Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva / Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation

INTRODUCCIÓN: El síndrome de obesidad-hipoventilación (SOH) es un factor de riesgo para presentar insuficiencia cardiaca (IC). Algunos estudios relacionan el uso de ventilación no invasiva (VNI) con la alteración de parámetros hemodinámicos. Nuestro objetivo fue describir la situación hemodinámica de un grupo de pacientes con SOH y estudiar el efecto de la VNI. PACIENTES Y MÉTODOS: Con un diseño transversal de mediciones repetidas, se incluyó a pacientes con SOH tratados con VNI en situación estable. Se estudió su hemodinámica con bioimpedancia: 30 min basales y otros 30 con VNI. Se midieron el gasto cardiaco (GC), el índice cardiaco y el volumen sistólico. Se tomó como referencia el GC calculado para cada paciente expresado como porcentaje sobre su límite inferior de normalidad (LIN) y se establecieron 2 grupos: sin IC con GC conservado (≥ 100% sobre LIN) y con IC y GC bajo (< 100% del LIN). Se utilizaron la U de Mann-Whitney para comparación de variables independientes y el test de Wilcoxon para variables apareadas, se consideró significativo p < 0,05. RESULTADOS: La muestra final fue de 36 casos, de 66 (8) años, 19 (52%) varones. En 17 (46%) detectamos IC con GC de 3,7 l/min (66%) frente al grupo sin IC con 7 l/min (107%). Tras VNI, los pacientes en IC mejoraron su GC (4,5 l/min [77%] p = 0,009) y no lo modificó el grupo sin IC: 6,8 l/min (104%), p = 0,2. CONCLUSIÓN: Un 46% de pacientes con SOH estable presenta IC. La VNI mejora su hemodinámica y no influye en los pacientes con GC conservado

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P < .05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P = .009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P = .2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO

Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation. / Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva.

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P<.05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.

Community-Acquired Moraxella catarrhalis Bacteremic Pneumonia: Two Case Reports and Review of the Literature.

Moraxella (formerly Branhamella) catarrhalis was discovered at the end of the nineteenth century, and for many decades it was considered to be a harmless commensal of the upper respiratory tract. It is a Gram-negative, aerobic diplococcus considered to be the third most common pathogen isolated in childhood sinusitis and otitis media and in adult chronic lower respiratory disease, as well as an etiological agent of pneumonia in immunosuppressed patients or those with chronic obstructive pulmonary disease. Moraxella catarrhalis pneumonia is rarely associated with bacteremia. Here, we present two cases of community-acquired Moraxella catarrhalis bacteremic pneumonia.

Community-acquired bacteremic Streptomyces atratus pneumonia in animmunocompetent adult: a case report.

INTRODUCTION: Streptomyces spp. are aerobic, Gram-positive bacteria of the order Actinomycetales, known for their ability to produce antimicrobial molecules such as streptomycin. Pneumonia due to Streptomyces is considered to be rare and limited to immunocompromised patients. Streptomyces spp. are only rarely associated with invasive systemic infections. To our knowledge, we report the first documented case of community-acquired Streptomyces atratus bacteremic pneumonia in an immunocompetent patient. CASE PRESENTATION: We describe a case of Streptomyces atratus bacteremic pneumonia in an otherwise healthy, 77-year-old Spanish man. Streptomyces identified by 16S ribosomal RNA sequencing grew in multiple blood cultures and bronchoalveolar lavage cultures. The infection resolved completely after treatment with imipenem and amoxicillin/clavulanic acid for 2 months. CONCLUSIONS: The majority of cases reported in the literature make reference to the difficulty of determining the pathogenic role of Streptomyces spp. Usually considered a contaminant, the pathogenic role of Streptomyces spp. is easier to confirm when the species is isolated from a catheter tip and, in the case of blood cultures, in more than one sample with a high count of colonies. To our knowledge, we report the first documented case of Streptomyces atratus bacteremic pneumonia in an immunocompetent patient. As the experience is limited, further studies are needed to better understand the interpretation of the isolates of the genus Streptomyces; the predisposing factors for infection; and the course, treatment, and evolution of these infections.

Air embolism: a complication of computed tomography-guided transthoracic needle biopsy.

Air embolism is a pathological condition caused by the entry of gas into vascular structures. It is a rare but feared complication due to its serious morbidity. We report two male patients who were diagnosed with air embolism as a complication of computed tomography-guided transthoracic needle biopsy. Both patients referred respiratory symptoms minutes after the procedure. The chest computed tomography of one of the patients showed air in the left ventricle and ascending aorta, and in the other, air was noted only in the left ventricle. Both patients suffered myocardial infarction without associated mortality. One patient showed anthracotic dust deposits in the lung biopsy suggestive of pneumoconiosis, and there was no definitive diagnosis in the other. We strongly believe that because of the very low incidence but high mortality of this entity, all physicians should be aware of this complication in order to know how to proceed in this situation.

Desmoplastic small round cell tumor of the lung: A case report and literature review.

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive and malignant tumor that is characterized by nests of small tumor cells surrounded by a cellular and vascular collagenous stroma and predominantly affects young adolescent males. This tumor most commonly originates in the abdomen; however, in rare cases, DSRCT can originate in other body regions. The main manifestations of DSRCT are chest pain and respiratory symptoms, and patients' average survival after diagnosis is less than two years. In this report, we describe a case involving DSRCT of the lung that proved to be difficult to diagnose, and we conduct a literature review.