Cocaine-Induced Asthma and the "Crack Lung": A Case Report.

Cocaine, the second most used illicit drug, is associated with cardiovascular, pulmonary, and other complications. Lung involvement associated with cocaine use, also known as "crack lung syndrome" (CLS), can elicit new-onset and exacerbate chronic pulmonary conditions. A 28-year-old female with a history of chronic controlled asthma arrived at the Emergency Department (ED), referring to cocaine inhalation, followed by symptoms compatible with an asthmatic crisis, requiring immediate steroid and bronchodilator therapy. Radiological studies and bronchoscopy confirmed CLS diagnosis. Despite treatment with oxygen, bronchodilators, and steroids, the asthmatic crises persisted. However, after 48 hours, we observed a complete regression of the lung infiltrates. This case highlights the importance of clinical suspicion, bronchoscopy findings, and the potential co-occurrence of CLS with asthma exacerbations. While computed tomography (CT) scans can be helpful, they should not be the only tool to diagnose CLS. The successful management of CLS involves the use of bronchodilators, steroids, and oxygen therapy and abstaining from cocaine use. Researchers should conduct further studies to diagnose and treat CLS in conjunction with acute asthma symptoms to assist this patient population better.

Gender differences in cardiology professionals: A Latin American Survey.

BACKGROUND: Gender-based differences among cardiology professionals have been reported in North America and Europe. However, the perspective of Latin American cardiologists remains unexplored. OBJECTIVES: The objectives of the study were to analyze the gender gap perspective among cardiologists from Latin America. METHODS: A cross-sectional study using an online survey directed to Latin American cardiologists from five different cardiology societies. The survey included questions on demographic data, professional development in the field of cardiology, and perceived barriers in clinical practice. RESULTS: A total of 240 professionals were surveyed, of which 41.7% were women (100) and 58.3% were men (140). The majority of women tend to work in the subfields of clinical cardiology and cardiovascular imaging. Women were underrepresented as heads of departments, earn less, and report less work satisfaction than men. The barriers that female cardiologists face at their workplace include labor discrimination, sexual harassment, family-related concerns, and lack of career development. CONCLUSIONS: The survey points toward the prevalence of a gender gap among cardiologists in Latin America, which is primarily driven by labor discrimination, sexual harassment, family-related concerns, and lack of career development among female cardiologists. Actions aimed at addressing this issue should be considered by different parties.

ANTECEDENTES: Existen diferencias de género entre los profesionales en cardiología en Europa y Norteamérica. La perspectiva de este suceso en América Latina permanece inexplorado. OBJECTIVOS: Analizar la perspectiva de la diferencia de género entre cardiólogos en América Latina. METODOS: Estudio transversal en el que se usó un cuestionario en línea dirigido a profesionales en cardiología en América Latina. El cuestionario incluía datos demográficos, desarrollo profesional en el campo de la campo de la cardiología y la percepción de las barreras en la práctica clínica. RESULTADOS: un total de 240 profesionales fueron analizados, de los cuales 41.7% (100) fueron mujeres y 58.3% (140) fueron hombres. La mayoría de las mujeres suelen trabajar en el área de imagen cardiovascular. Se encontró subrepresentación del género femenino en jefaturas de departamento, tienen un menor salario y reportan menor satisfacción laboral en comparación con los hombres. Las barreas que enfrentan en su lugar de trabajo fueron discriminación laboral, acoso sexual y falta de desarrollo profesional. CONCLUSIONES: El cuestionario señala la prevalencia de la diferencia de género en América Latina, principalmente por discriminación laboral, acoso sexual y falta de desarrollo profesional. Se necesita tomar acciones interinstitucionales que vayan dirigidas a reducir y eliminar esta brecha.

Alteration in the Lipid Profile and the Desaturases Activity in Patients With Severe Pneumonia by SARS-CoV-2.

The kidnapping of the lipid metabolism of the host's cells by severe acute respiratory syndrome (SARS-CoV-2) allows the virus to transform the cells into optimal machines for its assembly and replication. Here we evaluated changes in the fatty acid (FA) profile and the participation of the activity of the desaturases, in plasma of patients with severe pneumonia by SARS-CoV-2. We found that SARS-CoV-2 alters the FA metabolism in the cells of the host. Changes are characterized by variations in the desaturases that lead to a decrease in total fatty acid (TFA), phospholipids (PL) and non-esterified fatty acids (NEFAs). These alterations include a decrease in palmitic and stearic acids (p ≤ 0.009) which could be used for the formation of the viral membranes and for the reparation of the host's own membrane. There is also an increase in oleic acid (OA; p = 0.001) which could modulate the inflammatory process, the cytokine release, apoptosis, necrosis, oxidative stress (OS). An increase in linoleic acid (LA) in TFA (p = 0.03) and a decreased in PL (p = 0.001) was also present. They result from damage of the internal mitochondrial membrane. The arachidonic acid (AA) percentage was elevated (p = 0.02) in the TFA and this can be participated in the inflammatory process. EPA was decreased (p = 0.001) and this may decrease of pro-resolving mediators with increase in the inflammatory process. The total of NEFAs (p = 0.03), PL (p = 0.001), cholesterol, HDL and LDL were decreased, and triglycerides were increased in plasma of the COVID-19 patients. Therefore, SARS-CoV-2 alters the FA metabolism, the changes are characterized by alterations in the desaturases that lead to variations in the TFA, PL, and NEFAs profiles. These changes may favor the replication of the virus but, at the same time, they are part of the defense system provided by the host cell metabolism in its eagerness to repair damage caused by the virus to cell membranes.

Antioxidants and pentoxifylline as coadjuvant measures to standard therapy to improve prognosis of patients with pneumonia by COVID-19.

The type 2 coronavirus causes severe acute respiratory syndrome (SARS-CoV-2) and produces pneumonia with pulmonary alveolar collapse. In some cases it also causes sepsis and septic shock. There is no specific treatment for coronavirus disease 2019 (COVID-19). Vitamin C (Vit C), Vitamin E (Vit E), N-acetylcysteine (NAC) and Melatonin (MT) increase the intracellular content of GSH, kidnap free radicals and protect DNA, proteins in the cytosol and lipids in cell membranes. Pentoxifylline (Px) has anti-inflammatory activities. Here we evaluate the effect of Vit C, Vit E, NAC, and MT plus Px in COVID-19 patients with moderate and severe pneumonia. 110 patients of either sex were included. They were divided into five groups with 22 patients each. Group 1 received Vit C + Px, group 2 Vit E + Px, group 3 NAC + Px, group 4 MT + Px, and group 5 only Px. Oxidative stress (OS) markers such as lipid peroxidation (LPO) levels, total antioxidant capacity (TAC) and nitrites (NO2 -) were evaluated in plasma. The antioxidant therapy improved the survival scores including the Sequential Organ Failure Assessment (SOFA), the Acute Physiology and chronic Health Evaluation II (Apache II), the Simplified Acute Physiology Score II (SAPS II), the Critical Illness Risk Score, Launched during COVID-19 crisis (COVIDGRAM) and the Glasgow Coma Scale (GCS). We found that LPO (p≤0.04) and inflammation markers such as interleukin-6 (IL-6, p≤ 0.01), C reactive protein (CRP, p ≤ 0.01) and procalcitonin (PCT, p ≤ 0.05) were elevated. TAC (p ≤ 0.03) and NO2 - (p ≤ 0.04) found themselves diminished in diminished in COVID-19 patients upon admission to the hospital. The different antioxidants reversed this alteration at the end of the treatment. The treatment with antioxidant supplements such as Vit C, E, NAC, and MT plus Px could decelerate the aggressive and lethal development of COVID-19. Antioxidant therapy can be effective in this pandemia since it improves the survival scores including SOFA, Apache II, SAPS II, COVIDGRAM, GCS by lowering the LPO, IL-6, CRP, PCT and increasing systemic TAC and NO2 -.

A randomized controlled trial of lung ultrasound-guided therapy in heart failure (CLUSTER-HF study).

BACKGROUND: Lung ultrasound (LUS) has emerged as a new tool for the evaluation of congestion in heart failure (HF); incorporation of LUS during follow-up may detect congestion earlier and prompt interventions to prevent hospitalizations. The aim of this study was to test the hypothesis that the incorporation of LUS during follow-up of patients with HF may reduce the rate of adverse events compared with usual care. METHODS: In this single-blinded, randomized controlled trial, patients were randomized into an LUS-guided arm or control arm. Patients were followed in 4 prespecified visits during a 6-month period. LUS was performed in every patient visit in both groups; however, LUS results were available for the treating physician only in the LUS group. The primary outcome was the composite of urgent HF visits, rehospitalization for worsening HF, and death from any cause. RESULTS: One hundred twenty-six patients were randomized to either LUS (n = 63) or control (n = 63) (age 62.5 ±â€¯10 years, median left ventricular ejection fraction 31%). The primary end point occurred in 30 (47.6%) patients in the control group and 20 (31.7%) patients in the LUS group (P = .041). LUS-guided treatment was associated with a 45% risk reduction in the primary end point (hazard ratio 0.55, 95% CI 0.31-0.98, P = .044), mainly driven by a reduction in urgent HF visits (hazard ratio 0.28, 95% CI 0.13-0.62, P = .001). No significant differences in rehospitalizations for HF or death were found. CONCLUSIONS: Incorporation of LUS into clinical follow-up of patients with HF significantly reduced the risk of urgent visits for worsening HF.

Lung ultrasound in cardiology: realities and promises.

Lung ultrasound is an easily available, reproducible examination tool, both in ambulatory and critically-ill patients, which is used to evaluate congestion status and to differentiate the etiology of dyspnea. In this review, we explain lung ultrasound technique, acquisition protocols and their interpretation, as well as the evidence that shows its effectiveness among stable and critically-ill patients. Lung ultrasound should be used as an add-on to traditional physical examination in order to give an accurate diagnosis and a rapid treatment to patients with pulmonary congestion.

El ultrasonido pulmonar es una herramienta de fácil reproducibilidad en pacientes estables y críticos que se utiliza para valorar el estado de congestión y comprobar la causa de la disnea. En este texto se revisan los fundamentos de la ecografía pulmonar, los protocolos de adquisición y su interpretación, así como la evidencia que sustenta su uso en el paciente cardiovascular críticamente enfermo y en el paciente estable. Esta herramienta debe emplearse como complemento de la exploración física regular para poder instituir un tratamiento oportuno en los pacientes con congestión pulmonar.

El ultrasonido pulmonar en cardiología: realidades y promesas / Lung ultrasound in cardiology: realities and promises

Resumen El ultrasonido pulmonar es una herramienta de fícil reproducibilidad en pacientes estables y críticos que se utiliza para valorar el estado de congestón y comprobar la causa de la disnea. En este texto se revisan los fundamentos de la ecografía pulmonar, los protocolos de adquisición y su interpretación, así como la evidencia que sustenta su uso en el paciente cardiovascular críticamente enfermo y en el paciente estable. Esta herramienta debe emplearse como complemento de la exploración física regular para poder instituir un tratamiento oportuno en los pacientes con congestión pulmonar.

Abstract Lung ultrasound is an easily available, reproducible examination tool, both in ambulatory and critically-ill patients, which is used to evaluate congestion status and to differentiate the etiology of dyspnea. In this review, we explain lung ultrasound technique, acquisition protocols and their interpretation, as well as the evidence that shows its effectiveness among stable and critically-ill patients. Lung ultrasound should be used as an add-on to traditional physical examination in order to give an accurate diagnosis and a rapid treatment to patients with pulmonary congestion.