Plasma levels of neurogenic inflammation related neuropeptides in pediatric patients with community-acquired pneumonia and their potential diagnostic value in distinguishing viral and bacterial pneumonia.

Neurogenic inflammation is involved in the development and progression of respiratory inflammatory diseases. However, its role in community-acquired pneumonia (CAP) remains unclear. We therefore aimed to investigate plasma levels of neurogenic inflammation-related neuropeptides, calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY), and procalcitonin (PCT) in pediatric patients with CAP and to assess their diagnostic value in viral and bacterial/mixed pneumonia. A total of 124 pediatric patients with CAP (1 month-18 years old) and 56 healthy children of similar ages were prospectively enrolled. The patients were classified as viral (n = 99) and bacterial/mixed (n = 25) pneumonia. Plasma levels of the peptides were quantified by ELISA. ROC analysis was performed to evaluate possible diagnostic value of the peptides. While plasma levels of CGRP, VIP and PCT were significantly higher in patients with CAP than in the control group, respectively, NPY levels were significantly lower. Moreover, plasma levels of all neuropeptides and PCT were significantly higher in bacterial pneumonia patients compared to viral pneumonia patients. ROC analysis revealed that CGRP, SP and NPY had a diagnostic value in distinguishing viral and bacterial/mixed pneumonia. CONCLUSIONS: Our findings suggest that these neuropeptides may be implicated in pediatric CAP. CGRP, SP and NPY together may be a promising candidate in distinguishing viral and bacterial/mixed pneumonia, however, for this, further studies are needed. WHAT IS KNOWN: • Neurogenic inflammation contributes to the development and progression of respiratory inflammatory diseases such as chronic obstructive pulmonary disease and bronchial asthma. WHAT IS NEW: • Plasma levels of neurogenic inflammation related neuropeptides calcitonin gene-related peptide, substance P, vasoactive intestinal peptide and neuropeptide Y are changed in pediatric community-acquired pneumonia. Calcitonin gene-related peptide, substance P and neuropeptide Y are promising candidates in distinguishing viral and bacterial/mixed pneumonia.

[An experimental study of acute toxicity and pharmacology of fermented Platycodonis Radix].

This study investigated the acute toxicity of fermented Platycodonis Radix on mice and its effect on coughing in mice infected with Mycoplasma pneumoniae. The maximum dosage(MAD) was used in the acute toxicity experiment on mice to observe the signs of mice. After 14 days, dissection, blood biochemical examination, and pathological tissue section observation were conducted. In the pharmacological experiment of fermented Platycodonis Radix, 60 healthy BALB/c mice, 30 males and 30 females, were randomly divided into a blank group, a model group, a carbetapentane group(0.013 g·kg~(-1)·d~(-1)), and high-, medium-, and low-dose fermented Platycodonis Radix groups(5.2, 2.6, and 1.3 g·kg~(-1)·d~(-1)), with 10 mice in each group. Except for the blank group, the mice in the other five groups underwent model induction by intranasally instilling 20 µL of 1×10~6 CCU M. pneumoniae for 3 days, and the mice in each group were orally administered the corresponding drugs for 7 days. Cough induction experiment was conducted to observe and record the cough latency and total cough count within 3 min for each group. Hematoxylin-eosin(HE) staining and Masson staining were used to observe the pathological changes in lung tissues. Immunohistochemistry was performed to observe the protein expression of transient receptor potential A1(TRPA1), calcitonin gene-related peptide(CGRP), and substance P(SP) in the lung tissues of mice in each group. Real-time fluorescence-based quantitative polymerase chain reaction(qRT-PCR) was used to elucidate the changes in the mRNA levels of cough-related factors TRPA1, CGRP, and SP in mice treated with fermented Platycodonis Radix. No mice died in the acute toxicity experiment, and there were no changes in general behavior and major organ histopathological examinations. Compared with the blank group, there were no statistically significant differences in blood biochemical indexes. In the pharmacological experiment of fermented Platycodonis Radix, compared with the model group, the high-and medium-dose fermented Platycodonis Radix groups showed improved lung tissue structure of mice, with clear structure and regular tissue morphology. The qRT-PCR and immunohistochemical detection showed a decrease in the expression of TRPA1, CGRP, and SP in the fermented Platycodonis Radix groups. Fermented Platycodonis Radix can exert an inhibitory effect on cough by suppressing the expression of TRPA1, CGRP, and SP in lung tissues, thereby identifying the target of the drug.

Localization of sensory nerve terminals containing calcitonin gene-related peptide (CGRP) on striated muscle fibers in the rat esophagus: Evidence for triple innervation via motor endplates.

BACKGROUND: Many esophageal striated muscles of mammals are dually innervated by the vagal and enteric nerves. Recently, substance P (SP)-sensory nerve terminals with calcitonin gene-related peptide (CGRP) were found on a few striated muscle fibers in the rat esophagus, implying that these muscle fibers are triply innervated. In this study, we examined the localization and origin of CGRP-nerve endings in striated muscles to consider their possible roles in the esophagus regarding triple innervation. METHODS: Wholemounts of the rat esophagus were immunolabeled to detect CGRP-nerve endings in striated muscles. Also, retrograde tracing was performed by injecting Fast Blue (FB) into the esophagus, and cryostat sections of the medulla oblongata, nodose ganglion (NG), and the tenth thoracic (T10) dorsal root ganglion (DRG) were immunostained to identify the origin of the CGRP-nerve endings. RESULTS: CGRP-fine, varicose nerve endings were localized in motor endplates on a few esophageal striated muscle fibers (4 %), most of which received nitric oxide (NO) synthase nerve terminals, and most of the CGRP nerve endings were SP- and transient receptor potential vanilloid member 1 (TRPV1)-positive. Retrograde tracing showed many FB-labeled CGRP-neurons positive for SP and TRPV1 in the NG and T10 DGR. CONCLUSIONS: This study suggests that the CGRP-varicose nerve endings containing SP and TRPV1 in motor endplates are sensory, and a few esophageal striated muscle fibers are triply innervated. The nerve endings may detect acetylcholine-derived acetic acid from the vagal motor nerve endings and NO from esophageal intrinsic nerve terminals in the motor endplates to regulate esophageal motility.

Expression of calcitonin gene-related peptide and pulp sensitivity tests in irreversible pulpitis

Abstract The aim of the present study was to identify the relationship between the expression of calcitonin gene-related peptide (CGRP) and the responses of pulp sensitivity tests in healthy pulps and irreversible pulps by performing a cross-sectional study on patients. Two hundred subjects were evaluated. A total of 75 subjects complied with the criteria. The participants were divided into two groups: a) Healthy pulp (subjects [n = 35] having posterior teeth with clinically normal pulp tissue), and b) Irreversible pulpitis (subjects [n = 40] having posterior teeth with irreversible pulpitis). All participants were evaluated using the following variables: a) medical and dental history, b) pulp sensitivity tests, c) expression of CGRP by the enzyme-linked immunosorbent assay (ELISA), and d) expression levels of mRNA CGRP and mRNA CGRP receptor genes. We determined that the responses of the cold test between 4 and ≥12 s presented a higher average of the expression of CGRP in the group having irreversible pulpitis (p = 0.0001). When we compared the groups with the value of the electrical impulse, we found statistically significant differences (p = 0.0001), observing positive responses to the test with electrical impulses of 7 to 10, with an average of 72.15 ng/mL of CGRP in the irreversible pulpitis group. High values of CGRP expression were observed in that group in the responses of pulp sensitivity.

Usefulness of biomarkers on infection management: with or without them? / Utilidad de los biomarcadores en el manejo de la infección: ¿con o sin ellos?

Infectious diseases are disorders caused by many different microorganisms that produce clinical conditions with a wide variation in patient-rated symptoms and severity. Therefore, different diagnostic and prognostic tools are needed to help make the most accurate decisions at each moment of patient's care with suspected infection. This mini review will analyse how some biomarkers reduce the level of uncertainty in the making decision process at some phases of sepsis, including prompt identification of septic patients, early initiation of empiric broad-spectrum antimicrobials, regimen and duration

La patología infecciosa puede ser debida a microorganismos muy diferentes que producen cuadros clínicos con una expresividad muy variada tanto en los síntomas como en la gravedad. Por ello, se necesitan diferentes herramientas diagnósticas y pronósticas que ayuden a tomar las decisiones más adecuadas en cada momento de la atención a un paciente con sospecha de infección. En esta mini revisión se analizará cómo algunos biomarcadores disminuyen el nivel de incertidumbre en la toma de decisiones clínicas en algunas fases de la atención a la sepsis, como puede ser la propia identificación del paciente séptico, la necesidad de iniciar tratamiento antimicrobiano, el tipo y su duración

Biomarcadores empleados en sepsis / Sepsis biomarkers: A review

Las enfermedades infecciosas, como la sepsis, constituyen un grave problema de salud en el mundo, asociándose con una elevada morbilidad y mortalidad en todos los ámbitos de la asistencia sanitaria. Se trata de enfermedades tiempo dependientes en las que la aplicación precoz de una serie de medidas diagnostico terapéuticas mejoran de forma significativa la supervivencia y el pronóstico del paciente. Para ello se disponen de herramientas como los biomarcadores que nos ayudan tanto en el diagnóstico como pronóstico de estas patologías; biomarcadores clásicos y ampliamente utilizados como la PCR, procalcitonina o citocinas y otros menos conocidos como presepsina, pro-adrenomedulina (pro-ADM), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), soluble urokinase-type plasminogen activator receptor (suPAR), Pancreatic Stone Protein (PSP) o sCD25 (AU)

Infectious diseases, such as sepsis, are a serious health problem in the world, associated with high morbidity and mortality in all areas of health care. These are time dependent diseases in which the early application of diagnostic therapeutic actions, significantly improve patient survival and prognosis. To carry out this, we have tools such as biomarkers that help us in the diagnosis and prognosis of these pathologies; There are biomarkers widely used such as PCR, Procalcitonin or cytokines, and others that are less known as pro-adrenomedullin (pro-ADM), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), soluble urokinase-type plasminogen activator receptor (SuPAR), Pancreatic Stone Protein (PSP) or sCD25 (AU)

Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz / Cord blood procalcitonin in the assessment of early-onset neonatal sepsis

Introducción: El diagnóstico precoz es esencial para disminuir la morbimortalidad en la sepsis neonatal precoz (SNP). La procalcitonina (PCT) en sangre de cordón permitiría identificar al nacimiento a los pacientes infectados. Objetivo: Estudiar la utilidad y seguridad de un protocolo de valoración de recién nacidos con riesgo de SNP, basado en los valores de procalcitonina en sangre de cordón. Pacientes y métodos: Se incluyeron los nacidos en nuestro hospital de octubre de 2013 a enero de 2015, con factores de riesgo infeccioso. Se procedió según un algoritmo basado en los valores de procalcitonina (<0,6 ng/ml frente a ≥0,6 ng/ml). Posteriormente se clasificaron como infección comprobada, probable o no infección. Resultados y conclusiones: De 2.519 nacidos en el periodo de estudio 136 cumplieron criterios de inclusión. De 120 casos con PCT <0,6 ng/ml ninguno desarrolló SNP (valor predictivo negativo 100%). Por el contrario, de 16 casos con PCT ≥0,6 ng/ml, diez presentaron infección comprobada o probable (valor predictivo positivo 62,5%). La sensibilidad de la PCT frente a infección fue 100% y la especificidad 95,2% (área bajo la curva operador receptor 0,969). La incidencia de infección en el grupo de estudio fue de 7,4%; en RN de madre con corioamnionitis 26,1%. Recibieron antibioterapia 21 recién nacidos (15,4%). El protocolo clínico estudiado ha demostrado ser efectivo y seguro para diferenciar entre pacientes con mayor riesgo de SNP, en los que la aproximación diagnóstica y terapéutica fue más intervencionista, frente a aquellos con menor probabilidad de sepsis, que se beneficiaron de un manejo más conservador (AU)

Introduction: Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. Objective: To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methods: Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6 ng/ml versus ≥0.6 ng/ml). They were later classified as proved infection, probable, or no infection. Results and conclusions: Of the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6 ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6 ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management (AU)

Meningitis, punción lumbar y procalcitonina / Meningitis, lumbar puncture and procalcitonin

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Réplica a "Meningitis, punción lumbar y procalcitonina" / Reply to "Meningitis, lumbar puncture and procalcitonin"

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The effect of capsaicin on expression patterns of CGRP in trigeminal ganglion and trigeminal nucleus caudalis following experimental tooth movement in rats

ABSTRACT Objectives The aim of this study was to explore the effect of capsaicin on expression patterns of calcitonin gene-related peptide (CGRP) in the trigeminal ganglion (TG) and trigeminal subnucleus caudalis (Vc) following experimental tooth movement. Material and Methods Male Sprague-Dawley rats were used in this study and divided into small-dose capsaicin+force group, large-dose capsaicin+force group, saline+force group, and no force group. Closed coil springs were used to mimic orthodontic forces in all groups except for the no force group, in which springs were inactivated. Capsaicin and saline were injected into periodontal tissues. Rats were euthanized at 0 h, 12 h, 1 d, 3 d, 5 d, and 7 d following experimental tooth movement. Then, TG and Vc were obtained for immunohistochemical staining and western blotting against CGRP. Results Immunohistochemical results indicated that CGRP positive neurons were located in the TG, and CGRP immunoreactive fibers were distributed in the Vc. Immunohistochemical semiquantitative analysis and western blotting analysis demonstrated that CGRP expression levels both in TG and Vc were elevated at 12 h, 1 d, 3 d, 5 d, and 7 d in the saline + force group. However, both small-dose and large-dose capsaicin could decrease CGRP expression in TG and Vc at 1 d and 3 d following experimental tooth movement, as compared with the saline + force group. Conclusions These results suggest that capsaicin could regulate CGRP expression in TG and Vc following experimental tooth movement in rats.

Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients / Validez de la procalcitonina para el diagnóstico de infección bacteriana en pacientes ancianos

INTRODUCTION: PCT has been consolidated as a key tool in the diagnosis of bacterial infections in general population. Few studies have been conducted to determine the applicability of this test in elderly patients. METHODS: Study of validity of PCT on elderly patients. Two groups were formed; the first group was formed by patients aged 75 years or older, under bacterial infection criteria and PCT on the initial Lab test. The second group was formed by patients aged 75 years or older with any noninfectious disease; these patients were asked PCT in the initial Lab test. Sensitivity, specificity, positive and negative likelihood ratio were calculated.RESULTS:161 patients were included, 95 with probable bacterial infection and 66 without infection. Patients with probable bacterial infection criteria, 72% of them had PCT >0.5 ng/mL. Patients without infection, 8% of the patients had PCT >0.5 ng/mL. Sensitivity and specificity of PCT to bacterial infection with the cutoff value of 0.5 ng/mL was 72% and 92%, respectively. Conclusion PCT can be used in elderly patients to diagnose bacterial infections because it has proved good sensitivity and high specificity

INTRODUCCIÓN: La PCT se ha consolidado como una herramienta clave en el diagnóstico de las infecciones bacterianas en la población general. Pocos estudios se han realizado para determinar la aplicabilidad de esta prueba en pacientes ancianos. MÉTODOS: Estudio de validez de la PCT en población anciana. Se conformaron 2 grupos: un grupo con pacientes con edad igual o mayor de 75 años con criterios de probable infección bacteriana y a quienes se les hubiese realizado PCT en la analítica inicial. Otro grupo conformado por pacientes con edad igual o mayor de 75 años ingresados por patología no infecciosa; a estos pacientes se les solicitó PCT en la analítica de ingreso. Se calcularon: sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN), razones de verosimilitud positiva y el inverso de la razón de verosimilitud negativa (RVP y I-RVN). RESULTADOS: Se incluyeron 161 pacientes, 95 con probable infección bacteriana y 66 sin infección. De los pacientes con probable infección bacteriana, 72% tenían la PCT > 0,5 ng/mL. En el grupo sin infección, 8% tenían la PCT > 0,5 ng/mL. La S y E de la PCT fue de 72 y 92%, respectivamente. CONCLUSIÓN: La PCT se puede utilizar en pacientes ancianos de forma fiable porque posee una buena sensibilidad y alta especificidad para el diagnóstico de infección bacteriana

Utilidad de la procalcitonina en el diagnóstico precoz de apendicitis aguda / Usefulness of procalcitonin in early diagnosis of acute appendicitis

Introducción y objetivo: En los últimos años ha tratado de definirse la utilidad de los diferentes parámetros analíticos inflamatorios en el diagnóstico de la apendicitis aguda. El objetivo de este estudio es determinar el valor de la procalcitonina (PCT) en el diagnóstico precoz de esta entidad, comparándolo con los marcadores analíticos tradicionalmente solicitados en pacientes con dolor abdominal agudo (leucocitos/proteína C reactiva). Método: Estudio prospectivo analítico, durante el periodo comprendido entre julio y diciembre de 2011. Se incluyeron menores de 16 años con dolor abdominal y sospecha clínica de apendicitis. Se procedió al estudio de las variables analíticas (leucocitos, proteína C reactiva [PCR], PCT) y la elaboración de una curva ROC para los parámetros de laboratorio evaluados. Resultados: Se incluyeron 105 pacientes con una media de edad de 10,2 años (±3,3). El diagnóstico de apendicitis se confirmó por histología en el 39% (41/105), clasificándose el 42,5% como apendicitis perforada y el 11,5% como gangrenada. La cifra media de leucocitos fue significativamente mayor en el grupo con apendicitis (15,143/µL frente a 10,723/µL; p <0,001), al igual que el valor de la mediana de PCT (1,4 µg/L [rango: 0,7-6,1] frente a 0,6 µg/L [rango: 0,5-1,8]; p <0,05). El área bajo la curva ROC para la cifra de leucocitos fue de 0,76; los valores obtenidos para la PCR (0,63) y la PCT (0,6) fueron inferiores. La mayoría de los pacientes (94/105), así como los diagnosticados de apendicitis (31/41), mostraron valores de PCT normales. No obstante, el diagnóstico de apendicitis se confirmó en todos los que presentaron un aumento de la PCT, excepto en 2. Todas las apendicitis gangrenadas presentaron una elevación de la PCT. Conclusiones: La PCT no es un buen marcador precoz de apendicitis. No obstante, su elevación actúa como factor predictivo en el diagnóstico de apendicitis y su grado de evolución (AU)

Introduction and objective: Recent studies have tried to define the usefulness of different inflammatory laboratory parameters in the diagnosis of acute appendicitis. The objective of this study is to determine the value of procalcitonin (PCT) in the early diagnosis of this entity, compared with traditional laboratory markers in patients with acute abdominal pain (WBC/CRP). Methods: Prospective analytical study. Period: July to December 2011. Inclusion of children under 16 years with abdominal pain and clinical suspicion of appendicitis. Analytical analysis (leukocytes, CRP, PCT) and development of a ROC curve for laboratory parameters evaluated. Results: We included 105 patients with a mean age 10.2 years (± 3.3). The diagnosis of appendicitis was confirmed by histology in 39% (41/105), 42.5% of them were classified as perforated appendicitis and 11.5% as gangrenous. The average number of leukocytes was significantly higher in the group with appendicitis (15.143/μL vs 10.723/μL; p <0.001), like the median value of PCT (1.4 µg/L [0.7 to 6.1] vs 0.6 µg/L [0.5 to 1.8]; p <0.05). The area under the ROC curve for leukocyte count was 0.76; the values obtained for the PCR (0.63) and PCT (0.6) were lower. The majority of patients (94/105) and those diagnosed of appendicitis (31/41) showed normal PCT values. The diagnosis of appendicitis was confirmed in those with increased PCT, but 2. All patients with gangrenous appendicitis had elevation of PCT. Conclusions: PCT is not a good early marker of appendicitis. However, his elevation acts as a predictor for the diagnosis of appendicitis and its degree of evolution (AU)

Procalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinal / Procalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer

OBJETIVO: Evaluar la asociación entre niveles séricos de procalcitonina (PCT) y proteína C reactiva (PCR), en los 3 primeros días de postoperatorio, y la aparición de infección intraabdominal postoperatoria. MÉTODO: Estudio observacional prospectivo que incluye a 67 pacientes intervenidos quirúrgicamente de cáncer colorrectal, gástrico y pancreático. Los niveles séricos de PCT y PCR se midieron antes de la cirugía y a las 24, 48 y 72 h de la misma. Se registraron los valores de PCT y PCR, así como su fiabilidad para la detección de infección intraabdominal postoperatoria. RESULTADOS: La incidencia de infección intraabdominal postoperatoria fue de 13,4%. Los valores de PCR a las 72 h, los valores de PCT a las 24, 48 y 72 h y el cociente entre el valor de PCR a las 72 h y el valor de PCR a las 48 h (PCR D3/PCR D2) se asociaron significativamente con la aparición de infección intraabdominal postoperatoria. La sensibilidad más alta correspondió al valor de PCT a las 72 h (88,9%); la especificidad más alta y el valor predictivo positivo (VPP) más alto, al cociente PCR D3/PCR D2 (96,49 y 71,4%, respectivamente); el valor predictivo negativo (VPN) más alto, al valor de PCT a las 72 h y a las 24 h (97,7 y 96%, respectivamente). CONCLUSIÓN: Los valores de PCT se asocian significativamente con la aparición de infección intraabdominal postoperatoria en los 3 primeros días de postoperatorio. Su sensibilidad y VPP son bajos, pero su VPN es alto, incluso a las 24 h de la cirugía

AIM: to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection. METHOD: Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI). RESULTS: The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72 h, PCT serum levels at 24, 48 and 72 h and the ratio between serum levels of CRP at 72 hours and serum levels of CRP at 48 hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72 hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72 h and 24 h. CONCLUSIONS: Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24 h after surgery

Utilidad de los biomarcadores de inflamación e infección en los servicios de urgencias / Usefulness of inflammation and infection biomarkers in the Emergency Department

El 10% de las asistencias en los servicios de urgencias están relacionadas con procesos infecciosos. Administrar el tratamiento antibiótico de manera precoz y la toma inmediata de otras decisiones diagnóstico-terapéuticas (pruebas complementarias, obtener hemocultivos y muestras microbiológicas, intensidad del soporte hemodinámico, necesidad de ingreso, etc.) repercuten directamente en la supervivencia de los enfermos con infección bacteriana grave (bacteriemia, sepsis grave o shock séptico). En este contexto, el servicio de urgencias representa uno de los eslabones clave donde se establecen la sospecha y el diagnóstico y se inicia el tratamiento, lo que determinará la evolución y el pronóstico en función de la rapidez de esta actuación. Pero las manifestaciones clínicas de los procesos infecciosos son a menudo inespecíficas y variables, lo que dificulta el reconocimiento precoz de estos enfermos y estas situaciones. Los biomarcadores de respuesta inflamatoria e infección se han posicionado desde hace años como herramientas de gran ayuda para el médico de urgencias, mejorando el diagnóstico y el manejo de la infección en urgencias. La intención de esta revisión es poner de manifiesto las evidencias científicas publicadas, aclarar las controversias existentes, comparar la utilidad de los principales biomarcadores de inflamación e infección y generar, a partir de ella, una serie de recomendaciones para su uso con objeto de mejorar el diagnóstico, la valoración pronóstica y el manejo de los pacientes con infección en urgencias

Infectious processes account for 10% of patient seen in the emergency department. To administer antibiotics early, and before any other therapeutic-diagnostic decisions (complementary tests, microbiological samples, intensity of hemodynamic support, need for admission, etc.) have direct repercussions on the survival of patients with severe bacterial infections (bacteremia, severe sepsis or septic shock). In this context, the emergency department represents a critical level where the suspicion of infection and it diagnosis is made and treatment is started, and the progression and prognosis will be determined by the speed of this action. However, the clinical manifestations of infectious diseases are often non-specific and variable which makes early recognition of these patients and situations difficult. Inflammation and infection biomarkers have been around for years as helpful tools for improving emergency medical diagnoses and management of infection in the emergency department. The aim of this review is to summarize the published scientific evidence, in order to clarify the existing controversies, comparing the usefulness of the major biomarkers of inflammation and infection. It will alas suggest recommendations for their use in order to improve diagnosis, prognostic evaluation and management of infected patients in the emergency department

Migraña episódica frecuente y péptido relacionado con el gen de la calcitonina. Influencia del tratamiento con topiramato y zonisamida en los niveles del péptido / Frequent episodic migraine and calcitonin gene-related peptide. Influence of treatment with topiramate and zonisamide on levels of the peptide

Introducción. La fisiopatología del dolor en la migraña se relaciona con la activación del sistema trigeminovascular por medio de la liberación de neuropéptidos vasoactivos, y el más importante es el péptido relacionado con el gen de la calcitonina (CGRP), que causa una inflamación neurógena en los vasos leptomeníngeos. Objetivo. Investigar si el CGRP está incrementado en la migraña episódica frecuente y si el tratamiento preventivo con topiramato o zonisamida modifica sus niveles. Sujetos y métodos. Se estudiaron 28 pacientes con migraña episódica con o sin aura, cumpliendo los criterios de la Sociedad Internacional de Cefaleas, con una frecuencia de 4-14 días/mes. En todos los pacientes se determinaron los niveles plasmáticos del CGRP durante un período intercrítico (> 72 h sin dolor). Los pacientes se aleatorizaron en dos grupos de tratamiento, uno con 50 mg/día de topiramato y otro con 50 mg/día de zonisamida, durante tres meses. Al finalizar el período activo se analizó nuevamente el nivel del CGRP. El grupo control lo constituyeron nueve sujetos sanos. Resultados. El CGRP fue significativamente superior en el grupo de migraña episódica comparado con el grupo control (50,61 ± 22,5 pg/mL frente a 34,96 ± 17,03 pg/mL; p = 0,037). Después del tratamiento con neuromoduladores no se hallaron diferencias significativas en el nivel de CGRP (46,11 ± 24,2 pg/mL basal frente a 47,5 ± 24,88 pg/mL postratamiento). Tampoco se hallaron diferencias al analizar los grupos de topiramato y zonisamida de forma individualizada. Conclusiones. El nivel plasmático del CGRP está incrementado en la migraña episódica y sus niveles no son modificados por el tratamiento con dosis bajas de topiramato o zonisamida (AU)

Introduction. The pathophysiology of pain in migraine is related to the activation of the trigeminovascular system by releasing vasoactive neuropeptides, the most important of which is calcitonin gene-related peptide (CGRP), which causes a neurogenic inflammation in the leptomeningeal vessels. Aim. To study whether CGRP is increased in frequent episodic migraine and whether preventive treatment with topiramate or zonisamide modifies its levels. Subjects and methods. We studied 28 patients with episodic migraine with or without aura, in accordance with the International Headache Society criteria, with a frequency of 4-14 days/month. Plasma levels of CGRP were determined in all the patients during an interictal period (> 72 hours without pain). Patients were divided at random into two treatment groups, one with 50 mg/day of topiramate and the other with 50 mg/day of zonisamide, for three months. At the end of the active period the CGRP level was analysed again. The control group consisted of nine healthy subjects. Results. CGRP was significantly higher in the episodic migraine group than in the control group (50.61 ± 22.5 pg/mL versus 34.96 ± 17.03 pg/mL; p = 0.037). After treatment with neuromodulators no significant differences were found in the level of CGRP (46.11 ± 24.2 pg/mL basal versus 47.5 ± 24.88 pg/mL post-treatment). Neither were any differences found on analysing the topiramate and zonisamide groups individually. Conclusions. The plasma level of CGRP is increased in episodic migraine, and its levels are not modified by treatment with low doses of topiramate or zonisamide (AU)

Neumonía comunitaria y procalcitonina, ¿una oportunidad para mejorar? / Community-acquired pneumonia and procalcitonin, an opportunity to improve?

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Capacidad de la procalcitonina para predecir bacteriemia en pacientes con neumonía adquirida en la comunidad / Ability of procalcitonin to predict bacteremia in patients with community acquired pneumonia

Fundamento y objetivo: Analizar la posible utilidad y capacidad de la procalcitonina (PCT) para pronosticar la existencia de bacteriemia en los pacientes con neumonía adquirida en la comunidad (NAC) producida o no porStreptococcus pneumoniae (S. pneumoniae). Pacientes y método: Estudio observacional, prospectivo y descriptivo de pacientes diagnosticados de NAC en un servicio de urgencias (SU). Se recogieron variables sociodemográficas, de comorbilidad, el índice de Charlson, grados del Pneumonia Severity Index y criterios de NAC grave, estudios microbiológicos y determinaciones analíticas y de los biomarcadores (PCT y proteína C reactiva). Se realizó seguimiento durante 30 días. Se calculó el poder pronóstico y el rendimiento diagnóstico de bacteriemia originada o no por S. pneumoniae. Resultados: Se incluyeron 474 pacientes. Los hemocultivos fueron positivos en 85 casos (17,9%), 75 de ellos con aislamiento de S. pneumoniae (88,4%) (en 5 junto con otro patógeno). Para la predicción de bacteriemia (causada o no por S. pneumoniae) la PCT obtiene un área bajo la curva Receiver Operating Characteristic de 0,988 (intervalo de confianza del 95% 0,908-0,995; p < 0,001) y con un punto de corte de PCT ≥ 0,95 ng/ml, un valor predictivo negativo > 98%, con coeficiente de probabilidad positivo > 10. Los serotipos de S. pneumoniae más frecuentes fueron 19A, 7F, 1 y 3. Los valores medios mayores de PCT se encontraron en los serotipos 7F, 19A, 3 y 1, con diferencias significativas con el resto (p = 0,008). Los serotipos con mayor porcentaje de sepsis grave-shockséptico fueron 3, 1 y 19A, los de mortalidad a los 30 días fueron 1, 3 y 19A y los de afectación multilobar o bilateral, los serotipos 3, 19A y 6A. Conclusiones: En los pacientes con NAC en el SU la PCT consigue un gran rendimiento diagnóstico para descartar o sospechar bacteriemia y para orientar la etiología de la NAC por S. pneumoniae. Los serotipos 1, 3, 19A y 7F se presentan con mayor frecuencia, respuesta inflamatoria sistémica y gravedad clínica (AU)

Background and objective: To analyze the usefulness and ability of procalcitonin (PCT) to predict the presence of bacteremia in patients with community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae (S. pneumoniae) or other bacteria. Patients and method: This is an observational, prospective and descriptive study involving patients who were diagnosed with CAP in our Emergency Department. Data collected included socio-demographic and comorbidity variables, Charlson index, stage in the Pneumonia Severity Index and criteria of severe NAC, microbiologic studies and biomarker determinations (PCT and C reactive protein). The follow-up was carried out during 30 days to calculate the predictive power and the diagnostic performance for bacteremia caused or not by S. pneumoniae. Results: Four hundred and seventy-four patients were finally included in the study. Blood cultures were positive in 85 individuals (17.9%) and S. pneumoniae was identified as the responsible pathogen in 75 of them (88.4%) (in 5 cases together with another agent). The area under the Receiver Operating Characteristic curve for PCT to predict bacteremia (caused by S. pneumoniae or not) was 0.988 (95% confidence interval 0.908-0.995;P < .001) and, considering a cut-off value ≥ 0.95 ng/mL, the negative predictive value and the positive likelihood ratio were > 98% and > 10, respectively. The most frequently isolated serotypes of S. pneumoniaewere 19A, 7F, 1 and 3. The highest mean levels of PCT were found in serotypes 7F, 19A, 3 and 1, which showed statistically significant differences with regard to the others serotypes considered (P = .008). Serotypes associated with the highest percentage of severe sepsis-septic shock, 30-days mortality and multi-lobe or bilateral affection were 3, 1 and 19A; 1, 3 and 19A; and 3, 19A and 6A, respectively. Conclusions: PCT had a remarkable diagnostic ability to discard or suspect bacteremia and to guide the etiology of CAP caused by S. pneumoniae. Serotypes 1, 3, 19A and 7F showed greater frequency, systemic inflammatory response and clinical severity (AU)