RESUMEN
Introducción: el síndrome coronario agudo (SCA) es la primera causa de mortalidad en Colombia. Una estratificación de riesgo errónea, en la sala de emergencias (ER), afecta las intervenciones realizadas y la tasa de eventos adversos cardiovasculares puede ser mayor. El objetivo de esta investigación fue medir la diferencia en el puntaje GRACE y la estratificación del riesgo coronario, utilizando los resultados de las troponinas medidas secuencialmente durante la atención inicial. Metodología: con un diseño descriptivo retrospectivo, se evaluaron los registros clínicos de pacientes tratados por dolor precordial de probabilidad intermedia para SCA, sin indicación de manejo invasivo inmediato, atendidos en la sala de emergencias de una clínica del tercer nivel de Bogotá, durante el año 2017. Se determinó la diferencia entre la puntuación GRACE calculada con la primera troponina (GRACE-1), la segunda troponina (GRACE-2) o la troponina delta (GRACE-delta) [prueba T pareada], y la proporción de pacientes poco estratificados se midió al usar la primera troponina [X2, puntaje Z]. Resultados: se identificaron 44 pacientes en un período de 6 meses. La mayoría hombres con edad mediana de 73 años. El promedio (DE) de los puntajes GRACE-1, GRACE-2 y GRACE-delta, fue de 114.14 (30.73), 115.55 (30.14) y 111.11 (28.79), respectivamente; al comparar GRACE-delta con GRACE-1 y GRACE-2 se identificaron diferencias significativas (p:<0.05). Se identificó un error en la estratificación del riesgo coronario en 10/44 pacientes (22.7%) y 9/44 (20.4%) presentaron sobreestratificación. Conclusión: la estratificación del riesgo coronario con la primera troponina, a diferencia de la troponina delta (ítem no aclarado en las guías), evidenció una sobreestratificación en al menos 20% de los pacientes, estableciendo la necesidad de procedimientos más invasivos y posiblemente hospitalización más prolongada permanecer.
Background: Acute coronary syndrome (ACS) is the first cause of mortality in Colombia. An erroneous risk stratification, in the emergency room (ER), affects the interventions performed and the rate of major cardiovascular adverse events. We measured the difference in GRACE score and stratification of coronary risk, by using the results of troponins measured sequentially during initial care. Methods: With a retrospective descriptive design, clinical records of patients treated for precordial pain of ≥ intermediate probability for ACS were evaluated, without indication of immediate invasive management, attended in the ER of a clinic of the third level of Bogotá, during 2017. De-termined the difference between the GRACE score calculated with the first (GRACE-1), second (GRACE-2) or troponin delta (GRACE-delta [paired T-test], and the proportion of poorly stratified patients was measured when using the first troponin [X2, Z-score]. Results: 44 patients in a period of 6 months were identified. The majority men, older adults, middle age 73 years. The average (SD) of scores GRACE-1, GRACE-2 and GRACE-delta, was 114.14 (30.73), 115.55 (30.14) and 111.11 (28.79), respectively; when comparing GRACE-delta with GRACE-1 and GRACE-2 significant differences were identified (p:<0.05). Error in the stratification of coronary risk was identified in 10/44 patients (22.7%), and 9/44 (20.4%) presented over-stratification. Conclusion: The stratification of coronary risk using the first troponin, unlike the troponin delta (item not clarified in the guidelines), evidenced an over-stratification in at least 20% of the patients, establishing the need for more invasive procedures and possibly longer hospital stay.
Asunto(s)
Síndrome Coronario Agudo/terapia , Troponina/farmacología , Isquemia Miocárdica/epidemiología , Enfermedad CoronariaRESUMEN
Traumatic brain injury (TBI) produces several cellular changes, such as gliosis, axonal and dendritic plasticity, and inhibition-excitation imbalance, as well as cell death, which can initiate epileptogenesis. It has been demonstrated that dysfunction of the inhibitory components of the cerebral cortex after injury may cause status epilepticus in experimental models; we proposed to analyze the response of cortical interneurons and astrocytes after TBI in humans. Twelve contusion samples were evaluated, identifying the expression of glial fibrillary acidic protein (GFAP) and calcium-binding proteins (CaBPs). The study was made in sectors with and without preserved cytoarchitecture evaluated with NeuN immunoreactivity (IR). In sectors with total loss of NeuN-IR the results showed a remarkable loss of CaBP-IR both in neuropil and somata. In sectors with conserved cytoarchitecture less drastic changes in CaBP-IR were detected. These changes include a decrease in the amount of parvalbumin (PV-IR) neurons in layer II, an increase of calbindin (CB-IR) neurons in layers III and V, and an increase in calretinin (CR-IR) neurons in layer II. We also observed glial fibrillary acidic protein immunoreactivity (GFAP-IR) in the white matter, in the gray-white matter transition, and around the sectors with NeuN-IR total loss. These findings may reflect dynamic activity as a consequence of the lesion that is associated with changes in the excitatory circuits of neighboring hyperactivated glutamatergic neurons, possibly due to the primary impact, or secondary events such as hypoxia-ischemia. Temporal evolution of these changes may be the substrate linking severe cortical contusion and the resulting epileptogenic activity observed in some patients.
Asunto(s)
Lesiones Encefálicas/metabolismo , Lesiones Encefálicas/patología , Proteínas de Unión al Calcio/metabolismo , Corteza Cerebral/metabolismo , Corteza Cerebral/patología , Adolescente , Adulto , Anciano , Antígenos Nucleares/análisis , Antígenos Nucleares/metabolismo , Biomarcadores/metabolismo , Lesiones Encefálicas/fisiopatología , Calbindina 2 , Calbindinas , Proteínas de Unión al Calcio/análisis , Corteza Cerebral/lesiones , Progresión de la Enfermedad , Femenino , Proteína Ácida Fibrilar de la Glía/análisis , Proteína Ácida Fibrilar de la Glía/metabolismo , Gliosis/metabolismo , Gliosis/patología , Gliosis/fisiopatología , Ácido Glutámico/metabolismo , Humanos , Hipoxia-Isquemia Encefálica/metabolismo , Hipoxia-Isquemia Encefálica/patología , Hipoxia-Isquemia Encefálica/fisiopatología , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Fibras Nerviosas Mielínicas/metabolismo , Fibras Nerviosas Mielínicas/patología , Proteínas del Tejido Nervioso/análisis , Proteínas del Tejido Nervioso/metabolismo , Neuronas/metabolismo , Neuronas/patología , Parvalbúminas/análisis , Parvalbúminas/metabolismo , Proteína G de Unión al Calcio S100/análisis , Proteína G de Unión al Calcio S100/metabolismo , Adulto JovenRESUMEN
Introducción: El trauma craneoencefalico (TCE)es un fenómeno heterogéneo desde el punto de vista molecular, celular y en la respuesta clínica. Se considera que esta diversidad se debe a la intensidad de la injuria primaria, eventos secundarios asociados (hipoxia, isquemia, edema, inflamación), al estado metabólico del paciente, su base genética, edad, género, etc. Para determinar la integridad anatomo-funcional de las células nerviosas es importante verificar el estado de la cito, dendroarquitectura y preservación laminar como un requisito para garantizar conectividad. Objetivo: Valorar la respuesta de las neuronas al trauma con dos marcadores neuronales selectivos sensibles a la lesión NeuN y MAP2. Materiales y métodos: Se utilizaron muestras (4 de lóbulo temporal y 2 de lóbulo frontal) de 6 pacientes que habían sufrido TCE. Las muestras se fijaron en PLP, cortadas en vibrßtomo a 50 µm, incubadas con los anticuerpos NeuN y MAP2 y procesadas con el sistema avidina-biotina. Como control se utilizó tejido humano post-mortem. Resultados: La inmunorreactividad (IR) para NeuN fue anormal en todas las muestras, con sectores que mostraron IR ligeramente alterada, otros con perdida parcial de las capas supragranulares, sobre todo la lßmina III y otros con pérdida drastica de todas las laminas. La IR para MAP2 se alteró en todas las muestras con diferentes grados de compromiso. Los procesos dendríticos fueron difíciles de seguir, especialmente los procedentes de la lßmina V, los cuales se observaron tortuosos, fragmentados y con orientación aberrante. Conclusiones: Con el propósito de conocer el estado de las neuronas después de un evento lesivo se recomienda el uso de los marcadores NeuN y MAP2 complementarios a los métodos clasicos. El presente trabajo muestra la diversidad de respuestas histopatológicas en sectores adyacentes de una misma muestra con ambos marcadores, como un indicador de los diferentes estados de neurodegeneración.
Introduction: Traumatic brain injury (TBI) is a heterogeneous phenomenon from a molecular, cellular and pathological perspective. Clinical outcome is also extremely variable. It is considered that such a diversity response to TBI is related to the primary injury intensity, associated secondary events (hypoxia, ischemia, oedema and inflammation), metabolic patient state, genetic background, age, gender, etc. After injury the histopathological outcome is variable in time and space. In order to determine the anatomofunctional integrity of nerve cells in the cerebral cortex, it is important to verify the state of the cito and dendroarchitecture and the laminar preservation as a requisite to guarantee connectivity. Objective: The aim of the present work was to evaluate the response of human cortical neurons using two selective neuronal markers, NeuN and MAP2, which recognize citoarchitecture and dendritic arrangement, respectively. Materials and methods: In the present study we utilized six tissue samples (4 temporal and 2 frontal cortices) from TBI patients. Tissues from four post-mortem human brains were used as controls. Tissue samples were fixed in PLP, cut at 50 um in a vibratome, incubated with NeuN and MAP2 and processes with the avidin/biotin complex. Results: NeuN-IR was abnormal in all samples analyzed with some sectors showing slight NeuN-IR, others with NeuN-IR partial loss in supragranular layers, especially layer IIII, and other with a drastic reduction in staining in all cortical layers. MAP2-IR was altered across sections with sectors showing different degrees of changes in the normal pattern of MAP2-IR. Dendritic processes were difficult to follow because of its discontinuity. Layer V apical dendritic processes appear tortuous and its IR was fragmented in some cases they take aberrant orientations.
Asunto(s)
Humanos , Corteza Cerebral , Traumatismos Craneocerebrales , Lóbulo Frontal , Flujo Laminar , Lóbulo Temporal , Edema , Hipoxia , IsquemiaRESUMEN
OBJECTIVE: To assess the prevalence of high blood pressure (PHBP) and its association with age, sex, socioeconomic status (SES), and body mass index (BMI = kg/m2). MATERIAL AND METHODS: A cross-sectional survey was carried out in 1996, in a random sample of 356 adults aged 20 and older, residents of Bucaramanga, Colombia. Weight, height, and blood pressure readings were obtained, plus data on age and gender. Robust linear and log-binomial regression was used to estimate the independent effect of different risk factors on systolic (SBP) and diastolic (DBP) blood pressure and HBP. RESULTS: Mean SBP and DBP were significantly higher in men (122.5 and 88.1 mmHg) than in women (117.2 and 75.4 mmHg). The adjusted SBP increased with age, more in men than in women; DBP did not change with age. For each unit increase in BMI, SBP and DBP increased 0.76 and 0.69 mmHg, respectively. SBP was 6.8 and DBP was 9.8 mmHg higher in low-SES than in high-SES subjects. The adjusted PHBP increased with age and was higher in subjects > or = 50 years than in those 20-30 years old. Sex had no significant effect on PHBP (p = 0.795). For each unit increase in BMI the PHBP increased 3%, and low-SES subjects had a PHBP 1.84 times higher than high-SES subjects. CONCLUSIONS: A high PHBP was found. There is a great potential for prevention by weight control. Further studies are needed to confirm the increasing PHBP in low-SES subjects and to identify its causes.
Asunto(s)
Hipertensión/epidemiología , Adulto , Factores de Edad , Anciano , Presión Sanguínea , Índice de Masa Corporal , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Distribución Aleatoria , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVE: To assess the prevalence of high blood pressure (PHBP) and its association with age, sex, socioeconomic status (SES), and body mass index (BMI = kg/m2). MATERIAL AND METHODS: A cross-sectional survey was carried out in 1996, in a random sample of 356 adults aged 20 and older, residents of Bucaramanga, Colombia. Weight, height, and blood pressure readings were obtained, plus data on age and gender. Robust linear and log-binomial regression was used to estimate the independent effect of different risk factors on systolic (SBP) and diastolic (DBP) blood pressure and HBP. RESULTS: Mean SBP and DBP were significantly higher in men (122.5 and 88.1 mmHg) than in women (117.2 and 75.4 mmHg). The adjusted SBP increased with age, more in men than in women; DBP did not change with age. For each unit increase in BMI, SBP and DBP increased 0.76 and 0.69 mmHg, respectively. SBP was 6.8 and DBP was 9.8 mmHg higher in low-SES than in high-SES subjects. The adjusted PHBP increased with age and was higher in subjects > or = 50 years than in those 20-30 years old. Sex had no significant effect on PHBP (p = 0.795). For each unit increase in BMI the PHBP increased 3, and low-SES subjects had a PHBP 1.84 times higher than high-SES subjects. CONCLUSIONS: A high PHBP was found. There is a great potential for prevention by weight control. Further studies are needed to confirm the increasing PHBP in low-SES subjects and to identify its causes.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Hipertensión/epidemiología , Factores Sexuales , Tamizaje Masivo , Prevalencia , Estudios Transversales , Factores de Riesgo , Colombia , Obesidad , Distribución Aleatoria , Factores de Edad , Índice de Masa Corporal , Presión ArterialRESUMEN
El minimental se ha empleado como parte de las pruebas de tamizaje en el diagnóstico de las demencias durante años, en numerosos estudios realizados alrededor del mundo. Esta prueba ha sido modificada por los diferentes grupos que la han aplicado, sin que hasta ahora se haya hecho un análisis de los diferentes cambios efectuados, en cada uno de dichas investigaciones. Por tal motivo, se analiza la literatura científica mas relevante en inglés y español, publicada entre 1975 y 1995 comparando las metodologías empleadas, asi como los items, variables y puntos de corte utilizados en tales investigaciones. Se encontró que no existe un consenso acerca de la aplicación y análisis del mini-mental, incluyendo el personal que efectuó el estudio. Todas las variaciones hechas arbitrariamente hacen dificil comparar los resultados publicados en los diferentes trabajos demandando, por lo tanto, un consenso alrededor de esta herramienta, con el fin de que se ueda seguir utilizando con la confiabilidad diagnóstica para la que fue diseñada