Leuko-platelet index predicts thrombotic events in patients with acute coronary syndrome.

PURPOSE: To evaluate the predictive value of a bedside index in hospitalized patients with acute coronary syndromes (ACS). METHODS: We studied the association of leuko-platelet index (LPI: platelet count * leukocyte count/108) with risk of mortality, shock, or heart failure (combined end point-CEP), and with the response to antiplatelet therapy, measured by light transmission aggregometry. RESULTS: In the derivation cohort we included 1100 patients with non STEM-ACS, GRACE score of 133 ± 52, Crusade score 24,3 ± 14, 66% male, 65 + 11 years. LPI was 17 (12-24). LPI was higher (19 (13-25)) in patients with MI than in patients with unstable angina (16 (12-22) in (p < 0.001)). A total of 115 patients (10.5%) had the CEP. CEP was associated to LPI (OR 1.04 (1.002-1.08), p = 0.03), age (OR 1.01 (0.97-1.05), p = 0.62) and GRACE>140 (OR 8.1 (2.2-29), p = 0.02). LPI (OR 1.04 (1.004-1.07) p = 0.03) and GRACE score (OR 1.02 (1.01-1.03) p < 0.01) were associated to cardiovascular mortality. We confirmed these results in the validation cohort #1 (686 patients, 61 + 11 years old, 47% nonST-ACS, 53% ST-ACS, 21% had CEP) and in validation cohort #2 (218 patients, 56.8% males, 73 + 7 years old, 79% nonST-ACS, GRACE score 136 + 30) and 8.3% with CEP. We used the cutoff points of LPI obtained in the derivation cohort (>24). CONCLUSIONS: LPI > 24 was associated to CEP (OR (1.7-5.2), p 0.01), independently of age (OR 1 (0.98-1.02), p = 0.8), and GRACE score (OR 1.01 (0.99-1.01), p 0.69), and It was associated to antiplatelet resistance (OR 1.03 (95% CI 1.00-1.06) p = 0.05).

Chronic hypobaric hypoxia effects on rat colon in vitro sensitivity to acute hypoxia and amiloride.

Chronic hypoxia induces many physiological changes, but little is known about its effects on colonic epithelial function. Isolated distal colon mucosa from rats under normobaric conditions and rats submitted to hypobaric hypoxia for either 4 or 10 days was studied in an Ussing chamber. After 4 days of hypoxia, there was only a 15% increase in transepithelial resistivity. However, 10-day hypoxic rats showed higher short circuit current, potential difference, and resistivity. In this group, but not in normal or 4-day hypoxic animals, amiloride dose-dependently depressed short circuit current. The response to acute hypoxia in vitro was unchanged after chronic hypoxia and was not affected by amiloride. Although the amiloride-sensitive increase in short circuit current in 10-day hypoxic rats might resemble mineralocorticoid action, resistivity was increased and serum aldosterone was very low. It is suggested that chronic hypoxia may enhance electrogenic sodium transport by an aldosterone-independent mechanism.

Comparación del tiempo de recuperación del estado de conciencia en el postoperatorio inmediato: Anestesia General vs Anestesia Mixta / General anesthesia versus General Anesthesia plus Epidural Anesthesia. A comparison of conscience recovery in the postoperative period

Se comparó el tiempo de recuperación del estado de conciencia en el postoperatorio inmediato, como resultado de utilizar anestesia general contra anestesia mixta (general y epidural). Las pacientes se asignaron aleatoriamente en dos grupos: El grupo 1 de anestesia mixta y el grupo 2 de anestesia general. A ambos grupos se les instaló catéter epidural preoperatorio. En el grupo 2 el catéter se dejó inerte hasta 10 minutos antes de finalizar la cirugía y se utilizó para control del dolor postoperatorio. En el periodo preoperatorio así como en el postoperatorio se registraron las características de recuperación del estado de conciencia en tiempo mediante la prueba de cancelación de letras P, en intervalos de 30 minutos, durante 1 hr después de la anestesia, grado de sedación y tiempo de extubación. El tiempo anestésico y de extubación fue similar para ambos grupos. La prueba de cancelación de letras P fue mejor desarrollada por el grupo 1 (p<0.05), y los errores no tuvieron diferencias estadísticamente significativas