Obesidade e doença arterial coronariana: papel da inflamação vascular / Obesidad y enfermedad arterial coronaria: papel de la inflamación vascular / Obesity and coronary artery disease: role of vascular inflammation

A obesidade vem se tornando uma epidemia global. Cerca de 1,1 bilhões de adultos e 10 por cento das crianças do mundo são atualmente considerados portadores de sobrepeso ou obesos. Classicamente associada a fatores de risco para doença cardiovascular, como diabete melito e hipertensão arterial sistêmica, a obesidade vem sendo cada vez mais encarada como fator de risco independente para doença arterial coronariana (DAC). A aterosclerose coronariana compreende uma série de respostas inflamatórias em nível celular e molecular, cujas reações se encontram mais exacerbadas em pacientes obesos. Antes considerado mero depósito de gordura, o tecido adiposo é visto hoje em dia como órgão endócrino e parácrino ativo, produtor de diversas citocinas inflamatórias, como as adipocinas. Este artigo visa alertar para o grave problema de saúde pública em que a obesidade se tornou nas últimas décadas e correlacionar o processo inflamatório exacerbado nos indivíduos obesos com a maior incidência de DAC nessa população.

Obesity is becoming a global epidemic. Around 1.1 billion adults and 10 percent of the world's children are currently overweight or considered obese. Generally associated with risk factors for cardiovascular disease, such as Diabetes Mellitus and systemic arterial high blood pressure, the obesity has been more and more seen as an independent risk factor for Coronary Artery Disease (CAD). Coronary arteriosclerosis comprises a series of inflammatory responses at cellular and molecular level, whose reactions are stronger in obese patients. In the past, the adipose tissue was regarded as a mere fat deposition. Now it is seen from a totally different standpoint, as an active endocrine and paracrine organ that produces several inflammatory cytokines, such as the adipokines. This article aims to raise awareness about obesity as an increasingly significant public health issue over the past decades, as well as to relate the intense inflammatory process in obese individuals with an increased tendency for this group of individuals to develop CAD.

La obesidad se está tornando una epidemia global. Cerca de 1,1 billones de adultos y el 10 por ciento de los niños del mundo están considerados actualmente portadores de sobrepeso u obesos. Clásicamente asociada a factores de riesgo para enfermedad cardiovascular, como diabetes melitus e hipertensión arterial sistémica, la obesidad se está considerando cada vez más factor de riesgo independiente para enfermedad arterial coronaria (EAC). La aterosclerosis coronaria comprende una serie de respuestas inflamatorias a nivel celular y molecular, cuyas reacciones se encuentran más exacerbadas en pacientes obesos. Antes considerado mero depósito de grasa, el tejido adiposo está visto hoy en día como órgano endócrino y parácrino activo, productor de diversas citocinas inflamatorias, como las adipocinas. Este artículo apunta a alertar sobre el grave problema de salud pública en que se convirtió la obesidad en las últimas décadas y correlacionar el proceso inflamatorio exacerbado en los individuos obesos con la mayor incidencia de EAC en esta población.

Reanimación protocolizada del shcok séptico / Protocolized reanimation of septic shock

Severe sepsis and septic shock are pathologies with an increasing incidence in the world. Annually, in the USA 200.000 people die because of severe sepsis, the same number that die because of a myocardial infarction, being this last disease much more common. In Chile, a multicentric study found a 40 percent of prevalence of severe sepsis in critically ill patients, with amortality of 27 percent. In this scenario, it becomes of great importance the appropriate and integral management of this condition, by means of an early diagnosis and the implementation of anaggressive protocolized resuscitation, guided by clear goals. During the first stage of the resuscitation cristalloids and/ or colloids can be used, in order to expand the intravascular space, searching for CVP around 8 to 12 mmHg. In case of hypotension refractory to the administration of fluids, it is recommended to start with increasing doses of norepinephrin untila MAP of 65 - 75 mmHg is achieved. The intensity of the septic shock can be stratified according to the requirements of norepinephrine. It is of great importance to obtain blood cultures of the patients and to start with empiric antibiotic therapy as soon as possible. The initial metabolic goal must be the normalization of the central venous oxygen saturation. The implementation of the resuscitation bundle during the first six hours, since the diagnose of severe sepsis is done, increases the chances of surviving. Protocols of sedation and analgesia, and the use of protective mechanical ventilation is highly recommended. The use of hydrocortisone and human recombinant protein C in selected patients, may have a beneficial result in the outcome.Vasopressin, terlipressin and high-volume hemofiltration can be used as rescue measures for the most severe patients.

Proteína C reactiva: aspectos cardiovasculares de una proteína de fase aguda / C-reactive protein: cardiovascular issues of an acute-phase protein

C-reactive protein (CRP) is a nonspecific acute phase protein that has been used as an inflammatory marker for decades. More recently, it has been proposed as a predictor of cardiovascular disease (myocardial infarction, stroke, peripheral artery disease and sudden heart death). Physiologic functions of CRP as an anti-inflammatory scavenger molecule have begun to emerge. CRP binds to damaged lipoproteins and facilitates their removal by phagocytes, partially activating the complement cascade. Increased levels of CRP may result in direct effects on vascular cells, including the induction of cytokines and prothrombotic factors. Although previous studies suggested a potent independent association of CRP levels with cardiac events, the strength of this association has been shown to be weaker than previously reported in a recent large meta-analysis and in prospective studies. Therapy with statins in patients with coronary artery disease has been found to reduce adverse outcomes in association with reductions of CRP levels, independently of their effects on the lipid profile.

Associação de marcadores inflamatórios e níveis tensionais em indivíduos hipertensos com diabetes mellitus tipo 2 / Inflammatory markers and blood pressure levels in hypertensive patients with type 2 diabetes

A hipertensão arterial e o diabetes mellitus são fatores de risco que predispõem à aterosclerose.A capacidade funcional do endotélio vascular é exercida basicamente pela células endoteliais, que são sensíveis às mudanças das forças hemodinâmicas, liberando diversas substâncias, entre elas a Interleucina 6 (IL menos 6) e a Proteína C Reativa (PCR).Essa última é sintetizada pelo fígado e liberada pela estimulação pró-inflamatória da IL menos 6.Objetivo: verificar associação entre níveis elavados de pressão arterial e marcadores inflamátórios...

Proteína C reactiva: rol en enfermedad cardiovascular / C-reactive protein: role in cardiovascular disease

La patología cardiovascular ha adquirido una importancia creciente en el último tiempo, debido a que es la principal causa de muerte en países desarrollados. Esto ha llevado al desarrollo de múltiples estudios dentro de los que destacan aquellos que asocian los niveles plasmßticos basales de Proteína C reactiva (PCR) con el riesgo cardiovascular y la magnitud de su aumento durante un evento coronario con el pronóstico del paciente. Valores elevados de la línea basal de PCR se han visto asociados a síndromes metabólicos, lo que sugiere que el aumento de los marcadores de inflamación puede reflejar un estado metabólico particular que resulta ser también proaterogénico y/o predisponer a los eventos aterotrombóticos. Esta asociación es especialmente valiosa en los pacientes sin factores de riesgo tradicionales, porque nos permitiría pesquisarlos y realizar una prevención activa de futuros eventos aterotrombóticos.En esta revisión se explican los conceptos actuales tras una dÚcada de investigación, haciendo hincapié en la gÚnesis del proceso patológico, la utilidad clínica de la PCR tanto en la prevención como en el pronóstico de la patología aterotrombótica y las interrogantes que persisten.

Monitoreo de la respuesta inflamatoria / Monitoring inflammatory answer

The ill patients present frequently a systemic inflammatory response; showing problems in differing if there is an aggregated infection; it means sepsis. The objective of this article is to revise the literature about parameter evaluation which are used for monitoring the inflammatory response and its capacity to predict sepsis. Mainly, European studies show comparisons between different markers as leucocytes count, C reactive protein (CRP), procalcitonin (PCT), a new parameter described in 1993 and the interleukins. These studies reveal that the determination of cytokines and other acute phase proteins are laborious, and they do not differ if there is infection. In contrast, CPR an specially PCT show in different studies to have a sensibility and specificity over 80 percent, being similar for both. In relation with corporal temperature, leucocyte count and erythrocyte sedimentation rate do not show utility. Therefore, actually the best inflammatory markers are CRP and the PCT. In my opinion I consider the first one (CRP) not replace in our environment for the monitoring of the inflammatory response

Proteína C reactiva (PCR) cuantitativa: una novedosa herramienta para el diagnóstico de las enfermedades inflamatorias agudas

Los avances tecnológicos de las últimas décadas han rescatado pruebas de gran utilidad clínica como la determinación cuantitativa de los reactantes de fase aguda, dentro de los cuales, uno de los más interesantes, desde el punto de vista clínico, es la proteína C reactiva (PCR). La variada tecnología disponible del laboratorio clínico, permite al médico mediante la cuantificación rápida y confiable de los niveles de PCR, se mejore el diagnóstico y manejo de la mayoría de los procesos infecciosos y/o necróticos. En este artículo se analizan las diferentes situacuiones clínicas en las que la determinación seriada de la PCR ha demostrado ser de gran utilidad práctica dentro de las cuales las más importantes son en la cirugía de alto riesgo de infección (cardiovascular, Abdominal, de cadera y neurológica), en el manejo de enfermedades infecciosas de origen bacteriano, particularmente en inmunosuprimidos, en las enfermedades reumatológicas y en el infarto del miocardio. Existen además muchas otras indicaciones clínicas.