Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

INTRODUCTION: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. METHODS: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. INCLUSION CRITERIA: Adult ICU patients>18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48h. Statistical analysis was carried out using IBM-SPSS© 24 programme. RESULTS: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97g/kg/day (CI 0.95-0.99), P<0.001), and lower caloric intake than those who survived (12.94kcal/kg/day (CI 12.48-13.39) vs 16.47kcal/kg/day (CI 16.09-16.8), P<0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II>18. CONCLUSIONS: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

Introduction: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. Methods: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. Inclusion criteria: Adult ICU patients > 18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48 h. Statistical analysis was carried out using IBM-SPSS© 24 programme. Results: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97 g/kg/day (CI 0.95-0.99), P < 0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48-13.39) vs 16.47 kcal/kg/day (CI 16.09-16.8), P < 0.001).A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II > 18. Conclusions: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Introducción: En 2020, la pandemia provocada por el SARS-COV-2 demandó una enorme cantidad de recursos sanitarios para garantizar el tratamiento y apoyo adecuado a estos pacientes. Este estudio tiene como objetivo evaluar la ingesta de calorías/proteínas y evaluar sus asociaciones con resultados clínicos relevantes en pacientes críticamente enfermos con enfermedad por coronavirus (COVID-19). Métodos: Se realizó un estudio observacional prospectivo multicéntrico a nivel nacional que incluyó 12 unidades de cuidados intensivos (UCI) argentinas entre marzo y octubre de 2020. Criterios de inclusión: pacientes adultos de la UCI > 18 años ingresados en la UCI con diagnóstico de COVID-19 y ventilación mecánica durante al menos 48 h. El análisis estadístico se realizó mediante el programa IBM-SPSS© 24. Resultados: En el presente estudio se incluyeron 185 pacientes. Entre los que fallecieron se observó un aporte proteico más bajo (0,73 g/kg/día [intervalo de confianza {IC} del 95% 0,70-0,75] vs. 0,97 g/kg/día [IC 0,95-0,99], p < 0,001), y menor aporte calórico que los que sobrevivieron (12,94 kcal/kg/día [IC 12,48-13,39] vs. 16,47 kcal/kg/día [IC 16,09-16,8], p < 0,001).Se construyó un modelo de regresión logística para analizar qué factores estaban asociados con la probabilidad de lograr los objetivos calóricos/proteicos. Se observó una mayor probabilidad de lograr dichos objetivos cuando el inicio del soporte nutricional era precoz, el puntaje NUTRIC modificado era superior a 5 puntos y el paciente tenía diagnóstico de desnutrición mediante la Evaluación Global Subjetiva(B o C). Por otra parte, en los pacientes que necesitaron ventilación mecánica en decúbito prono se observó menor aporte calórico y proteico, situación similar en aquellos con APACHE II > 18. Conclusiones: Los pacientes críticos con insuficiencia respiratoria asociada a la enfermedad por COVID-19 que requerían ventilación mecánica y que fallecieron en la UCI tuvieron una ingesta calórica y proteica menor que los que sobrevivieron. El inicio temprano del soporte nutricional y la desnutrición aumentaron la posibilidad de alcanzar los objetivos calóricos y proteicos, mientras que la gravedad de la enfermedad y la ventilación mecánica en decúbito prono disminuyeron la posibilidad de alcanzar los objetivos calóricos y proteicos.

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19.

INTRODUCTION: Introduction: the COVID-19 pandemic put the world's population at risk. As the relationship between nutritional risk and clinical outcomes in critically ill patients with COVID-19 is still poorly understood, a multidisciplinary research team of the Argentine Society of Intensive Care (SATI) conducted a multicenter study aimed to define nutritional features, and to evaluate the relationship between nutritional risk and relevant clinical outcomes for COVID-19 patients in an intensive care unit (ICU). Methods: a multicenter, prospective, observational study including twelve Argentinian ICUs was conducted between March and October 2020. Inclusion criteria were: adult patients older than 18 years who were admitted to the ICU with a COVID-19 diagnosis were included. Clinical data included comorbidities scores, and nutritional screening tools such as the Subjective Global Assessment (SGA), the Nutritional Risk Screening (NRS) 2002, and the modified NUTRIC score (mNUTRIC SCORE) were used. In addition, clinical outcomes including overall mortality, mechanical ventilation (MV) days, and ICU and hospital length of stay (LOS) were recorded. Results: a total of 285 ICU patients met our inclusion criteria. Mean age was 61.24 (SD = 14.6) years; APACHE-II, 14.2 (SD = 6.6); Charlson Comorbidity Index (CCI), 2.3 (SD = 2.3). Most patients were admitted from the emergency room to the ICU. Hypertension, obesity, and diabetes were the most common comorbidities. Nutritional assessment showed that 36.9 % were SGA B+C, and 46 % were obese. Mean ICU LOS was 22.2 (SD = 19.5), and hospital LOS was 28.1 (SD = 21.9) days. Of all patients, 90.2 % underwent MV, and MV days were 20.6 (SD = 15.6). The univariate and multivariate analyses showed that risk factors for COVID-19 mortality were (odds ratio [95 % confidence interval]): SGA score of B or C: 2.13 [1.11-4.06], and NRS 2002 ≥ 3: 2.25 [1.01-5.01]. Conclusions: in the present study, nutritional status (SGA) and NRS 2002 were major mortality risk factors for CODIV-19 patients in the ICU.

INTRODUCCIÓN: Introducción: la pandemia de COVID-19 puso en riesgo a la población mundial. Dado que la relación entre el riesgo nutricional y los resultados clínicos en pacientes críticos con COVID-19 es aún poco conocida, un equipo de investigación multidisciplinario de la Sociedad Argentina de Cuidados Intensivos (SATI) realizó un estudio multicéntrico con el objetivo de definir las características nutricionales y evaluar la relación entre el riesgo nutricional y los resultados clínicos relevantes para los pacientes de la unidad de cuidados intensivos (UCI) de COVID-19. Métodos: entre marzo y octubre de 2020 se realizó un estudio observacional prospectivo y multicéntrico que incluyó 12 UCI argentinas. Criterios de inclusión: se incluyeron pacientes adultos mayores de 18 años que habían ingresado en la UCI con diagnóstico de COVID-19. Se utilizaron datos clínicos que incluían scores de comorbilidades, herramientas de cribado nutricional como la Evaluación Global Subjetiva (EGS) y el Cribado de Riesgo Nutricional (NRS) 2002, y la puntuación NUTRIC. Además. Se registraron los resultados clínicos, incluida la mortalidad, los días de ventilación mecánica (VM) y la duración de la estancia en la UCI y hospitalaria en general. Resultados: en total, 285 pacientes en UCI cumplieron nuestros criterios de inclusión. La edad media fue de 61,24 (DE = 14,6) años, la puntuación APACHE-II de 14,2 (DE = 6,6) y el índice de comorbilidad de Charlson (ICC) de 2,3 (DE = 2,3). La mayoría de los pacientes ingresaron desde la sala de emergencias a la UCI. La hipertensión, la obesidad y la diabetes fueron las comorbilidades más frecuentes. La evaluación nutricional mostró que el 36,9 % eran VGS B + C y el 46 % eran obesos. La estancia en la UCI fue de 22,2 (DE = 19,5) y la hospitalaria de 28,1 (DE = 21,9) días. El 90,2 % se sometieron a VM, siendo la media de días de VM de 20,6 (DE = 15,6). El análisis univariado y multivariado mostró que los factores de riesgo de mortalidad por COVID-19 eran (razón de posibilidades [intervalo de confianza del 95 %]): puntuación SGA de B o C: 2,13 [1,11-4,06], y NRS 2002 ≥ 3: 2,25 [1,01-5,01]. Conclusiones: en el presente estudio, el estado nutricional (EGS) y el NRS 2002 fueron los principales factores de riesgo de mortalidad para los pacientes con COVID-19 en la UCI.

SIMBIO-SYS/STC stereo camera calibration: Geometrical distortion.

The STereo imaging Channel (STC) is the first push-frame stereo camera on board an European Space Agency (ESA) satellite, i.e., the ESA-Japan Aerospace eXploration Agency mission BepiColombo. It was launched in October 2018, and it will reach its target, Mercury, in 2025. The STC main aim is to provide the global three-dimensional reconstruction of the Mercury surface. STC, the stereo channel of spectrometer and imagers for Mercury Planetary Orbiter BepiColombo-Integrated Observatory System, is based on an original optical design that incorporates the advantages of a compact unique detector instrument and the convenience of a double direction acquisition system. In fact, STC operates in a push-frame imaging mode and its two optical sub-channels will converge the incoming light on a single focal plane assembly allowing to minimize mass and volume. The focal plane of the instrument is housing six different filters: two panchromatic filters in the range 600-800 nm and four broadband filters with central wavelengths in the range 420-920 nm. In this paper, the geometrical calibration of the instrument, including the optical setups used, will be described. The methods used to derive the focal lengths, the boresights, and the reference systems of the different filter models are presented, and the related distortion results are discussed. The STC off-axis configuration forced to develop a distortion map model based on the RFM (rational function model). In contrast to other existing models, which allow linear estimates, the RFM is not referred to specific lens geometry, but it is sufficiently general to model a variety of distortion types, as it will be demonstrated in this particular case.

An open-label, randomized, placebo-controlled study on the effectiveness of a novel probiotics administration protocol (ProbiotiCKD) in patients with mild renal insufficiency (stage 3a of CKD).

PURPOSE: Gut dysbiosis has been described in advanced, but not in initial stages of CKD. Considering the relevant impact of gut dysbiosis on renal and cardiovascular risk, its diagnosis and treatment are clinically relevant. METHODS: We designed, open-label, placebo-controlled intervention study (ProbiotiCKD) to evaluate gut microbiota metabolism in a cohort of KDIGO CKD patients (n = 28) at baseline and after a randomly assigned treatment with probiotics or placebo. Gut microbiota status was evaluated on:. RESULTS: Basal mean fecal Lactobacillales and Bifidobacteria concentrations were abnormally low in both groups, while urinary indican and 3-MI levels were, indicating a mixed (fermentative and putrefactive) dysbiosis. After treatment, mean fecal Lactobacillales and Bifidobacteria concentrations were increased, only in the probiotics group (p < 0.001). Conversely, mean urinary indican and 3-MI levels only in the group treated with probiotics (p < 0.001). Compared to placebo group, significant improvements of C-reactive protein (p < 0.001), iron (p < 0.001), ferritin (p < 0.001), transferrin saturation (p < 0.001), ß2-microglobulin (p < 0.001), serum iPTH and serum calcium were observed only in the probiotics group. CONCLUSIONS: ProbiotiCKD is the first intervention study demonstrating that an intestinal mixed dysbiosis is present even in early CKD stage and can be effectively corrected by the novel mode of administration of high-quality probiotics with improvement of inflammatory indices, iron status and iPTH stabilization.

Correction to: An open-label, randomized, placebo-controlled study on the effectiveness of a novel probiotics administration protocol (ProbiotiCKD) in patients with mild renal insufficiency (stage 3a of CKD).

In the original publication of the article, few of the authors were missed in the author group.

[A cause of acute renal dysfunction: a giant bladder diverticulum].

We describe the case of a previously 77-year-old man who accessed in our Nephrology Unit for acute kidney injury (AKI) on chronic kidney disease (CKD), gastric discomfort and vague urinary symptoms with apparently preserved diuresis and suspected "ascites". Physical examination confirmed the presence of abdominal effusion, even though ultrasound abdominal examination revealed the presence of a giant diverticular urinary bladder with bilateral hydronephrosis. We discuss the diagnostic and therapeutic approach of these rare complications by briefly reviewing the technical aspects and the possible consequences.

Nature, formation, and distribution of carbonates on Ceres.

Different carbonates have been detected on Ceres, and their abundance and spatial distribution have been mapped using a visible and infrared mapping spectrometer (VIR), the Dawn imaging spectrometer. Carbonates are abundant and ubiquitous across the surface, but variations in the strength and position of infrared spectral absorptions indicate variations in the composition and amount of these minerals. Mg-Ca carbonates are detected all over the surface, but localized areas show Na carbonates, such as natrite (Na2CO3) and hydrated Na carbonates (for example, Na2CO3·H2O). Their geological settings and accessory NH4-bearing phases suggest the upwelling, excavation, and exposure of salts formed from Na-CO3-NH4-Cl brine solutions at multiple locations across the planet. The presence of the hydrated carbonates indicates that their formation/exposure on Ceres' surface is geologically recent and dehydration to the anhydrous form (Na2CO3) is ongoing, implying a still-evolving body.

Variations in the amount of water ice on Ceres' surface suggest a seasonal water cycle.

The dwarf planet Ceres is known to host a considerable amount of water in its interior, and areas of water ice were detected by the Dawn spacecraft on its surface. Moreover, sporadic water and hydroxyl emissions have been observed from space telescopes. We report the detection of water ice in a mid-latitude crater and its unexpected variation with time. The Dawn spectrometer data show a change of water ice signatures over a period of 6 months, which is well modeled as ~2-km2 increase of water ice. The observed increase, coupled with Ceres' orbital parameters, points to an ongoing process that seems correlated with solar flux. The reported variation on Ceres' surface indicates that this body is chemically and physically active at the present time.

Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients.

RATIONAL: Our aim was to investigate the quality of life (QoL) in 103 patients undergoing chronic hemodialysis (HD) in an integrated assessment of clinical, personological, and adaptation parameters, also in a non-urban context. OBJECTIVES: We collected data from all chronic HD patients attending four HD units. Clinical status was assessed by Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and by Age-adjusted Charlson Comorbidity Index (ACCI). Patients completed the following questionnaires: Kidney Disease Quality of Life Short Form (KDQOL-SF), Pittsburgh Sleep Quality Index (PSQI). Personality profile and coping style were assessed by Temperament and Character Inventory (TCI) revised and Coping Inventory for Stressful Situation (CISS). Data were analyzed by conventional descriptive statistics. Multiple forward stepwise linear regression analyses were performed. MAIN FINDINGS: Variables significantly associated with physical and mental components of KDQOL-SF were: intact parathyroid hormone (iPTH) (p = .004; p = .0015), typology of cohabitant (family member or not) (p = .022; p = .007), years of dialysis (p = .022; p = .048). Variables associated with mental component of KDQOL-SF were: PSQI (p = .000), task-coping (p = .000), avoidance-coping (p = .003), work status (p = .021). Principle conclusions: Our results suggest the importance of an integrated and multidirectional management of patients chronically undergoing HD and living in a non-urban context.

AstRoMap European Astrobiology Roadmap.

The European AstRoMap project (supported by the European Commission Seventh Framework Programme) surveyed the state of the art of astrobiology in Europe and beyond and produced the first European roadmap for astrobiology research. In the context of this roadmap, astrobiology is understood as the study of the origin, evolution, and distribution of life in the context of cosmic evolution; this includes habitability in the Solar System and beyond. The AstRoMap Roadmap identifies five research topics, specifies several key scientific objectives for each topic, and suggests ways to achieve all the objectives. The five AstRoMap Research Topics are • Research Topic 1: Origin and Evolution of Planetary Systems • Research Topic 2: Origins of Organic Compounds in Space • Research Topic 3: Rock-Water-Carbon Interactions, Organic Synthesis on Earth, and Steps to Life • Research Topic 4: Life and Habitability • Research Topic 5: Biosignatures as Facilitating Life Detection It is strongly recommended that steps be taken towards the definition and implementation of a European Astrobiology Platform (or Institute) to streamline and optimize the scientific return by using a coordinated infrastructure and funding system.

Leucoencefalopatía multifocal progresiva (LMP) con cd4 > 200 mm3 / Progressive multifocal leukoencephalopathy (PML) with cd4> 200 mm3

Introducción: La LMP es una enfermedad causada por el virus JC.Afecta la sustancia encefálica provocando desmielinización progresiva. La infección se produce en la infancia y es en general asintomática. En condiciones de inmunosupresión, adquiere potencial neuropatógeno destruyendo los oligodendrocitos. Generalmente se presenta en pacientes bajo tratamiento QMT o personas HIV + CD4<100 mm3. Objetivos:presentación de un caso clínico y revisión bibliográfica. Reporte de caso: Paciente de 37 años, con diagnóstico reciente HIV, en tratamiento con antirretrovirales, inicia cuadro clínico com impotencia funcional en miembro inferior izquierdo. En un mes, el paciente evolucionó con progresión del foco neurológico,desarrollando plejía FBC izquierda + plejía crural derecha, disartria, trastornos deglutorios, desorientación culminando finalmente condeterioro del sensorio. El paciente fallece a los dos meses derealizado el diagnóstico.Discusión: El diagnóstico de LMP debe plantearse ante um paciente inmunodeprimido, que presenta un cuadro de deterioro cognitivo o déficit neurológico de curso progresivo. La mayoría delos casos ocurre en HIV + con recuento de CD4 muy bajos. Aunque no existe tratamiento específico para LMP, las terapias antirretrovirales de alta potencia (HAART) parecen influir en la supervivência.

Introduction: PML is a disease caused by the JC virus. It affects the brain substance causing progressive demyelination. The infection occurs in childhood and is generally asymptomatic. Under conditions of immunosuppression, acquired destroying oligodendrocytes neuropathogenic potential. It usually occurs in patients receiving QMT or HIV + CD4 <100 mm3. Objectives: clinical case report and literature review. Case report: Patient 35 years old, with newly diagnosed HIV in antiretroviral therapy, clinical starts with loss of function of the left lower limb. In one month, the patient developed focal neurologic progression, developing hemiplegia FBC crural left + right crural pegia, dysarthria, swallowing disorders, disorientation, culminating with sensory impairment. The patient died two months after the diagnosis. Discussion: The diagnosis of PML should be raised in an immunocompromised patient, presented symptoms of cognitive decline or neurological deficits progressive course. Most cases occur in HIV + with very low CD4 count. Although there is no specific treatment for PML, antiretroviral.

Coupled plasma filtration adsorption for the treatment of a patient with acute respiratory distress syndrome and acute kidney injury: a case report.

Coupled plasma filtration adsorption (CPFA) is an extracorporeal blood purification therapy based on non-specific pro- and anti-inflammatory mediator adsorption on a special resin cartridge coupled with continuous veno-venous haemofiltration or continuous veno-venous haemodiafiltration and is one of the emerging treatments for septic patients. However, in the literature, there are limited data about its efficacy in treating patients with acute diseases but without the traditional criteria for sepsis. We describe the case of a 43-year-old male who developed acute respiratory distress syndrome secondary to pneumonia and acute kidney injury, whose clinical conditions rapidly improved after early CPFA therapy.

Los desgarros del manguito rotador en atletas / Rotator cuff injuries in athletes

La patología del hombro en deportistas de uso dominante del miembro superior son tan habituales como problemáticas, y las lesiones del manguito rotador, especialmente del supraespinoso son las más frecuentes, abarcando desde tendinopatías, desgarros parciales y desgarros completos. Los factores predisponentes en general son la inadecuada utilización del hombro junto con disbalances musculares sometidos a microtraumas o macrotraumas, y en deportistas de mediana edad se agrega el estado degenerativo del manguito rotador. En este trabajo se abordan estas lesiones para comprender su fisiopatología, cuadro clínico, estudios complementarios, y las opciones de tratamiento.

Los desgarros del manguito rotador en atletas / Rotator cuff injuries in athletes

La patología del hombro en deportistas de uso dominante del miembro superior son tan habituales como problemáticas, y las lesiones del manguito rotador, especialmente del supraespinoso son las más frecuentes, abarcando desde tendinopatías, desgarros parciales y desgarros completos. Los factores predisponentes en general son la inadecuada utilización del hombro junto con disbalances musculares sometidos a microtraumas o macrotraumas, y en deportistas de mediana edad se agrega el estado degenerativo del manguito rotador. En este trabajo se abordan estas lesiones para comprender su fisiopatología, cuadro clínico, estudios complementarios, y las opciones de tratamiento.

[Relationship between Hoover sign, functional and variables, and curvature radius in patients with obstructive pulmonary disease]. / Análisis del signo de Hoover en relación con parametros funcionales, radiologicos y de radio de curvatura en pacientes con enfermedad pulmonar obstructiva crónica.

The purpose of the present study was: 1) to relate the Hoover sign -SH (+)- with several functional (spirometry and lung volumes) and radiographic (AP x-ray) parameters, 2) to characterize the changes in diaphragmatic curvature radius and the efficiency and to establish some relationships with the functional and radiographic parameters. Fifteen patients with COPD (SH (+), n: 8) were studied. The radius was determined in the right hemidiaphragm after maximal inspired and expired x-ray. The SH (+) was found in more severely obstructed patients (FEV1%, p 0.005%) and with high degree of air trapping (RV/TLC %, p 0.01). The expiratory radius (Re) was higher (p 0.05), and their efficiency (1/Re), was minor (p 0.05). The FEV1% correlated with the degree of hyperinflation according to TLC % (r -0.58, p 0.022) and with air trapping according to RV % (r -0.77, p 0.0008). The patients with low FEV1% showed high Re (r -0.61, p 0.015) and decreased diaphragmatic efficiency during expiration (1/Re) according to 1/Re = 0.093 cm-1 + 0.0012 cm-1* FEV1% (r 0.688, p 0.0054). The FEV1 correlated with the diaphragmatic movement (r 0.71, p 0.003). The PaCO2 correlated with the TLC % (r 0.534, p 0.04), the RV% (r 0.62, p 0.014) and with the radiographic parameters of hyperinflation (r 0.546, p 0.035) and air trapping (r 0.528, p 0.043). The presence of Hoover sign suggest severe bronchial obstruction, diaphragmatic flattening, increase of curvature radius, decrease of mobility and efficiency.

Analisis del signo de Hoover en relacion con parametros funcionales, radiologicos y de radio de curvatura en pacientes con enfermedad pulmonar obstrutiva cronica / Relationship between Hoover's sign, functional and variables, and curvature radius in patients with obstrutive pulmonary disease

El propósito de presente trabajo fue: 1) relacionar el signo de Hoover SH (+) con diversos paráme tros funcionales (espirometría y volúmenes pulmonares) y radiológicos (radiografias posteroan teriores), 2) caracterizar los cambios en el radio de curvatura y Ia eficiencia dei diafragma, y restablecer relaciones con los parámetros funcionales y radiológicos. Se estudiaron 15 pacientes con EPOC (SH (+), n: 8). El radio de curvatura fue determinado en el hemidiafragma derecho en inspiración y espiración máximas. Los SH(+) se hallaron más severamente obstruidos (VEF1%, p 0.005%) y con mayor atrapamiento aéreo (VR/CPT %, p 0.01). EI radio espiratorio (Re) fue mayor (p 0.05), y su eficiencia (1/Re), fue menor (p 0.05). El VEF1 % correlacionó con el grado de hiperinflación según CPT % (r 0.58, p 0.022) y con el atrapamiento aéreo según VR% (r 0.77, p 0.0008). Los pacientes con menor VEF1% presentaron un Re mayor (r 0. 61, p 0.015) y menor eficiencia diafragmática en spiración (1/Re) de acuerdo a: 1/Re = 0.093 cm ' + 0.0012 cm ' * VEF1 % (r 0.688, p 0.0054). El VEF1 correlacionó con Ia movilidad diafragmática (r 0.71, p 0.003). La PaC02 correlacionó con Ia CPT % (r 0.534, p 0.04), con el VR (r 0.62, p 0.014) y con los parámetros radiológicos de hiperinflación (r 0.546, p 0.035) y atrapamìento aéreo (r 0.528, p 0.043). El SH(+) sugiere obstrucción bronquial severa, aplanamìento dei diafragma, consiguiente aumento dei radio de curvatura, menor movilidad y menor eficiencia.

Análisis del signo de Hoover en relación con parametros funcionales, radiologicos y de radio de curvatura en pacientes con enfermedad pulmonar obstructiva crónica / [Relationship between Hoover sign, functional and variables, and curvature radius in patients with obstructive pulmonary disease]

The purpose of the present study was: 1) to relate the Hoover sign -SH (+)- with several functional (spirometry and lung volumes) and radiographic (AP x-ray) parameters, 2) to characterize the changes in diaphragmatic curvature radius and the efficiency and to establish some relationships with the functional and radiographic parameters. Fifteen patients with COPD (SH (+), n: 8) were studied. The radius was determined in the right hemidiaphragm after maximal inspired and expired x-ray. The SH (+) was found in more severely obstructed patients (FEV1

) and with high degree of air trapping (RV/TLC

, p 0.01). The expiratory radius (Re) was higher (p 0.05), and their efficiency (1/Re), was minor (p 0.05). The FEV1

correlated with the degree of hyperinflation according to TLC

(r -0.58, p 0.022) and with air trapping according to RV

(r -0.77, p 0.0008). The patients with low FEV1

showed high Re (r -0.61, p 0.015) and decreased diaphragmatic efficiency during expiration (1/Re) according to 1/Re = 0.093 cm-1 + 0.0012 cm-1* FEV1

(r 0.688, p 0.0054). The FEV1 correlated with the diaphragmatic movement (r 0.71, p 0.003). The PaCO2 correlated with the TLC

(r 0.534, p 0.04), the RV

(r 0.62, p 0.014) and with the radiographic parameters of hyperinflation (r 0.546, p 0.035) and air trapping (r 0.528, p 0.043). The presence of Hoover sign suggest severe bronchial obstruction, diaphragmatic flattening, increase of curvature radius, decrease of mobility and efficiency.

Análisis del signo de Hoover en relación con parametros funcionales, radiologicos y de radio de curvatura en pacientes con enfermedad pulmonar obstructiva crónica. / [Relationship between Hoover sign, functional and variables, and curvature radius in patients with obstructive pulmonary disease]

The purpose of the present study was: 1) to relate the Hoover sign -SH (+)- with several functional (spirometry and lung volumes) and radiographic (AP x-ray) parameters, 2) to characterize the changes in diaphragmatic curvature radius and the efficiency and to establish some relationships with the functional and radiographic parameters. Fifteen patients with COPD (SH (+), n: 8) were studied. The radius was determined in the right hemidiaphragm after maximal inspired and expired x-ray. The SH (+) was found in more severely obstructed patients (FEV1

, p 0.005

) and with high degree of air trapping (RV/TLC

, p 0.01). The expiratory radius (Re) was higher (p 0.05), and their efficiency (1/Re), was minor (p 0.05). The FEV1

correlated with the degree of hyperinflation according to TLC

(r -0.58, p 0.022) and with air trapping according to RV

(r -0.77, p 0.0008). The patients with low FEV1

showed high Re (r -0.61, p 0.015) and decreased diaphragmatic efficiency during expiration (1/Re) according to 1/Re = 0.093 cm-1 + 0.0012 cm-1* FEV1

(r 0.688, p 0.0054). The FEV1 correlated with the diaphragmatic movement (r 0.71, p 0.003). The PaCO2 correlated with the TLC

(r 0.534, p 0.04), the RV

(r 0.62, p 0.014) and with the radiographic parameters of hyperinflation (r 0.546, p 0.035) and air trapping (r 0.528, p 0.043). The presence of Hoover sign suggest severe bronchial obstruction, diaphragmatic flattening, increase of curvature radius, decrease of mobility and efficiency.