The behavior of arsenic accumulation in onion (Allium cepa) structures by irrigation water: effect of phosphates and arsenic on the total bioactive compounds and antioxidant capacity.

The presence of arsenic (As) in irrigation water is a threat to agricultural crops as well as human health. The presence of arsenic and phosphorous in irrigation water influences the behavior of bioaccumulation, biotransfer, and total bioactive compounds in the distinct parts of the onion structure. The present work evaluates the behavior of the bioaccumulation and biotransfer of As in the structures of onion (Allium cepa) through a composite central design and response surface method. The factors employed include the concentration of arsenic (V) and phosphate (V) in the nutritive solution. Additionally, this study analyzes the behavior of the effect that the induced stress has on the total bioactive compounds (phenols and flavonoids) and antioxidant capacity (ABTS and DPPH) in the onion roots. The results showed that the physiological properties, bioaccumulation factors, As transference, and the total bioactive compounds in the onion structure are affected by the competition of As and phosphates (P(V)) in the irrigation water. For concentrations of As and phosphorous of 450 µg L-1 and 0.30 mg L-1 respectively in irrigation water, there are negative effects on the equatorial diameter of the bulb (DE), length, weight of the leaf, and weight of the bulb. Besides, the transference and bioaccumulation factors range from 0.02 to 0.22 and from 2.15 to 7.81, respectively, suggesting that the plant has the ability to accumulate As but exhibits a low translocation ability of As from the root to aerial organs. Besides, it is found for central concentrations of As and phosphorous (450 µg L-1 and 0.30 mg L-1, respectively) in irrigation water, a greater production occurs in total phenolic compounds and antioxidant capacity (ABTS and DPPH) as a response to the stress generated by As.

Synthesis of Composites for the Removal of F- Anions.

This work presents the synthesis of amine and ferrihydrite functionalized graphene oxide for the removal of fluoride from water. The synthesis of the graphene oxide and the modified with amine groups is developed by following the modified Hummer's method. Fourier transform infrared spectrometry, X-ray, Raman spectroscopy, thermogravimetric analysis, surface charge distribution, specific surface area and porosity, adsorption isotherms, and the van't Hoff equation are used for the characterization of the synthesized materials. Results show that the addition of amines with ferrihydrite generates wrinkles on the surface layers, suggesting a successful incorporation of nitrogen onto the graphene oxide; and as a consequence, the adsorption capacity per unit area of the materials is increased.

Diferencia de edad entre cónyuges por nivel educativo en América Latina. El caso de Bolivia, Ecuador y Uruguay / Diferença de idade entre cônjuges por nível de escolaridade na América Latina. O caso de Bolívia, Equador e Uruguai / Spousal age difference by education in Latin America. The case of Bolivia, Ecuador and Uruguay

Resumen El objetivo del estudio es hacer un análisis descriptivo de la asociación entre la educación y la diferencia de edad entre los cónyuges en uniones de distinto sexo y conocer cómo ha evolucionado esta relación a lo largo de las cohortes en las últimas décadas a la luz del incremento del nivel educativo de la población en América Latina, en particular de las mujeres. Se hizo un análisis descriptivo utilizando muestras de rondas censales desde 1970 hasta 2010 de tres países de la región, Bolivia, Ecuador y Uruguay, seleccionando a hombres y a mujeres de 25 a 29 años de edad. Tanto en hombres como en mujeres, no se observa en general un descenso significativo de la diferencia etaria a lo largo de las cohortes. Mientras en las mujeres se observó una relación negativa entre la diferencia etaria entre cónyuges y nivel educativo, en los hombres se constató mayor heterogeneidad entre los países.

Resumo O objetivo do estudo é realizar uma análise descritiva da associação entre escolaridade e diferença de idade entre cônjuges em uniões de diferente sexo e como essa relação evoluiu ao longo das coortes nas últimas décadas em função do aumento da escolaridade da população da América Latina, especialmente para as mulheres. Foram utilizadas amostras de rodadas dos censos de 1970 a 2010 de três países da região − Bolívia, Equador e Uruguai −, selecionando homens e mulheres de 25 a 29 anos de idade. Para o total da amostra, não foi observada diminuição significativa na diferença de idade ao longo das coortes. Para as mulheres, verificou--se relação negativa entre a diferença de idade entre os cônjuges e a escolaridade. Para os homens, observou-se maior heterogeneidade entre os países.

Abstract The purpose of this study is to investigate the association between education and the age gap between spouses in heterosexual unions. The study also examines how this association has changed over time in different cohorts, especially among women, in the context of educational expansion in Latin America. The research used the data collected from census rounds conducted between 1970 and 2010 in Bolivia, Ecuador, and Uruguay. The sample included men and women aged between 25 to 29. The findings reveal that there was no significant decrease in the age difference throughout the cohorts for both men and women. However, a negative relationship was observed between the spousal age difference and educational level in women. On the other hand, men showed greater heterogeneity between countries.

A 16th century artificial reservoir under human pressure: water quality variability assessment in Laguna de Yuriria, central Mexico.

This study assesses the variability of physicochemical and biochemical parameters, identifies principal pollutant sources, and characterizes water quality in Yuriria reservoir using water quality indexes in combination with multivariate statistical techniques. In situ parameters were measured in 55 reservoir sites including surface and deep points and in 7 associated channels. Moreover, major compounds and biochemical data were determined. Yuriria reservoir had alkaline, bicarbonate-mixed waters, with total dissolved solids (TDS) of 393.83 ± 3.43 mg L-1. Water quality index (WQI) indicated a good class for agricultural irrigation but very poor and poor classes for preservation of aquatic life. The nutrient inputs and the internal nitrogen recycling triggered a hypereutrophic status in the reservoir. The decomposition of residual biomass from aquatic macrophytes contributed to reduce dissolved oxygen (DO) in the hypolimnetic waters (mean DO = 3.86 mg L-1). Statistical analysis revealed that the study area is highly exposed to anthropogenic stress and in a lesser extent to natural processes. Urban and agriculture runoff enhanced the salinization and the generation of solid particles which deteriorated water quality. Chemical oxygen demand (COD), biochemical oxygen demand (BOD), and NO3--N presented a common anthropogenic origin by external (point and diffuse) and internal pollution sources, while a diffuse source (agricultural activities) was reveled for phosphorus. This study is important to be used in systematic monitoring and sustainable co-management programs and for formulating the necessary strategies to remediate the Yuriria reservoir water quality and extrapolate to other reservoirs worldwide.

Graphene-Based Adsorbents for Arsenic, Fluoride, and Chromium Adsorption: Synthesis Methods Review.

Water contamination around the world is an increasing problem due to the presence of contaminants such as arsenic, fluoride, and chromium. The presence of such contaminants is related to either natural or anthropogenic processes. The above-mentioned problem has motivated the search for strategies to explore and develop technologies to remove these contaminants in water. Adsorption is a common process employed for such proposals due to its versatility, high adsorption capacity, and lower cost. In particular, graphene oxide is a material that is of special interest due to its physical and chemical properties such as surface area, porosity, pore size as well as removal efficiency for several contaminants. This review shows the advances, development, and perspectives of materials based on GO employed for the adsorption of contaminants such as arsenite, arsenate, fluoride, and hexavalent chromium. We provided a detailed discussion of the synthesis techniques and their relationship with the adsorption capacities and other physical properties as well as pH ranges employed to remove the contaminants. It is concluded that the adsorption capacity is not proportional to the surface area in all the cases; instead, the synthesis method, as well as the functional groups, play an important role. In particular, the sol-gel synthesis method shows better adsorption capacities.

Spatio-temporal groundwater arsenic distribution in Central Mexico: implications in accumulation of arsenic in barley (Hordeum vulgare L.) agrosystem.

In the present work, a spatio-temporal study of arsenic (As) concentration in groundwater and its impact in barley uptake is presented. The impact of As on barley is studied through the determination of its bioaccumulation in the soil-plant system, As uptake, as well as a correlation between As concentration in water and its temperature in the groundwater. For the groundwater, spatial and temporal variability of As concentration in central Mexico was determined through a geostatistical analysis using ordinary kriging. The results show that the variability of As in the ground water is correlated with its temperature (R2 > 0.83). The As accumulation in the structures of plant follows the order root > leaf > ear in concentration. The bioaccumulation factor BAFT suggests that As is mobilized to the aerial parts of the barely for both As concentrations used in the irrigation water. However, for As concentration lower than 25 µg L-1, the BAFT is lower than 0.57, suggesting that the amount of As in root is the same as that contained in the aerial parts; whereas, for higher As concentrations (from 170 to 250 µg L-1), the BAFT is around 0.92, indicating that the As is mainly contained in root. The spatial distribution of As concentration trend in groundwaters along the time is the same, which means high As concentration areas remain in the same groundwaters and these areas are presenting the highest water temperature. These results shall contribute to understand the bioaccumulation of As in barley and the As spatial variability in central Mexico.

Microbiomes in agricultural and mining soils contaminated with arsenic in Guanajuato, Mexico.

In this report, physical and chemical properties, and total arsenic (As) concentrations were analyzed in agricultural (MASE) and mining soils (SMI) in the State of Guanajuato, México. Additionally, a metagenomic analysis of both types of soils was the bases for the identification and selection of bacteria and fungi resistant to As. The SMI soil showed higher concentration of As (39 mg kg-1) as compared to MASE soil (15 mg kg-1). The metagenome showed a total of 175,240 reads from both soils. MASE soil showed higher diversity of bacteria, while the SMI soil showed higher diversity of fungi. 16S rRNA analysis showed that the phylum Proteobacteria showed the highest proportion (39.6% in MASE and 36.4% in SMI) and Acidobacteria was the second most representative (24.2% in SMI and 11.6% in MASE). 18S rRNA analysis, showed that the phylum Glomeromycota was found only in the SMI soils (11.6%), while Ascomycota was the most abundant, followed by Basidiomycota, and Zygomycota, in both soils. Genera Bacillus and Penicillium were able to grow in As concentrations as high as 5 and 10 mM, reduced As (V) to As (III), and removed As at 9.8% and 12.1% rates, respectively. When aoxB, arsB, ACR3(1), ACR3(2,) and arrA genes were explored, only the arsB gene was identified in Bacillus sp., B. simplex, and B. megaterium. In general, SMI soils showed more microorganisms resistant to As than MASE soils. Bacteria and fungi selected in this work may show potential to be used as bioremediation agents in As contaminated soils.

[Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema]. / Volúmenes pulmonares normales en pacientes con fibrosis pulmonar idiopática y enfisema.

Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. Previous reports suggest that when both diseases coexist, pulmonary volumes are compensated and a smaller than expected reduction or even normal lung volumes can be found. We report 4 male patients of 64, 60, 73 and 70 years, all with heavy cigarette smoking history and progressive breathlessness. Three of them had severe limitation in their quality of life. All four showed advanced lung interstitial involvement, at high resolution CT scan, fibrotic changes predominantly in the subpleural areas of lower lung fields and concomitant emphysema in the upper lobes. Emphysema and pulmonary fibrosis was confirmed by open lung biopsy in one patient. The four patients showed normal spirometry and lung volumes with severe compromise of gas exchange and poor exercise tolerance evaluated by 6 minute walk test. Severe pulmonary arterial hypertension was also confirmed in three patients. Normal lung volumes does not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.

Volúmenes pulmonares normales en pacientes con fibrosis pulmonar idiopática y enfisema / Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema

La fibrosis pulmonar idiopática (FPI) es una enfermedad que se caracteriza por presentar un compromiso pulmonar de tipo restrictivo, resultante de una reducción en la complacencia pulmonar secundaria a fibrosis difusa. En el enfisema, la pérdida de elasticidad pulmonar y el colapso de las vías aéreas periféricas generan obstrucción e hiperinflación. El efecto simultáneo que ambas enfermedades producen sobre la fisiología pulmonar no es del todo claro y se han descripto volúmenes pulmonares normales o casi normales. Presentamos 4 pacientes de sexo masculino de 64, 60, 73 y 70 años, con antecedentes de tabaquismo e historia de disnea progresiva, tres de ellos con grave limitación en su calidad de vida al momento de la consulta. En la tomografía de tórax de alta resolución todos los pacientes presentaban signos de enfermedad intersticial pulmonar avanzada, con cambios de tipo fibrótico con predominio basal y subpleural, que coexistían con enfisema centroacinar con predominio en lóbulos superiores. Uno de ellos tuvo confirmación diagnóstica de ambas condicioes por biopsia pulmonar a cielo abierto. En los cuatro pacientes la espirometría y volúmenes pulmonares fueron normales, pero tenían importante compromiso del intercambio gaseoso evaluado mediante el test de caminata de 6 minutos. Tres de los pacientes tenían hipertensión pulmonar grave diagnosticado por ecocardiograma. La presencia de volúmenes pulmonares normales no excluye un diagnóstico de fibrosis pulmonar idiopática en pacientes fumadores si coexisten evidencias tomográficas de enfisema. En estos pacientes el grado de compromiso funcional, determinado por la reducción de los volúmenes pulmonares, no debería ser considerado en la evaluación de la gravedad.

Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. Previous reports suggest that when both diseases coexist, pulmonary volumes are compensated and a smaller than expected reduction or even normal lung volumes can be found. We report 4 male patients of 64, 60, 73 and 70 years, all with heavy cigarette smoking history and progressive breathlessness. Three of them had severe limitation in their quality of life. All four showed advanced lung interstitial involvement, at high resolution CT scan, fibrotic changes predominantly in the subpleural areas of lower lung fields and concomitant emphysema in the upper lobes. Emphysema and pulmonary fibrosis was confirmed by open lung biopsy in one patient. The four patients showed normal spirometry and lung volumes with severe compromise of gas exchange and poor exercise tolerance evaluated by 6 minute walk test. Severe pulmonary arterial hypertension was also confirmed in three patients. Normal lung volumes does not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.

[Lung volume reduction surgery for emphysema. Long term results]. / Cirugía de reducción de volumen pulmonar en enfisema. Resultados alejados.

We prospectively analyzed 19 patients submitted to lung volume reduction surgery (LVRS). Mean age 54 years. Fourteen patients, with predominant emphysema of upper lobes, were approached through a median sternotomy. Five patients with predominant lower lobes lesions, were approached through a bilateral anterolateral thoracotomy. Surgery consisted in resection of 20 to 30% of lung volume corresponding to areas of severe parenchymal destruction by stapling suture additioned with bovine pericardium. Changes in lung function and physical performance were evaluated by FEV1, FVC and RV, 6 minutes walk test and dyspnea index according to Medical Research Council at 3, 12, 24, 36 and 48 months. Variance analysis with correction of Bonferroni was performed. One patient died of acute myocardial infarction. There was a significant average improvement in all parameters measured at 3, 12, 24 and 36 months with regard to preoperative values. Comparing the preoperative and 3 months values, there was an increment in FEV1 from 0.94 +/- 0.37 (31% of predicted) to 1.35 +/- 0.40 L (45%) (p < 0.05), in FVC from 2.24 +/- 0.69 (54%) to 3.05 +/- 0.80 L (75%) (p < 0.05) and in 6 minutes walk test from 395 +/- 66 to 517 +/- 50 mts (p < 0.001). There was also a decrease in the RV of 4.78 +/- 1.14 L (284%) to 3 +/- 0.68 L (180%) (p < 0.001) and in dyspnea index of 3.34 +/- 0.82 to 0.53 +/- 0.53 (p < 0.001). The percentage of average increment in FEV1 was 53% at 3 months (n = 18), 72% at 12 months (n = 13), 58% at 24 months (n = 10), 53% at 36 months (n = 6) and 60% at 48 months (n = 3). LVRS can be performed with acceptable morbidity and mortality in highly selected emphysematous patients. Decrease of dyspnea and improvement in physical performance reach a maximum between 3 and 12 months and may remain so after four years.

Cirugía de reducción de volumen pulmonar en enfisema. Resultados alejados / [Lung volume reduction surgery for emphysema. Long term results]

We prospectively analyzed 19 patients submitted to lung volume reduction surgery (LVRS). Mean age 54 years. Fourteen patients, with predominant emphysema of upper lobes, were approached through a median sternotomy. Five patients with predominant lower lobes lesions, were approached through a bilateral anterolateral thoracotomy. Surgery consisted in resection of 20 to 30

of lung volume corresponding to areas of severe parenchymal destruction by stapling suture additioned with bovine pericardium. Changes in lung function and physical performance were evaluated by FEV1, FVC and RV, 6 minutes walk test and dyspnea index according to Medical Research Council at 3, 12, 24, 36 and 48 months. Variance analysis with correction of Bonferroni was performed. One patient died of acute myocardial infarction. There was a significant average improvement in all parameters measured at 3, 12, 24 and 36 months with regard to preoperative values. Comparing the preoperative and 3 months values, there was an increment in FEV1 from 0.94 +/- 0.37 (31

of predicted) to 1.35 +/- 0.40 L (45

) (p < 0.05), in FVC from 2.24 +/- 0.69 (54

) to 3.05 +/- 0.80 L (75

) (p < 0.05) and in 6 minutes walk test from 395 +/- 66 to 517 +/- 50 mts (p < 0.001). There was also a decrease in the RV of 4.78 +/- 1.14 L (284

) to 3 +/- 0.68 L (180

) (p < 0.001) and in dyspnea index of 3.34 +/- 0.82 to 0.53 +/- 0.53 (p < 0.001). The percentage of average increment in FEV1 was 53

at 36 months (n = 6) and 60

at 48 months (n = 3). LVRS can be performed with acceptable morbidity and mortality in highly selected emphysematous patients. Decrease of dyspnea and improvement in physical performance reach a maximum between 3 and 12 months and may remain so after four years.

Cirugía de reducción de volumen pulmonar en enfisema. Resultados alejados. / [Lung volume reduction surgery for emphysema. Long term results]

We prospectively analyzed 19 patients submitted to lung volume reduction surgery (LVRS). Mean age 54 years. Fourteen patients, with predominant emphysema of upper lobes, were approached through a median sternotomy. Five patients with predominant lower lobes lesions, were approached through a bilateral anterolateral thoracotomy. Surgery consisted in resection of 20 to 30

of lung volume corresponding to areas of severe parenchymal destruction by stapling suture additioned with bovine pericardium. Changes in lung function and physical performance were evaluated by FEV1, FVC and RV, 6 minutes walk test and dyspnea index according to Medical Research Council at 3, 12, 24, 36 and 48 months. Variance analysis with correction of Bonferroni was performed. One patient died of acute myocardial infarction. There was a significant average improvement in all parameters measured at 3, 12, 24 and 36 months with regard to preoperative values. Comparing the preoperative and 3 months values, there was an increment in FEV1 from 0.94 +/- 0.37 (31

of predicted) to 1.35 +/- 0.40 L (45

) (p < 0.05), in FVC from 2.24 +/- 0.69 (54

) to 3.05 +/- 0.80 L (75

) (p < 0.05) and in 6 minutes walk test from 395 +/- 66 to 517 +/- 50 mts (p < 0.001). There was also a decrease in the RV of 4.78 +/- 1.14 L (284

) to 3 +/- 0.68 L (180

) (p < 0.001) and in dyspnea index of 3.34 +/- 0.82 to 0.53 +/- 0.53 (p < 0.001). The percentage of average increment in FEV1 was 53

at 3 months (n = 18), 72

at 12 months (n = 13), 58

at 24 months (n = 10), 53

at 36 months (n = 6) and 60

at 48 months (n = 3). LVRS can be performed with acceptable morbidity and mortality in highly selected emphysematous patients. Decrease of dyspnea and improvement in physical performance reach a maximum between 3 and 12 months and may remain so after four years.

Neumonia eosinofilica aguda. Presentación de un caso y revisión de la literatura / Acute eosinophilic pneumonia. Case report and review of literature

Se comunica un caso de enfermedad febril aguda en una mujer de 37 años, fumadora, con infiltrados pulmonares difusos, que evolucionó a insuficiencia respiratoria en 24 hs con necesidad de intubación cuyo único hallazgo positivo fue eosinofilia marcada en el lavado broncoalveolar, sin eosinofilia en sangre periférica. Se diagnosticó Neumonía Eosinfílica Aguda. El tratamiento con metil prednisolona permitió la extubación al segundo día, con mejoría clínica y remisión parcial de los infiltrados radiólogicos. No hubo recurrencia del cuadro en los 2 años posteriores. Describimos este caso de neumonía eosinofilica aguda porque creemos importante su inclusión como diagnóstico diferencial entre las múltiples causas de insuficiencia respiratoria aguda, ya que es una patología potencialmente curable. Se realiza revisión de la literatura, se analizó posibles causas desencadenantes y mecanismos fisiopatogénicos. (Au)

Neumonia eosinofilica aguda. Presentación de un caso y revisión de la literatura / Acute eosinophilic pneumonia. Case report and review of literature

Se comunica un caso de enfermedad febril aguda en una mujer de 37 años, fumadora, con infiltrados pulmonares difusos, que evolucionó a insuficiencia respiratoria en 24 hs con necesidad de intubación cuyo único hallazgo positivo fue eosinofilia marcada en el lavado broncoalveolar, sin eosinofilia en sangre periférica. Se diagnosticó Neumonía Eosinfílica Aguda. El tratamiento con metil prednisolona permitió la extubación al segundo día, con mejoría clínica y remisión parcial de los infiltrados radiólogicos. No hubo recurrencia del cuadro en los 2 años posteriores. Describimos este caso de neumonía eosinofilica aguda porque creemos importante su inclusión como diagnóstico diferencial entre las múltiples causas de insuficiencia respiratoria aguda, ya que es una patología potencialmente curable. Se realiza revisión de la literatura, se analizó posibles causas desencadenantes y mecanismos fisiopatogénicos.

Implicancias clínicas y predictores del sindrome de apnea del sueño

RESUMEN: El sindrome de apnea del sueño (SAS) es un desorden potencialmente letal, cuyas manifestaciones clínicas estan vinculadas a los episodios de hipoxemia nocturna y a la hipersomnoliencia diurna. Se evaluó el valor predictivo de la anammesis y estudio complementarios para el diagnóstico de SAS, correlacionandos estos datos con los hallazgos polisomnográficos. De 39 pacientes con anamnesis sugestiva de SAS, la polisomnografía (PSG) confirmó este diagnóstico en 32. No se encontraron síntomas predictivos de SAS, lo que fue atribuido a que los pacientes sin SAS presentaban una baja eficiencia del sueño. Las alteraciones cefalométricas y la presencia de melladuras en la curva flujo/volumen fueron más frecuentes en los pacientes sin SAS (p=0,014 p=0,12 NS, respectivamente), no así la espirometría que fue anormal con más frecuencia en los pacientes sin SAS (p=0,007). Se encontró una correlación lineal entre índice de perturbación respiratoria (IPR) con el número de sintomas positivos a la anamnesis (p=0,017) y la duración media de la apnea (DMA)(p=0,002), no correlacionándose con el índice de peso corporal (BMI) ni con la SaO2 Hb basal.

Sarcoidosis toracopulmonar: nuestra experiencia / Tyoracopulmonary sarcoidosis: our experience

RESUMEN: Se analizó nuestra experiencia en sarcoidosis toracopulmonar, mediante la evaluación retrospectiva de las historias clínicas de 15 pacientes. Se consideraron síntomas de presentación, espirometría, radiografía de tórax, tratamiento y evolución de 12 mujeres y 3 hombres con edad promedio de 48,6 años (rango 34 a 62). Los síntomas iniciales fueron respiratorios en 7/15(40 por ciento). Los dos pacientes(ptes), restantes estaban asintomáticos. El 53.3 por ciento presentó compromiso extratoráxico. La espirometría fue anormal en 8/15 (53.3 por ciento) a predominio restrictivo. Todas las Rx de tórax fueron anormales; 4/15 (26.7 por ciento) correspondieron al estadio I;9/15 (60 por ciento) al estadio II y 2/15 (13.3 por ciento) al estadio III. Se realizó tomografía computada de tórax de alta resolución en 11 ptes. (73.3 por ciento). Todos presentaron adenopatías mediastínicas (100 por ciento); 6/11 (54.5 por ciento) engrosamiento perivascular y 4/11 (36.4 por ciento) nodulos pulmonares. El diagnóstico fue por biopsia ganglionar en 10 (7 por mediastinoscopía y 3 de ganglios periféricos) y por biopsia transbronquial en 5. El 80 por ciento recibio tratamiento con corticoides sistémicos. En 5/12 (41.7 por ciento) se produjeron recaidas al disminuirlos o suspenderlos y 8/12 (66.7 por ciento) presentaron efectos colaterales por el mismo. Concluimos que: la sarcoidosis toracopulmonar se presentó con igual incidencia de síntomas respiratorios y sistémicos. La disnea se asoció a espirometría anormal y compromiso radiológico pulmonar. Mas de la mitad presentaron manifestaciones extratoráxica. La biopsia ganglionar fue el método mas utilizado para diagnóstico. La mayoría de los pacientes recibió tratamiento con corticoides sistémicos, tuvieron efectos colaterales leves y menos de la mitad recayeron al suspenderlos.

Ventilacion no invasiva en la insuficiencia respiratoria aguda: otra alternativa / Non invasive ventilation in acute respiratory insufficiency: an alternative

Se evaluó prospectivamente, la efectividad de la ventilación no invasiva a presión positiva (NIPPV) en 22 pacientes selecionados con insuficiencia respiratoria aguda con criterios de intubación y ARM convencional. Se diferenciaron 2 grupos: grupo A (17 pacientes) con PaCO2 > 45 mmHg, y grupo B (5 pacientes) con PaCo2 < 45 mmHg. La NIPPV se aplicó con 2 niveles de presión (BIPAP) via máscara nasal o facial. Se evaluó la frecuencia respiratoria (fr), pH, PaCO2 y PaO2/FiO2, previo al tratamiento, a 1 hora y 24 horas después. El análisis estadístico se efectuó mediante el test de ANOVA, considerando significativa una p < 0.05. Resultados: En el grupo A: hubo reducción en la fr (X + DS) de 31.2 + 8.2 a 24.7 + 8.2 a la 1er hora (h) (p = 0.02) y a 23.4 + 6.5 a las 24 hs (p = 0.01), el pH se modificó de 7.33 + 0.07 a 7.37 + 0.07 a la 1er h (p = 0.13) y a 7.40 + 0.07 a las 24 hs (p = 0.01), la PaCO2 se modificó de 69.5 + 19.6 a 57.8 + 16.9 a la 1er h (p = 0.06) y a 54 + 13 a las 24 hs (p = 0.02), y la PaO2/FiO2 se modificó de 187.3 + 60.2 a 223.9 + 6.5 a la 1er h (p = 0.12) y a 245.8 75 a las 24 hs (p = 0.03). En el grupo B: fr se modificó de 33 + 16.3 a 26.6 + 12.5 a la 1er h (p = 0.46) y a 21.3 + 4.2 a las 24 hs (p = 0.27) y la PaOs/FiO2 se modificó de 113.4 + 31 a 137.8 + 57.2 a 1er h (p = 0.44) y a 208.7 + 51.2 a las 24 horas (p = 0.27) y la PaOs/FiO2 se modificó de 113.4 + 31 a 137.8 + 57.2 a 1er h (p = 0.44) y a 208.7 + 51.2 a las 24 horas (p = 0.03). Sólo 2 ptes. del grupo A y 1 del grupo B requirieron ARM convencional. Conclusiones: 1) la NIPPV es una alternativa válida para el tratamiento de un grupo selecionado de pacientes con IRA que permitiría reducir la morbimortalidad asociada a ARM convencional. 2) En pacientes con insuficiencia respiratoria aguda hipercápnica la mejoría en la función respiratória se manifestó por una reducción precoz significativa en la frecuencia respiratoria, lográndose un cambio significativo en los gases arteriales a las 24 horas.

Ventilacion no invasiva en la insuficiencia respiratoria aguda: otra alternativa / Non invasive ventilation in acute respiratory insufficiency: an alternative

Se evaluó prospectivamente, la efectividad de la ventilación no invasiva a presión positiva (NIPPV) en 22 pacientes selecionados con insuficiencia respiratoria aguda con criterios de intubación y ARM convencional. Se diferenciaron 2 grupos: grupo A (17 pacientes) con PaCO2 > 45 mmHg, y grupo B (5 pacientes) con PaCo2 < 45 mmHg. La NIPPV se aplicó con 2 niveles de presión (BIPAP) via máscara nasal o facial. Se evaluó la frecuencia respiratoria (fr), pH, PaCO2 y PaO2/FiO2, previo al tratamiento, a 1 hora y 24 horas después. El análisis estadístico se efectuó mediante el test de ANOVA, considerando significativa una p < 0.05. Resultados: En el grupo A: hubo reducción en la fr (X + DS) de 31.2 + 8.2 a 24.7 + 8.2 a la 1er hora (h) (p = 0.02) y a 23.4 + 6.5 a las 24 hs (p = 0.01), el pH se modificó de 7.33 + 0.07 a 7.37 + 0.07 a la 1er h (p = 0.13) y a 7.40 + 0.07 a las 24 hs (p = 0.01), la PaCO2 se modificó de 69.5 + 19.6 a 57.8 + 16.9 a la 1er h (p = 0.06) y a 54 + 13 a las 24 hs (p = 0.02), y la PaO2/FiO2 se modificó de 187.3 + 60.2 a 223.9 + 6.5 a la 1er h (p = 0.12) y a 245.8 75 a las 24 hs (p = 0.03). En el grupo B: fr se modificó de 33 + 16.3 a 26.6 + 12.5 a la 1er h (p = 0.46) y a 21.3 + 4.2 a las 24 hs (p = 0.27) y la PaOs/FiO2 se modificó de 113.4 + 31 a 137.8 + 57.2 a 1er h (p = 0.44) y a 208.7 + 51.2 a las 24 horas (p = 0.27) y la PaOs/FiO2 se modificó de 113.4 + 31 a 137.8 + 57.2 a 1er h (p = 0.44) y a 208.7 + 51.2 a las 24 horas (p = 0.03). Sólo 2 ptes. del grupo A y 1 del grupo B requirieron ARM convencional. Conclusiones: 1) la NIPPV es una alternativa válida para el tratamiento de un grupo selecionado de pacientes con IRA que permitiría reducir la morbimortalidad asociada a ARM convencional. 2) En pacientes con insuficiencia respiratoria aguda hipercápnica la mejoría en la función respiratória se manifestó por una reducción precoz significativa en la frecuencia respiratoria, lográndose un cambio significativo en los gases arteriales a las 24 horas. (AU)

Implicancias clínicas y predictores del sindrome de apnea del sueño

RESUMEN: El sindrome de apnea del sueño (SAS) es un desorden potencialmente letal, cuyas manifestaciones clínicas estan vinculadas a los episodios de hipoxemia nocturna y a la hipersomnoliencia diurna. Se evaluó el valor predictivo de la anammesis y estudio complementarios para el diagnóstico de SAS, correlacionandos estos datos con los hallazgos polisomnográficos. De 39 pacientes con anamnesis sugestiva de SAS, la polisomnografía (PSG) confirmó este diagnóstico en 32. No se encontraron síntomas predictivos de SAS, lo que fue atribuido a que los pacientes sin SAS presentaban una baja eficiencia del sueño. Las alteraciones cefalométricas y la presencia de melladuras en la curva flujo/volumen fueron más frecuentes en los pacientes sin SAS (p=0,014 p=0,12 NS, respectivamente), no así la espirometría que fue anormal con más frecuencia en los pacientes sin SAS (p=0,007). Se encontró una correlación lineal entre índice de perturbación respiratoria (IPR) con el número de sintomas positivos a la anamnesis (p=0,017) y la duración media de la apnea (DMA)(p=0,002), no correlacionándose con el índice de peso corporal (BMI) ni con la SaO2 Hb basal.(AU)