatemala, both species of nematodes have been reported by morphological identification; however, molecular confirmation has not been carried out. It is the first study to validate the presence of both nematode species by multiplex PCR and determine the diversity and genetic structure of the populations using molecular markers. Sampling was carried out in four pota-to-producing departments of the country. PCR identification was performed with the common primer ITS5 and the primers PITSr3 specific for G. rostochiensis and PITSp4 for G. pallida. We performed molecular characterization with the AFLP marker. We confirmed the presence of the two nematode species in the four departments. Shannon diversity and expected heterozygosity indices revealed higher genetic diversity in G. rostochiensis (H = 0.311, He = 0.301) than in G. pallida (H = 0.035, He = 0.223). The NJ, DAPC, and PCA methods exhibited weak structure among populations of both nematode species. The results suggest a dispersal pattern from Quetzaltenango to the rest of the country, attributed to the commer-cialization of seed contaminated with nematodes. We suggest promoting socialization programs on the benefits of using certified seeds and constant molecular monitoring for an accurate diagnosis of both species of nematodes.
Assuntos
Variação Genética/genética , Solanum tuberosum/parasitologia , Reação em Cadeia da Polimerase Multiplex/métodos , Nematoides/genética , Parasitos/parasitologia , Doenças das Plantas/parasitologia , Sementes/parasitologia , Estruturas Genéticas/genética , Guatemala , Nematoides/patogenicidadeRESUMO
El fósforo (P) es un elemento esencial en la producción agrícola, pero debido a su compleja dinámica en el suelo, solo una pequeña cantidad es aprovechable para las plantas, ya que la mayoría del P se encuentra en formas insolubles, especialmente, en suelos Andisoles de origen volcánico. Los microorganismos con capacidad solubilizadora de fósforo (MSF) son una alternativa para transformar el P a formas solubles y aprovechables por las plantas; además de brindar múltiples beneficios ambientales. Este trabajo identificó y evaluó in vitro, aislados nativos de Pseudomonas fluorescens Mingula, obtenidos de regiones guatemaltecas con suelos Andisoles que limitan la producción agrícola por la alta fijación de P. Se realizaron cultivos in vitro de la bacteria en medio National Botanical Research Instituteís phosphate growth (NBRIP), con fosfato tricálcico Ca3(PO4)2 como fuente de P insoluble y se midió el índice de solubilización de fósforo (ISF). Un total de 35 aislados de P. fluorescensfueron identificados y confirmados por PCR específico. El análisis de relaciones genéticas con el marcador AFLP, mostró dos grupos: el grupo A incluyó a los aislados con ISF mayores a 1.75, mientras el grupo B incluyó a aquellos con ISF menor a 1.75. La comparación de ISF entre los aislados y departamentos, demostró diferencia estadísticamente significativa (p < .001), con el aislado Pf_33 como más eficiente. Debido al potencial de solubilización de los aislados nativos del grupo genético A (ISF > 1.75), estos se recomiendan para futuras investigaciones que determinen su respuesta a condiciones de campo y estrategias para el desarrollo de biofertilizantes.
Phosphorus (P) is an essential element in agricultural production, but due to its complex dynamics in the soil, only a tiny amount is usable by plants. This is because most P is in insoluble forms, especially in volcanic Andisol soils. Microorganisms with phosphorus solubilizing capacity (MSF) are an alternative for transforming P into soluble forms usable by plants and providing multiple environmental benefits. This research identified and evaluated in vitro native isolates of Pseudomonas fluorescens Mingula, obtained from Guatemalan regions with Andisol soils that limit agricultural production due to high P fixation. In vitro cultures of the bacteria were grown on the National Botanical Research Instituteís phosphate medium (NBRIP), with tricalcium phosphate Ca3(PO4)2 as a source of insoluble P, and We measured the phosphorus solubilization index (PSI). We identified and confirmed a total of 35 isolates of P. fluorescens by specific PCR. Using the AFLP marker, genetic relationship analysis showed two groups: group A included isolates with PSI greater than 1.75, while group B included those with FSI less than 1.75. Comparing of PSI between isolates and departments showed statistically significant dif-ferences (p < 0.001), respectively, with the Pf_33 isolate as the most efficient. Because of the high solubilization potential of the native isolates of genetic group A (FSI > 1.75), We recommend future research to determine their response to field conditions and strategies for biofertilizer development.
Assuntos
Fósforo/análise , Solubilidade , Pseudomonas fluorescens , Qualidade do Solo , Produtos Agrícolas/crescimento & desenvolvimento , Técnicas de Cultura/métodosRESUMO
El aguacate es un cultivo de consumo a nivel mundial, y según teorías recientes, se sugiere a la región de la Sierra Nevada, en California, como centro de origen y, a Guatemala, como uno de los principales centros de domesticación. Mediante caracterizaciones morfológicas se ha reportado una alta diversidad genética en el país, pero debido al comportamiento de polinización cruzada e hibridaciones interraciales, no se ha podido detallar el estado genético actual de la especie. Sin embargo, los marcadores moleculares son útiles para este tipo de estudios al enfocarse en las diferencias a nivel del ADN. Este estudio analizó la diversidad genética del aguacate nativo guatemalteco de siete poblaciones geográficas con el marcador molecular AFLP. Los datos de estructura poblacional mostraron un alto grado de diversidad a nivel de individuos (Ht = 0.1933, Hw = 0.1872) y baja diferenciación entre poblaciones (Hb = 0.0061). Los resultados sugieren una alta tasa de migración que influye directamente en el grado de mezcla genética de los materiales analizados. El bajo índice de estructura poblacional apunta a un alto flujo genético entre las poblaciones, por lo que la especie no presenta mayor riesgo ante la deriva genética, minimizándose el riesgo de pérdida de alelos por fijación. Se sugiere el resguardado del recurso fitogénetico total y no únicamente de materiales promisorios, evitando así el riesgo de erosión genética de la especie y garantizando la permanencia de la diversidad genética, la cual será la base de futuros programas de mejoramiento.
Avocado is one of the most widely consumed crops worldwide and according to new theories, the Sierra Nevada region in California is suggested as the center of origin and Guatemala as one of the main domestication cen-ters. Through morphological characterizations, a high genetic diversity has been reported in the country, but due to the behavior of cross pollination and interracial hybridizations, it has not been possible to detail the current genetic status of the species. Molecular markers are useful for this type of study by focusing on differences at DNA level. This study analyzed the genetic diversity of the native Guatemalan avocado from seven geographic populations with AFLP molecular marker. Population structure data showed a high degree of diversity at the individual level (Ht = 0.1933, Hw = 0.1872) and low differentiation between populations (Hb = 0.0061). The results suggest a high rate of migration that directly influences the degree of genetic mixing of the analyzed materials. The low index of population structure points to a high genetic flow between populations, so that the species does not present a greater risk due to genetic drift, minimizing the risk of loss of alleles due to fixation. The protection of the total genetic resource is suggested, and not only of promising materials, thus avoiding the risk of genetic erosion of the species and guaranteeing the permanence of genetic diversity, which will be the basis of future breeding programs.
Assuntos
Variação Genética , Folhas de Planta/genética , Persea/genética , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados/classificação , Variação Genética/genética , DNA de Plantas/análise , Deriva Genética , Loci Gênicos , DomesticaçãoRESUMO
La punta morada es una enfermedad que afecta la producción de algunas especies de solanáceas como la papa y el tomate, causando enrollamiento en las puntas de las hojas con una marcada coloración morada, decaimiento temprano de la planta y en la papa se observa tuberización aérea. Como patógenos asociados a la enfermedad se consideran al fitoplasma BLTVA y la bacteria Candidatus Liberibacter solanacearum. Dada la similitud en la sin-tomatología foliar que generan ambos patógenos, es difícil precisar cuál de ellos está implicado en la enfermedad. En Guatemala, existen reportes de la sintomatología típica de punta morada en las principales zonas productoras de papa y tomate, desconociéndose el agente asociado. La investigación determinó cuál de los dos patógenos reportados está asociados a la enfermedad en 12 municipios productores de papa y/o tomate en el país. Se realizaron ampli-ficaciones de ADN con cebadores específicos para cada patógeno asociado a la enfermedad. Por la alta incidencia del fitoplasma BLTVA en las muestras de papa (73.9%), en comparación a C. Liberibacter solanacearum (26%), este es considerado como el patógeno asociado más importante en papa. En las muestras de tomate, la incidencia del fitoplasma BLTVA (29.8%) y C. Liberibacter solanacearum del (27.6%) fue similar. Además, sobresale el primer reporte de la detección del fitoplasma BLTVA afectando el cultivo de tomate en Guatemala. Se sugiere un monitoreo constante, mediante métodos moleculares, para un diagnóstico certero y establecer medidas de manejo de la enfermedad para evitar su diseminación hacia zonas aún no afectadas.
The potato purple top is a disease that affects the production of some solanaceous species such as potatoes and tomatoes, causing curl at the tips of the leaves with a marked purple coloration, early decay of the plant, and aerial tuberization is observed in the potato. BLTVA phytoplasma and Candidatus Liberibacter solanacearum are considered as pathogens associated with the disease. Given the similarity in foliar symptoms generated by both pathogens, it is difficult to determine which one is involved in the disease. There are reports of the typical potato purple top symptoms in the main potato and tomato producing areas in Guatemala, being unknown the associated agent. The research determined which of the two reported pathogens is associated with the disease in 12 potatoes and/or tomato producing areas in the country. We performed DNA amplification with specific primers for each disease-associated pathogen. Due to the high incidence of BLTVA phytoplasma in potato samples (73.9%), com-pared to C. liberibacter solanacearum (26%), this is considered the most important associated pathogen in potatoes. In tomato samples, the incidence of BLTVA phytoplasma (29.8%) and C. liberibacter solanacearum (27.6%) was similar. Besides, the first report of the detection of the BLTVA phytoplasma affecting tomato cultivation in Gua-temala stands out. Using molecular methods, constant monitoring is suggested for an accurate diagnosis and to establish management measures for the disease to prevent its spread to areas not yet affected.
Assuntos
Solanum tuberosum/virologia , Solanaceae/virologia , Doenças por Fitoplasmas/microbiologia , Vírus de Plantas/isolamento & purificação , Produção Agrícola , DNA de Plantas/análise , Liberibacter/patogenicidadeRESUMO
El oomicete Phytophthora infestans (Mont) DeBary es el patógeno responsable de causar la enfermedad denominada comúnmente como tizón tardío. Dicho patógeno afecta cultivos de importancia económica para el país, entre ellos el tomate, cultivo en el cual puede generar pérdidas totales en la producción. Dada la agresividad del patógeno, los programas de mejoramiento desarrollan nuevos genotipos de tomate resistentes a esta enfermedad mediante la incorporación de genes de resistencia, como los genes Ph. Sin embargo, las nuevas cepas de P. infestans, producto de la recombinación genética, pueden sobrepasar la resistencia de los genotipos mejorados. En este estudio se evaluó la resistencia genética de 13 genotipos de tomate mejorados, ante cinco aislados de P. infestans obtenidos de un estudio previo. Mediante inoculaciones in vitro y con la variable de respuesta de área bajo la curva del progreso de la enfermedad (AUDPC), se determinó que existió diferencia estadísticamente significativa (p < 0.05) entre el comportamiento de la resistencia, la agresividad de los aislados del patógeno y la interacción entre ambos factores. Además, se sugiere el uso de algunas líneas para ser incorporadas en programas de mejoramiento genético y así desarrollar nuevos genotipos aptos para el país y, por último, la profundización para establecer las bases genéticas de la resistencia de los dos cultivares evaluados en este estudio.
The oomycete Phytophthora infestans (Mont) DeBary causes late blight disease. This pathogen affects economically important crops for the country, including tomato, a crop in which it can causes total losses in production. Given the aggressiveness of the pathogen, tomato breeding programs develop new genotypes with resistance to P. infestans, being a source of resistance Ph genes. However, the new strains of P. infestans, product of the genetic variability of their populations, can overcome the resistance of the genotypes. In this study, the genetic resistance of 13 tomato materials was evaluated against 5 isolates of P. infestans obtained from a previous study. Through in vitro inoculations and with the area under the disease progress curve (AUDPC), it was determined that there was a statistically significant difference (p < 0.05) between the behavior of the genetic resistance, the aggressiveness of the isolates of the pathogen and the interaction between both factors. It is also suggested the use of some lines to be incorporated into tomato breeding programs and develop new genotypes suitable for the country and, finally, to establish the genetic basis of the resistance of the two cultivars evaluated in this study.
Assuntos
Solanum lycopersicum/genética , Phytophthora infestans/parasitologia , Doenças das Plantas , GenótipoRESUMO
Phytophthora infestans (Mont) DeBary es el agente causal de la enfermedad conocida como tizón tardío, la cual ha sido catalogada como la enfermedad de plantas más devastadora reportada en la historia de la humanidad. Este patógeno afecta plantas de importancia económica de la familia solanaceae, como el tomate y la papa. P. infestans es un oomicete heterotálico y necesita de dos tipos de apareamiento, A1 y A2, para presentar reproducción sexual, la cual es la vía por la que este patógeno incrementa su grado de diversidad, a través de una recombinación de su material genético, que representa el mayor desafío para el manejo de la enfermedad. Este estudio determinó el nivel de variabilidad genética, a través del marcador molecular amplified fragment length polymorphism (AFLP), de 22 aislados de P. infestans colectados en diferentes zonas productoras de papa y tomate. Con el perfil de bandas generado por el marcador molecular, se realizó un análisis cluster y se elaboró un dendograma de tipo unweighted pair group method with arithmetic mean (UPGMA), con el índice de Dice, mediante una matriz de distancias genéticas. Los aislados fueron situados en tres grupos principales, los cuales responden al lugar de procedencia y al tipo de planta hospedera. Se encontró un valor de similitud de 0.49 entre los aislados analizados, por lo que se concluyó que la variabilidad genética de P. infestans en Guatemala es alta.
Phytophthora infestans (Mont) DeBary is the causal agent of late blight disease, which has been cataloged as the most devasting plant disease in the history of humankind. This pathogen is capable of affecting economically important plants of the solanaceae family, such as tomato and potato. P. infestans is a heterothallic oomycete for which it needs two types of mating known as A1 and A2 to present a sexual reproduction, which is the main way by this pathogen increases its degree of genetic diversity through a recombination of its genetic material; this condition represents the major defiance to control this disease. This study determined the level of genetic variability, through the molecular marker amplified fragment length polymorphism (AFLP), of 22 P. infestans isolates collected in different potato and tomato producing areas in Guatemala. With the band profile generated by the molecular marker AFLP, a cluster analysis was performed creating a UPGMA dendrogram with Dice´s index through a genetic distances matrix. The isolates were located in three main groups, which respond to the place of origin and the type of host plant. A similarity value of 0.49 was found among the analyzed isolates. It is concluded that genetic variability of the isolates analyzed is high.
Assuntos
Plantas/virologia , Solanum tuberosum , Solanum lycopersicum/genética , Doenças das Plantas , Análise por Conglomerados , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados/métodosRESUMO
Son numerosos los estudios que intentan establecer una relación directa entre variables de tipo físico, táctico, psicológico y la ocurrencia de lesiones deportivas. El objetivo fundamental del presente estudio fue evaluar la influencia de la ansiedad y la posición en el terreno de juego, en el desarrollo de lesiones físicas que se producen en el deporte. La participación de un total de 277 jugadores de fútbol permitió el registro y evaluación de las variables edad, lesión deportiva, demarcación y ansiedad estado/rasgo (medida con el Cuestionario de Spielberger, Gorsuch & Lusbene). Los resultados no mostraron diferencias estadísticamente significativas entre la variable lesión deportiva y ansiedad estado/rasgo, respectivamente (p = 0.583; p = 0.598), ni tampoco entre lesión deportiva y demarcación (p = 0.541). Como principal conclusión se indica la necesidad de elaborar más estudios que intenten dilucidar aquellas variables tácticas y psicológicas que pueden prevenir lesiones deportivas.
There has been a number of studies aiming to establish a relationship between physical, tactical, psychological-type variables and the incidence of sports injuries. The aim of this paper was to assess the influence of anxiety and self- esteem in the development of physical injuries when practising sport. In this regard, the participation of277 football in this study allowed to record and assess such variables as age, sports injury, field position and anxiety state/ trait (measured by the Spielberger, Gorsuch & Lusbene questionnaire). The results did not yield statistically significant differences between the sports injuries and the anxiety state/trait variables (p = 0.583; p = 0.598), nor did they prove a relationship between sports and field position (p = 0.541). As a main conclusion, we advocate the necessity of further studies for the elucidation of such psychological variables which may prevent sports injuries.
Assuntos
Ansiedade , Esportes , Ferimentos e LesõesRESUMO
La tromboembolia pulmonar (TEP) es considerada como una urgencia cardiovascular, representa una de las principales causas de morbilidad y mortalidad en pacientes hospitalizados. El diagnóstico debe realizarse lo más tempranamente posible, y su tratamiento instaurarse de manera inmediata. El manejo de la embolia pulmonar aguda, incluye medidas de soporte, apoyo hemodinámico, utilización de anticoagulantes y en el caso del paciente inestable, trombólisis o embolectomía. En el presente artículo, se revisan las generalidades en el tratamiento de los pacientes con TEP.
Acute pulmonary embolism (APE) is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Pulmonary embolism diagnosis has to be made early in the course of the disease and its management installed immediately. Pulmonary embolism management includes hemodynamic support, anticoagulation, thrombolysis and embolectomy. We present an overview of the treatment of APE.
Assuntos
Humanos , Embolia Pulmonar/terapia , Doença Aguda , Anticoagulantes/uso terapêutico , Embolectomia , Guias de Prática Clínica como Assunto , Terapia TrombolíticaRESUMO
Los miembros del Task Force pediátrico del Pulmonary Vascular Research Institute (PVRI, su sigla en Inglés) fueron conscientes de la necesidad de desarrollar una clasificación funcional de la hipertensión pulmonar en niños. La clasificación que se propone sigue el mismo patrón y utiliza los mismos criterios de la clasificación de la hipertensión pulmonar específica para adultos de Dana Point. Fue necesario incluir modificaciones para los niños, teniendo en cuenta que la edad, el crecimiento físico y la madurez influyen en la expresión funcional de la enfermedad. Es necesario definir el estado clínico del niño, pues ello facilita revisar la evolución del mismo en una forma consistente y objetiva a medida que él/ella crecen. Particularmente en los niños más jóvenes, se trató de incluir indicadores objetivos como el crecimiento, la necesidad de alimentos suplementarios y los registros de asistencia al colegio y a la guardería. Esto ayuda a monitorear la evolución clínica y la respuesta al tratamiento a través de los años y facilita el desarrollo de algoritmos de tratamiento en estos pacientes. Se presenta un artículo de consenso sobre una clasificación aplicable a los niños con hipertensión pulmonar que se discutió en la reunión anual del PVRI que se llevó a cabo en Panamá en febrero de 2011.
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
Assuntos
Hipertensão , Criança , Hipertensão PulmonarRESUMO
Las clasificaciones actuales de la hipertensión pulmonar han contribuido significativamente al conocimiento de la enfermedad vascular pulmonar, han facilitado ensayos farmacológicos y han mejorado nuestro conocimiento de las cardiopatías congénitas del adulto; sin embargo estas clasificaciones no son aplicables completamente a la enfermedad en el niño. La clasificación que aquí se propone se basa principalmente en la práctica clínica. Los objetivos específicos de esta nueva clasificación son mejorar las estrategias diagnósticas, promover la investigación clínica, mejorar nuestro conocimiento de la patogénesis, de la fisiología y de la epidemiología de la enfermedad y orientar el desarrollo de modelos de la enfermedad humana en el laboratorio y estudios en animales; también puede servir como un recurso docente. Se hace énfasis en los conceptos de maladaptación perinatal, alteraciones del desarrollo e hipoplasia pulmonar como factores causantes de la hipertensión pulmonar pediátrica; así mismo, en la importancia de los múltiples síndromes malformativos congénitos, genéticos y cromosómicos en la presentación de la hipertensión pulmonar pediátrica. La enfermedad vascular pulmonar hipertensiva en niños se divide en diez grandes categorías.
Current classifications of pulmonary hypertension have contributed a great deal to our understanding of pulmonary vascular disease, facilitated drug trials, and improved our understanding of congenital heart disease in adult survivors. However, these classifications are not applicable readily to pediatric disease. The classification system that we propose is based firmly in clinical practice. The specific aims of this new system are to improve diagnostic strategies, to promote appropriate clinical investigation, to improve our understanding of disease pathogenesis, physiology and epidemiology, and to guide the development of human disease models in laboratory and animal studies. It should be also an educational resource. We emphasize the concepts of perinatal maladaptation, maldevelopment and pulmonary hypoplasia as causative factors in pediatric pulmonary hypertension. We highlight the importance of genetic, chromosomal and multiple congenital malformation syndromes in the presentation of pediatric pulmonary hypertension. We divide pediatric pulmonary hypertensive vascular disease into 10 broad categories.
Assuntos
Humanos , Hipertensão , Cardiopatias Congênitas , Pediatria , Artéria PulmonarRESUMO
Objectives: We sought to analyze exercise-derived mean pulmonary artery pressure (Mpap) - cardiac index (CI) - relationship to expand the concepts regarding its nature and to better identify pulmonary hemodynamic responders to acute oxygen breathing (AOB - 99.5%) in pulmonary hypertension (PH) - COPD patients. Methods: mPAP/CI and extrapolated pressure (Pext) to zero flow were obtained breathing room air (BRA) and under AOB - 99.5% in 40 stable COPD patients with rest and exercise PH. Hemodynamic characteristics were analyzed for the entire cohort and separate for cases those with resting < or > 30 mmHg mPAP (cohort - A and B, respectively). Results: mPAP/CI abnormal location, slope (Sp: 5.77; 95% CI: 5.02 - 6.52 mmHg/L min/m²) and Pext values (15.8 mmHg) were associated with hypoxemia/decreased mixed venous - PO2 and lung mechanics abnormalities. Hemodynamic conditions that did not change for Sp (5.47; 95% CI: 3.64 - 7.3 mmHg/L min/m², p = 0.4) and Pext (15.7 mmHg, p = 0.2) associated with a mPAP/CI significantly decrease in parallel during AOB - 99.5%. For cohort - A, an average-mPAP decline (12.3 mmHg, p <0.004) associated with a slope decrease (from 6.02; 95% CI: 4.04 - 8 to 4.3; 95% CI: 4.11 - 4.49 mmHg/L min/m², (p <0.008), mPAP/CI - 95% CI down-ward displacement and Pext decrease (from 8.58 ± 3 to 4.7 ± 1.4 mmHg, p <0.01) in relation to BRA were observed. For cohort-B, average-mPAP and mPAP/CI - 95% CI location did not change, Sp show a trend to decrease (p = 0.08) and Pext significantly increase (from 12 ± 2.9 to 20.6 ± 4.9 mmHg, p <0.03) in relation to BRA. Under AOB - 99.5%, significant differences for mPAP/ CI - 95% CI location, average-mPAP (A: 19.5 ± 6 vs. B: 41.2 ± 11.5 mmHg, p <0.001) and Pext (A: 4.7 ± 1.4 vs. B: 20.6 ± 4.9 mmHg, p <0.001), without Sp change between cohorts A and B were documented. Conclusions: When exercise derived mPAP/CI is analyzed, valuable information for linear-pulmonary vascular resistance - (LPVR) could be obtained for PH - COPD patients. mPAP/CI abnormalities not always reflect "pure arteriolar" increased LPVR for all PH-COPD patients. Hemodynamic benefit on the pulmonary circulation and right ventricular afterload could be expected with long-term oxygen therapy in resting <30 mmHg mPAP-PH-COPD patients.
Objetivos: En esta investigación clínica-hemodinámica, analizamos la relación que se establece entre la presión arterial pulmonar media (PAPm) con la del índice cardiaco (IC), obtenida durante el ejercicio, con miras a expandir los conceptos relacionados con su propia naturaleza. Con ello, tratar de identificar mejor a los sujetos portadores de EPOC que se han caracterizado por ser respondedores durante la administración aguda de oxígeno (AAO2 - 99.5%). Métodos: Se obtuvieron la PAPm/IC y la presión extrapolada a cero flujo (Pext = bo)en 40 sujetos con EPOC y portadores de hipertensión pulmonar (HP) clínicamente estables, respirando aire ambiental (RAA) y bajo la influencia de la AAO2 - 99.5% en las condiciones de reposo y durante el ejercicio. Las características hemodinámicas se analizaron para toda la cohorte y para aquellos sujetos con PAPm en resposo < o > de 30 mmHg (Cohorte A y B, respectivamente). Resultados: La ubicación anormal de la PAPm/IC, de la pendiente (Sp: 5.77; 95% IC: 5.02 - 6.52 mmHg/L min/m²) y la de los valores para Pext (15.8 mmHg) se asociaron con: hipoxemia/ disminución de la presión venosa mezclada del O2, así como con anormalidades de la mecánica pulmonar. Condiciones hemodinámicas que no se modificaron para la Sp (5.47; 95% IC: 3.64 - 7.3 mmHg/L min/m², p = 0.4) y la Pext (15.7 mmHg, p = 0.2); sin embargo, sí se vieron asociadas a una disminución significativa en paralelo de la PAPm/IC durante la AAO2 99.5%. Observaciones hemodinámicas que para la cohorte A, se caracterizaron por una reducción de la PAPm promedio (12.3 mmHg, p <0.004), por una disminución de la Sp de 6.02; 95% CI: 4.04 - 8 a 4.3; 95% CI: 4.11 - 4.49 mmHg/L min/m², (p <0.008) y por el descenso de Pext de 8.58 ± 3 a 4.7 ± 1.4 mmHg, p <0.01, al compararse con las documentadas RAA. En cambio, para la cohorte B, la PAPm promedio y la PAPm/IC no se modificaron, Sp mostró sólo tendencia a disminuir (p = 0.08) y Pext aumento de 12 ± 2.9 a 20.6 ± 4.9 mmHg, (p <0.03) en relación a las registradas RAA. Bajo la AAO2 - 99.5%, se observaron diferencias significativas para la PAPm/ IC - 95% IC en su localización, para la PAPm promedio (A: 19.5 ± 6 vs. B: 41.2 ± 11.5 mmHg, p <0.001) y Pext (A: 4.7 ± 1.4 vs. B: 20.6 ± 4.9 mmHg, p <0.001) y sin cambios en la Sp, entre la cohorte A y la B. Conclusiones: Cuando se analiza la PAPm/IC, se obtiene información que es valiosa para interpretar la resistencia vascular pulmonar linear en sujetos con EPOC e H P. Sin embargo, las anormalidades de la PAPm/IC, no necesariamente reflejan aumento exclusivo de la resistencia arteriolar pulmonar para sujetos con EPOC e H P. De acuerdo con las observaciones agudas de este estudio, posiblemente solo sea de esperarse beneficio con la oxigenoterapia a largo plazo sobre la circulación pulmonar y la post-carga del ventrículo derecho, para aquellos portadores de EPOC e HP cuando la PAPm en el reposo sea <30 mmHg.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Sanguínea , Hemodinâmica , Hipertensão Pulmonar/fisiopatologia , Oxigenoterapia , Artéria Pulmonar/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Cardíaca , Hipertensão Pulmonar/complicações , Doença Pulmonar Obstrutiva Crônica/complicaçõesRESUMO
Introduction: Despite the prognostic importance of traditionally derived measurements, the significance of right heart catheterization (RHC) remains controversial. Thus, a continued search for hemodynamic markers that define better responsive patients is required. Since, right ventricular failure is the most fatal pathway, right (RVPO) and left (LVPO) ventricular power output are parameters that could provide input for a better understanding of the hemodynamics involved in idiopathic pulmonary artery hypertension (IPAH). Method: We retrospectively analyzed how demographics and outcome correlate with hemodynamics to identify responders among IPAH patients. Results: Ninety patients fulfilled the following criteria for inclusion in this study: (1) complete RHC at baseline; (2) an acute evaluation for vasodilators (AEFV, including a positive response, that is, an increase in CO, a decrease in both mPAP and pulmonary vascular resistance ≥ 20% from baseline, respectively); and (3) a long-term follow-up under accepted IPAH treatments. If RVPO decreased (p < 0.001) and LVPO increased (p < 0.012) during AEFV, it is considered that these findings reinforce our ability to identify responders; that is, patients that remained as responders after 6.4 ± 3 years under nifedipine treatment (37.7% of the studied IPAH population). After multivariate analysis, age, RVPO, and LVPO remained as independent variables (OR = 0.927, 95%CI: 0.87-0.98, p = 0.01; OR = 0.114, 95%CI: 0.00-0.91, p = 0.045; and OR = 171.5, 95% CI: 5.3-549, p = 0.004, respectively) when estimating the probability of being a responder. On this basis, an equation was derived to identify responders among IPAH patients, where the probability of being a responder = 1.0196-0.0631 (age) - 4.7693 (RVPO) + 3.8152 (LVPO), ROC: 0.76, 95% CI: 0.63-0.89; p = 0.001. Conclusion:based on the proposed equation, LVPO and RVPO could be used for the identification of responders among IPAH patients.
Introducción: A pesar de la importancia y del significado pronóstico que tienen las mediciones directas y las derivadas del cateterismo cardiaco derecho, éstas permanecen hasta el día de hoy en el terreno académico de la controversia. Por lo tanto, se requiere la continua búsqueda de marcadores hemodinámicos para estratificar a los enfermos con hipertensión arterial pulmonar idiopática. Particularmente, cuando la disfunción contráctil del ventrículo derecho es la vía final más común de esta patología. En esta circunstancia, la determinación del poder del ventrículo derecho y del ventrículo izquierdo representa parámetros que pudieran ser de utilidad para lograr un mejor entendimiento en la hemodinámica de la hipertensión arterial pulmonar idiopática. Método: De manera retrospectiva, analizamos los aspectos demográficos, los hemodinámicos y la sobrevivencia, y si éstos se vieron asociados a la posibilidad de ser enfermos respondedores entre los portadores de hipertensión arterial pulmonar idiopática. Resultados: Noventa enfermos llenaron los siguientes criterios para ser incluidos en el estudio: 1. Contar con cateterismo cardiaco derecho basal; 2. Tener valoración aguda con adenosina, en donde quedó definida una respuesta "positiva aguda" como: aumento del gasto cardíaco, disminución de la presión arterial pulmonar media y de la resistencia vascular pulmonar calculada (≥ 20% de la basal, respectivamente) y; 3. Contar con un seguimiento a largo plazo bajo la influencia de los tratamientos modernos aceptados para enfermos con hipertensión arterial pulmonar idiopática. Sí, el poder del ventrículo derecho disminuyó (p < 0.001) y el poder ventrículo izquierdo aumentó (p < 0.012) durante el reto vasodilatador agudo se consideró que éstos hallazgos reforzaban la habilidad para detectar a los sujetos respondedores con hipertensión arterial pulmonar idiopática; población de enfermos que guardó ese comportamiento hemodinámico durante 6.4 ± 3 años bajo la influencia de nifedipina (37% de la totalidad de la población con hipertensión arterial pulmonar idiopática). Después de efectuar un análisis multivariado, la edad, el poder del ventrículo derecho y del ventrículo izquierdo permanecieron como variables independientes (OR = 0.927, 95%IC: 0.87-0.98, p = 0.01; OR = 0.114, 95%IC: 0.00-0.91, p = 0.045; y OR = 171.5, 95%IC: 5.3-549, p = 0.004, respectivamente) para ser considerados "respondedores". Como resultado, se derivó una ecuación donde la probabilidad de ser respondedor = 1.0196-0.0631 (edad) - 4.7693 (poder del ventrículo derecho) + 3.8152 (poder del ventrículo izquierdo), ROC: 0.76, 95%CI: 0.63 - 0.89; p = 0.001. Conclusión: Con fundamento en los hallazgos de este estudio, la ecuación propuesta, el poder del ventrículo derecho y el ventrículo izquierdo pueden ser utilizados para identificar "respondedores" entre los enfermos con hipertensión arterial pulmonar idiopática.
Assuntos
Adulto , Feminino , Humanos , Masculino , Débito Cardíaco/efeitos dos fármacos , Hipertensão Pulmonar Primária Familiar/tratamento farmacológico , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Hemodinâmica , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Vasodilatadores/farmacologia , Vasodilatadores/uso terapêutico , Estudos RetrospectivosRESUMO
Objetivo: Conocer más de la relación presión arterial pulmonar media/índice cardiaco y sus perfiles en enfermos con hipertensión arterial pulmonar idiopática. Métodos: La presión arterial pulmonar media/índice cardiaco y la presión extrapolada al eje de cero flujo se obtuvo en 40 enfermos respirando aire ambiente, oxígeno 99.5% e hidralazina. Se obtuvieron dos grupos de acuerdo a criterios de "respuesta vasodilatadora aguda", respondedores (n = 20) y no respondedores (n = 20). Se analizó este criterio versus el propuesto por la Task Force de la Sociedad Europea de Cardiología en la población respondedora. Resultados: La presión arterial pulmonar media/Índice cardiaco se ubicó de forma anormal en el diagrama de presión-flujo de la cohorte total, (p < 0.01). Sin alteraciones en el intercambio gaseoso o mecánica pulmonar. Para los enfermos respondedores versus no respondedores, la pendiente fue anormal 2.2 (95%IC:1.1-3.3) vs. 5.89 (95%IC:4.69-7.11) mm Hg/L min/m² e incremento de la presión extrapolada al eje de cero flujo (38.2 ± 7.5 a 66.3 ± 7.5 mm Hg, p < 0.01). Sin diferencias con oxígeno al 99.5%. Con vasodilatador, la presión arterial pulmonar media disminuyó (52.1 ± 9.5 a 40 ± 5.5 mm Hg, p < 0.01) vs. no se modificó (96.2 ± 8.5 vs. 90 ± 7.5 mmHg, p = 0.3), pendiente 1.15 (95%IC:0.68-1.62) vs. 1.28 (95%IC:0.78-1.78) mmHg/Lmin/m², la presión extrapolada al eje de cero flujo no cambió vs. incrementó (69.4 ± 7.8 a 85.1 ± 8.5 mm Hg, p < 0.01), en relación al control. En no respondedores con vasodilatador, la presión arterial pulmonar media/índice cardiaco (90 ± 7.5 mmHg, pendiente:1.28; 95%IC: 0.78 - 1.78 mm Hg/L min/m²) fue diferente al comparar respondedores con menor o mayor de 40 mm Hg de presión arterial pulmonar media. Presiones 34 ± 3 vs. 45 ± 4 mm Hg y pendientes 1.14 (95%IC: 0.67 -1.61 vs. 2.22 (95%IC: 1.35 - 3.09 mm Hg/L min/m²), respectivamente p < 0.01. Conclusiones: Las anormalidades de la relación presión arterial pulmonar media/Índice cardiaco reflejan el incremento de las resistencias vasculares pulmonares reales a nivel arteriolar pulmonar en enfermos con hipertensión arterial pulmonar idiopática. Ambos criterios de respuesta vasodilatadora aguda son de utilidad para identificar respondedores y no, en esta población de enfermos.
Objectives: We analyze exercise-derived mean pulmonary artery pressure/cardiac index relationship to expand the concepts regarding its nature and to better identify "responders" in idiopathic pulmonary arterial hypertension patients. Methods: Mean pulmonary artery pressure/cardiac index relationship and extrapolated pressure to zero flow were obtained in 40 patients' breathing room air, oxygen 99.5% and hydralazine. The hemodynamic characteristics were analyzed for the cohort and separate for responders (n = 20) and non responders (n = 20) according to the acute response to vasodilator. We tested this previous criteria versus the Task Force on diagnosis and treatment prescribed by the European Society of Cardiology. Results: The mean pulmonary arterial pressure/cardiac index was located abnormally in the pressure-flow diagram of the total cohort (p < 0.01). No alterations in gas exchange or lung mechanics. For patients responders versus non-responders, the slope was abnormal 2.2 (95% CI:1.1-3.3) vs. 5.89 (95% CI: 4.69 - 7.11), mm Hg/L min/m² and increased extrapolated pressure to zero flow (38.2 ± 7.5 to 66.3 ± 7.5 mm Hg, p <0.01). Without difference with oxygen 99.5%. With vasodilator effect, mean pulmonary arterial pressure decreased (52.1 ± 9.5 to 40 ± 5.5 mm Hg, p <0.01) versus it did not change (96.2 ± 8.5 versus 90 ± 7.5 mm Hg, p=0.3), slope 1.15 (95% CI: 0.68 - 1.62) vs. 1.28 (95% CI: 0.78-1.78) mmHg/L min/m², the extrapolated pressure to zero flow did not change (69.4 ± 7.8 to 85.1 ± 8.5 mm Hg), p <0.01, compared to control. In non-responders with vasodilator, mean pulmonary arterial pressure/cardiac index (90 ± 7.5 mmHg, slope: 1.28, 95% CI :0.78 - 1.78 mm Hg/L min/m²) was different between responders < or > 40 mmHg mean pulmonary arterial pressure. Pressures were 34 ± 3 vs. 45 ± 4 mm Hg and slopes 1.14 (95% CI: 0.67 - 1.61) vs. 2.22(95% CI: 1.35 - 3.09) mm Hg/L min/m², p <0.01, respectively.. Conclusions: Abnormalities of the mean pulmonary arterial pressure/cardiac index relationship exercise-derived seems to reflect "mainly arteriolar" increased lineal pulmonary vascular resistance in idiopathic pulmonary arterial hypertension patients. Both acute vasodilator response criteria are useful to identify responders and not responders in this patient population.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Pressão Sanguínea , Artéria Pulmonar , Fluxo Sanguíneo Regional , Estudos RetrospectivosRESUMO
La mortalidad materna en el mundo es aún alta. La tromboembolia pulmonar como causa de muerte ocupa el segundo lugar en países desarrollados. En Latinoamérica, la frecuencia informada es de 0.6%, lo cual contrasta con la señalada para países desarrollados (14.9%). Esta diferencia puede estar relacionada a sesgos de información. Por tal motivo se revisó la información actual del tema y presentamos un breve caso clínico de una mujer quien presentó evento de tromboembolia pulmonar en la semana 30 del embarazo; el manejo adecuado de la misma, permitió la supervivencia materna y fetal.
Maternal mortality is still high in the world. Pulmonary thromboembolism as a cause of death is the second in developed countries. The frequency of reported events in Latin-American is 0.6%, which contrasts with that reported for developed countries (14.9%). This difference may be related to information bias. A review of the current information about this topic is presented, and we report a short case of a pregnant woman who presented pulmonary thromboembolism event at 30 weeks of pregnancy. Appropriate therapy allowed maternal and fetal survival.
Assuntos
Adolescente , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez , Embolia Pulmonar , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológicoRESUMO
OBJECTIVES: We sought to analyze exercise-derived mean pulmonary artery pressure (mPAP)-cardiac index (CI) relationship to expand the concepts regarding its nature and to better identify pulmonary hemodynamic responders to acute oxygen breathing (AO2B-99.5%) and to hydralazine (H) in extrinsic allergic alveolitis (EAA) and chronic interstitial lung disease (CILD) pulmonary hypertension (PH) patients. MATERIAL AND METHODS: mPAP/CI and extrapolated pressure (Pext) to zero flow were obtained while breathing room air (BRA) and under AO2B-99.5% in 38 stable (EAA (n = 14) and CILD (n = 24)) patients with resting and exercising PH. Hemodynamic characteristics were analyzed for the entire cohort and separate for EAA and CILD patients. AO2B-99.5% was tested in cohorts, H only in CILD and the effect of long-term corticosteroid treatment in EAA patients. Lung biopsies (LB) were obtained to evaluate the inflammatory-fibrosis stage and the degree of vascular lesion in the entire cohort. RESULTS: LB studies reveal a predominant stage of inflammation associated with grade-I vascular lesion for EAA patients. A predominant stage for fibrosis (although moderate) over inflammation associated with grade-II vascular lesions were documented for CILD patients. mPAP/CI abnormal location were associated with hypoxemia/decreased mixed venous-PO2 and lung mechanics abnormalities for both cohorts. An abnormal slope (Sp: 4.13; 95% CI: 3.42-4.84 mmHg/L/min/m2) and a normal Pext value (7 +/- 1.9 mmHg) were found for EAA patients. On the contrary, a normal slope (Sp: 1.22; 95% CI: 0.47-1.99 mmHg/L/min/m2) and an abnormal Pext value (19.7 +/- 3.5 mmHg) were found for CILD patients. Hemodynamic conditions that did not change for the Sp (4.0; 95% CI: 3.18-4.82 mmHg/L/min/m2); however, were associated with a statistical significant decrease in parallel for mPAP/CI during AO2B-99.5% when compared to BRA (p < 0.01), although not to normal slope values (0.96; 95% CI: 0.41-1.37) or mPAP/CI location. For CILD patients, during AO2B-99.5% no change for the slope, for Pext and mPAP/CI location in relation to BRA were observed. Under the effect of H, no change for the previous mentioned hemodynamic findings were found in relation to the control condition for CILD patients. After long-term corticosteroid treatment, normalization for mPAP/CI location and for the slope value (1.6; 95% CI: 0.91-2.29 mmHg/L/min/m2) were associated with lung mechanics and blood-gas exchange normalization were document...
Assuntos
Adulto , Feminino , Humanos , Masculino , Alveolite Alérgica Extrínseca , Alveolite Alérgica Extrínseca , Hemodinâmica , Hipertensão Pulmonar , Hipertensão Pulmonar , Doenças Pulmonares Intersticiais , Doenças Pulmonares Intersticiais , Alveolite Alérgica Extrínseca , Hipertensão Pulmonar , Doenças Pulmonares IntersticiaisRESUMO
OBJECTIVE: Capillary blood gas test has had ample use in the infantile population. In the adult population, the information is limited and controversial. The agreement between capillary-arterial gases seems to parallel the pH and the carbon dioxide pressure in different studied populations. In order to know the degree of agreement between these gases, we evaluate them at breathing room air and at 100% of oxygen fractions at 2,240 meters above sea level. METHODS: We obtained capillary-arterial blood gases simultaneously from subjects with stable cardiopulmonary disease in both conditions of inspired oxygen. Demographic, hemodynamic, diagnostic, and laboratory variables were gathered. Statistical analysis: agreement was analyzed with the intraclass correlation coefficient and the Bland-Altman procedure. RESULTS: We studied 101 subjects, 48 men and 53 women, whose respective ages were 55 +/- 16 and 56 +/- 16. Mean systemic arterial pressure was 94.96 +/- 10.57 mmHg. Hemoglobin was 15.94 +/- 2.48 g/dl. The agreement between the variables with the inspired oxygen fractions, 21%, 100%, and the mean difference in parenthesis was respectively: potential hydrogen, 0.94 (0.0091), 0.94 (0.0039); oxygen pressure, 0.90 (2.94), 0.84 (74.99); carbon dioxide pressure, 0.97 (0.079), 0.97 (0.179); bicarbonate, 0.93 (-0.067), 0,96 (0.262); total dissolved carbon dioxide, 0.94 (-0.142), 0.93 (0.161); base excess: 0.94, (-0.125), 0.92 (0.235); oxygen saturation, 0.98 (0.764), 0.97(0.202). CONCLUSIONS: Capillary blood gas test could be a useful alternative to the arterial one, nevertheless, it is limited by its low agreement with the oxygen pressure in both oxygen inspired fractions.