Sex-related differences of fatty acid-binding protein 4 and leptin levels in atrial fibrillation.

AIMS: Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Our aim was to study the sex differences in adipokines levels according to AF burden. METHODS AND RESULTS: Two independent cohorts of patients were studied: (i) consecutive patients with AF undergoing catheter ablation (n = 217) and (ii) a control group (n = 105). (i) Adipokines, oxidative stress, indirect autonomic markers, and leucocytes mRNA levels were analysed; (ii) correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients; and (iii) logistic regression and random forest model were used to determine predictors of AF recurrence after ablation. Our results showed that: (i) fatty acid-binding protein 4 (FABP4) and leptin levels were higher in women than in men in both cohorts (P < 0.01). In women, FABP4 levels were higher on AF cohort (20 ± 14 control, 29 ± 18 paroxysmal AF and 31 ± 17 ng/mL persistent AF; P < 0.01). In men, leptin levels were lower on AF cohort (22 ± 15 control, 13 ± 16 paroxysmal AF and 13 ± 11 ng/mL persistent AF; P < 0.01). (ii) In female with paroxysmal AF, there was a lower acetylcholinesterase and higher carbonic anhydrase levels with respect to men (P < 0.05). (iii) Adipokines have an important role on discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor of recurrence after ablation (1.067, 95% confidence interval 1-1.14; P = 0.046). CONCLUSION: The major finding of the present study is the sex-based differences of FABP4 and leptin levels according to AF burden. These adipokines are associated with oxidative stress, inflammatory and autonomic indirect markers, indicating that they may play a role in AF perpetuation.

Organ donation in an aging population: the experience of the last 8 years in Galicia.

BACKGROUND: Mean organ donor age has increased in recent years, conditioned by causes of death and population profile. We analyzed organ donation in Galicia during the last 8 years. MATERIALS AND METHODS: We analyzed donors in Galicia between 2000 and 2007, studying age, cause of death, donation effectiveness, and organs transplanted per donor. RESULTS: Donation rates fluctuated between 29 and 35 donors per million population (pmp) during the study period. Mean donor age increased from 51.6 years (Spain, 47.1 years) in 2000 to 63.3 years (Spain, 53.4 years) in 2007. Donors of 75 years or older increased from 7.5% to 27.2%. Cerebrovascular accident (CVA) as cause of death rose from 57% in 2000 to 75.3% in 2007. The variations in the proportions of organs transplanted between 2000 and 2007 were: kidney, 68.8% to 53.7%; liver, 86% to 88.9%; heart, 33.5% to 9.9%; and lung, 10.8% to 9.9%. Valid transplanted organs per donor decreased from 2.8 to 2.2, and effective donors from 93.5% (Spain, 90.3%) to 92.6% (Spain, 87.8%) with a mean of 94%. CONCLUSIONS: The population in Galicia has aged considerably and is widely dispersed. Despite the increased mean donor age, the percentage of effective donors has not diminished and donor rates have remained stable. This reflects the extremely conscientious attitude of transplant coordinators and the high degree of activity of transplant teams in Galicia.

Sarcoma de Ewing esofágico con invasión traqueal con presentación como crisis asmática / Esophageal Ewing’s sarcoma with tracheal invasion with presentation as asthmatic episode

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Organ donation process: quinquennial analysis in a Spanish autonomous region.

BACKGROUND: At present, transplantation of organs represents a therapeutic alternative, but the candidates for this treatment suffer from the scarcity of donors. We analyzed the process of the donation of organs in Galicia, an autonomous region in the northwest of Spain. METHODS: We summed all the potential donors in Galicia between January 1996 and December 2000 to analyze the reasons for nonconversion, the characteristics of the actual donors, and the use of the generated organs. RESULTS: We found 779 potential donors of whom 443 (56%) became actual donors (annual rate 31.6 pmp), although an important interterritorial variability was observed. The main reason for not obtaining potential donors was family refusal (32%), with denial during life being given as the reason in 45% of these families. We observed a progressive aging of the donors (39% older than 60 years in 2000), who had a mean age of 46 +/- 18 years. There also was an increased percentage of deaths due to vascular causes (mean 53%), while traumatic deaths (mean 40%) showed an inverse tendency. Donation because of asystole represented 5%. Among all the retrievals, 90% were multiorgan, generating 1437 organs including 1227 that were transplanted, yielding 3.3 possible organs from each donor including 2.8 organs that were transplanted. Among donors younger than 45 years, the numbers increased to 3.7 and 3.4, respectively, and for donors older than 60 years, the numbers were 2.7 and 1.9, respectively. CONCLUSIONS: Despite the increase in donors and organs, family refusal did not decrease, as this was the main reason for potential donor loss. Therefore it is necessary to create a regional program to promote donation.

[Paraquat poisoning and hemoperfusion with activated charcoal]. / Envenenamiento por Paraquat y hemoperfusión con carbón activado.

Paraquat is a common herbicide in Spain. In our country there are a few cases of this intoxication and it presents a high mortality even if the patients ingest a minimal amount. We present two cases of accidental poisoning with paraquat. These patients were admitted three hours after ingestion of toxin. They were treated with with orogastric lavage, activated charcoal, N-acetylcysteine, Fuller's earth, cathartics, support measures and hemoperfusion with activated charcoal. With these treatments both patients had a undetectable levels of paraquat 48 hours after and improvement of their symptoms, gastric and intestinal predominantly . We present the graphics of evolution of the plasma and urine levels of paraquat in both patients. We review the different aspects of treatment and update of this poisoning.

Envenenamiento por paraquat y hemoperfusión con carbon activado / Paraquat intoxications and hemoperfusion with activated charcoal

El Paraquat es un herbicida del grupo de los biperidilicos, de los más utilizados en nuestro pais.En España existen muy pocos casos descritos de esta intoxicación y presenta una alta mortalidad incluso con la ingestión de mínimas cantidades.Presentamos dos casos de intoxicación por ingesta accidental de este producto, que llegan a nuestro hospital en las tres horas posteriores. Se instaura tratamiento con lavado gástrico, carbón activado, N acetil cisteina, tierra de Fuller, catárticos, medidas de apoyo y hemoperfusión con carbón activado; consiguiendose niveles indetectables del tóxico 48 horas después y mejorando su sintomatología, predominantemente gastrointestinal.Se comentan los casos clínicos durante su estancia en U.C.I así como aspectos clínicos de estas intoxicaciones, su tratamiento actual y últimas tendencias y factores pronósticos (AU)

The Paraquat is a herbicide more using in Spain. In our country there are a few cases this intoxication and it presents a hight mortality even if the patients ingest a minimal amount. We present two cases of casual poisoning with paraquat. These patients were admited three hours after ingestion of toxic. They were treated with with orogastric lavage, activated charcoal, N-acetil-cysteina, Fuller´s earth, catartics, support measuring and hemperfusion with activated charcoal, with this treatments both patients had a indetectable levels of paraquat 48 hours after and yours symptoms that was gastric and intestinal predominantly had missing. We present the graphics of evolution the plasmatic and urine levels of paraquat the both patients. We review the differents aspects of treatment and update of this intoxication (AU)

Consideraciones acerca del tratamiento de las intoxicaciones agudas en Atención Primaria / Aspects about poisoning treatment in Primary Health Care

En muchas ocasiones la posibilidad de que una intoxicación aguda tenga una buena evolución viene condicionada por las medidas terapéuticas que se realicen en los primeros minutos. Dichas medidas son básicamente de tres tipos: soporte vital, técnicas encaminadas a impedir la absorción del tóxico y favorecer la eliminación del ya absorbido, y la administración de antídotos. En los últimos años se ha puesto en duda la eficacia de las técnicas de descontaminación gástrica cuando el tiempo transcurrido tras la ingestión del tóxico es mayor de una hora. Esto hace que en un gran número de pacientes intoxicados sólo sea posible su realización en el contexto de Atención Primaria ya que es únicamente en este nivel asistencial donde es posible atenderlos con un margen de tiempo menor del referido. Por otra parte, también es necesario plantearse cuál es el arsenal de antídotos del que se debe disponer en el ámbito de la asistencia primaria (AU)