DNA and RNA oxidative damage are associated to mortality in patients with cerebral infarction / El daño oxidativo del ADN y ARN se asocian con la mortalidad en los pacientes con inf0arto cerebral

OBJECTIVE: Secondary injury due to oxidation may occur during ischemic stroke, possibly leading to oxidative damage to deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Higher blood concentrations of 8-hydroxy-2′-deoxyguanosine (8-OHdG) (through the oxidation of guanosine from DNA) have been found in ischemic stroke patients than in healthy subjects, and in patients with versus without post-ischemic stroke depression. The present study was carried out to explore the possible association between serum DNA and RNA oxidative damage and mortality in patients with cerebral infarction. METHODS: A prospective, multicenter observational study was carried out in the Intensive Care Units of 6 Spanish hospitals. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as ischemic changes evidenced by computed tomography in more than 50% of the middle cerebral artery territory and a Glasgow Coma Score (GCS)<9. Serum concentrations of the three oxidized guanine species (OGS) (8-hydroxyguanine from DNA or RNA, 8-hydroxyguanosine from RNA, and 8-OHdG from DNA) on the day of MMCAI diagnosis were determined. The study endpoint was 30-day mortality. RESULTS: We found higher serum OGS levels (p < 0.001) in non-surviving (n=34) than in surviving patients (n=34). Logistic regression analyses showed serum OGS levels to be associated to 30-day mortality controlling for lactic acid, GCS and platelet count (OR=1.568; 95%CI=1.131-2.174; p = 0.01). CONCLUSIONS: The novel observation in this study is the association between global serum OGS concentration and mortality in ischemic stroke patients

OBJETIVO: En el infarto cerebral puede aparecer una lesión cerebral secundaria debido a la oxidación del ácido desoxirribonucleico (ADN) y del ácido ribonucleico (ARN). Se han encontrado concentraciones sanguíneas de 8-hidroxi-2'-desoxiguanosina (8-OHdG) (por la oxidación de la guanosina del ADN) más altas en pacientes con infarto cerebral que en individuos sanos, y en pacientes con depresión tras un infarto cerebral. El objetivo de nuestro estudio fue determinar si existe una asociación entre el daño oxidativo del ADN y del ARN, y la mortalidad de los pacientes con infarto cerebral. MÉTODOS: Estudio prospectivo, observacional y multicéntrico realizado en unidades de cuidados intensivos de 6 hospitales españoles. Se incluyeron pacientes con un infarto maligno grave de la arteria cerebral media (MMCAI), definido como la presencia de cambios isquémicos en la tomografía en más del 50% del territorio de la arteria cerebral media y menos de 9 puntos en la escala Glasgow Coma Scale (GCS). Se determinaron los niveles séricos de las 3 especies oxidadas de la nucleobase guanina (OGS) (8-hidroxiguanina del ADN o ARN, 8-hidroxiguanosina del ARN y 8-OHdG del ADN) en el día del diagnóstico del MMCAI. La variable principal fue la mortalidad a 30 días. RESULTADOS: Encontramos concentraciones séricas de OGS (p < 0,001) más altas en los pacientes fallecidos (n=34) que en los supervivientes (n=34). La regresión logística mostró que los niveles séricos de OGS se asociaban con la mortalidad a los 30 días controlando por ácido láctico, GCS y recuento plaquetario (odds ratio=1,568; IC 95%=1,131-2,174; p = 0,01). CONCLUSIONES: El nuevo hallazgo de nuestro estudio fue la asociación entre los niveles séricos de OGS globales y la mortalidad de los pacientes con infarto cerebral

DNA and RNA oxidative damage are associated to mortality in patients with cerebral infarction.

OBJECTIVE: Secondary injury due to oxidation may occur during ischemic stroke, possibly leading to oxidative damage to deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Higher blood concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG) (through the oxidation of guanosine from DNA) have been found in ischemic stroke patients than in healthy subjects, and in patients with versus without post-ischemic stroke depression. The present study was carried out to explore the possible association between serum DNA and RNA oxidative damage and mortality in patients with cerebral infarction. METHODS: A prospective, multicenter observational study was carried out in the Intensive Care Units of 6 Spanish hospitals. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as ischemic changes evidenced by computed tomography in more than 50% of the middle cerebral artery territory and a Glasgow Coma Score (GCS)<9. Serum concentrations of the three oxidized guanine species (OGS) (8-hydroxyguanine from DNA or RNA, 8-hydroxyguanosine from RNA, and 8-OHdG from DNA) on the day of MMCAI diagnosis were determined. The study endpoint was 30-day mortality. RESULTS: We found higher serum OGS levels (p<0.001) in non-surviving (n=34) than in surviving patients (n=34). Logistic regression analyses showed serum OGS levels to be associated to 30-day mortality controlling for lactic acid, GCS and platelet count (OR=1.568; 95%CI=1.131-2.174; p=0.01). CONCLUSIONS: The novel observation in this study is the association between global serum OGS concentration and mortality in ischemic stroke patients.

Platelet-Derived Growth Factor C in Alcoholics.

AIMS: Platelet-derived growth factor (PDGF) promotes liver collagen deposition, acting on hepatic stellate cells. Despite this, low serum PDGF levels were reported in chronic hepatitis C or B infection, although some studies yield the opposite result. Since PDGF may be related not only to fibrosis but also with vascular, neuronal or muscle disease, it is important to analyze its behavior in alcoholics. METHODS: In total, 17 controls and 62 alcoholic patients consecutively admitted to the hospitalization unit of the Internal Medicine Service were included. We determined serum levels of PDGF C, routine laboratory evaluation, tumor necrosis factor-α, interleukin (IL)-6 and IL-8 and malondialdehyde (MDA) levels. We analyzed the relationships between PDGF and liver function, ethanol intake and inflammatory reaction by both univariate and multivariate analysis to discern which variables PDGF levels depend on. RESULTS: Serum PDGF levels were significantly lower among patients (675 ± 466 pg/ml) than among controls (1074 ± 337 pg/ml; Z = 3.70; P < 0.001), and even lower among cirrhotics (549 ± 412 among cirrhotics vs 778 ± 487 among non-cirrhotics; Z = 2.33; P = 0.02). PDGF levels showed a direct correlation with prothrombin activity (ρ = 0.50; P < 0.001), platelet count (ρ = 0.44; P < 0.001) and inverse ones with bilirubin (ρ = -0.39; P = 0.002), IL-6 (ρ = -0.33; P = 0.016), IL-8 (ρ = -0.47; P < 0.001), and MDA levels (ρ = -0.44; P < 0.001). By multivariate analysis, only prothrombin activity and platelet count were independently related to PDGF. CONCLUSION: PDGF-C levels are decreased in alcoholics, especially among cirrhotics. Multivariate analysis discloses that only prothrombin activity and platelet count are independently related to PDGF-C levels.

Influencia del tratamiento con morfina en la mortalidad intrahospitalaria de pacientes con insuficiencia cardíaca aguda / Influence of morphine treatment on in-hospital mortality among patients with acute heart failure

No disponible

El ritmo circadiano y el pronóstico de los pacientes en la unidad de cuidados intensivos / Circadian rhythm and patient prognosis in intensive care

No disponible

Influencia de las condiciones meteorológicas en el ingreso hospitalario en pacientes con síndrome coronario agudo con y sin elevación del segmento ST: resultados del estudio AIRACOS / Influence of meteorological conditions on hospital admission in patients with acute coronary syndrome with and without ST-segment elevation: Results of the AIRACOS study

OBJETIVO: Evaluar si los parámetros meteorológicos influyen en los ingresos de pacientes con síndrome coronario agudo (SCA) con y sin elevación del ST. DISEÑO: Cohorte prospectiva. ÁMBITO: Unidad Coronaria del Hospital Universitario de Canarias. PACIENTES: Se estudió un total de 307 pacientes consecutivos con el diagnóstico de SCA con y sin elevación del ST. Analizamos las concentraciones medias de partículas con tamaño inferior a 10 y 2,5 Mim de diámetro, partículas de carbono negro, concentraciones de gases contaminantes y los parámetros meteorológicos a los que estuvieron expuestos los pacientes desde el día anterior hasta 7 días previos al ingreso. Intervenciones: Ninguna. Variables de interés principales: Demográficas, clínicas, partículas atmosféricas, contaminantes en fase gas y parámetros meteorológicos. RESULTADOS: Del total, 138 (45%) pacientes fueron clasificados como SCA con elevación del ST y 169 (55%) sin elevación del ST. No encontramos diferencias estadísticamente significativas en la exposición a partículas atmosféricas entre ambos grupos. Respecto a los datos meteorológicos, no encontramos diferencias estadísticamente significativas, a excepción de una mayor presión atmosférica en el SCA con elevación del ST (999,6 ± 2,6 vs. 998,8 ± 2,5 mbar, P = 0,008). El análisis multivariante mostró que la presión atmosférica fue predictor significativo de presentación del SCA con elevación del ST (OR: 1,14 IC 95%: 1,04 a 1,24; p = 0,004). CONCLUSIONES: En los pacientes que sufren un SCA, la presencia de cifras más elevadas de presión atmosférica durante la semana previa al evento incrementa el riesgo de que dicho SCA sea con elevación del ST

OBJECTIVE: Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS. DESIGN: A prospective cohort study was carried out. SETTING: Coronary Care Unit of Hospital Universitario de Canarias PATIENTS: We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5 Mim diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission. INTERVENTIONS: None. Variables of interest: Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters. RESULTS: A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6 ± 2.6 vs. 998.8 ± 2.5 mbar, P = .008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24,P = .004). CONCLUSIONS: In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS

Influence of meteorological conditions on hospital admission in patients with acute coronary syndrome with and without ST-segment elevation: Results of the AIRACOS study. / Influencia de las condiciones meteorológicas en el ingreso hospitalario en pacientes con síndrome coronario agudo con y sin elevación del segmento ST: resultados del estudio AIRACOS.

OBJECTIVE: Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS. DESIGN: A prospective cohort study was carried out. SETTING: Coronary Care Unit of Hospital Universitario de Canarias PATIENTS: We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5µm diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters. RESULTS: A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6±2.6 vs. 998.8±2.5 mbar, P=.008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24, P=.004). CONCLUSIONS: In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS.

Valor pronóstico intrahospitalario de la valoración funcional mediante el índice de Barthel en pacientes con síndrome coronario agudo: evaluación inicial de la enfermera en la unidad de cuidados intensivos cardiológicos / In-hospital prognostic value of functional assessment using the Barthel index in patients with acute coronary syndrome: Initial evaluation of the nurse in the cardiac intensive care unit

No disponible

Relative and combined effects of selenium, protein deficiency and ethanol on hepatocyte ballooning and liver steatosis.

Oxidative damage plays a key role in alcohol-mediated liver alterations. Selenium, a potent antioxidant, is decreased in alcoholics. This study was conducted to analyse if the supplementation with selenium may alter liver changes in a murine model fed ethanol and/or a 2 % protein-containing diet, following the Lieber-DeCarli design. Adult male Sprague Dawley rats were divided into eight groups which received the Lieber-DeCarli control diet; an isocaloric, 36 % ethanol-containing diet; an isocaloric, 2 % protein-containing diet; and an isocaloric diet containing 2 % protein and 36 % ethanol diet; and other similar four groups to which selenomethionine (1 mg/kg body weight) was added. After sacrifice (5 weeks later), liver fat amount and hepatocyte areas of pericentral and periportal cells were measured, and liver and serum selenium, activity of liver glutathione peroxidase (GPX), and liver malondialdehyde were determined. Ethanol-fed rats showed increased hepatocyte areas and fat accumulation especially when ethanol was added to a 2 % protein diet. Selenium caused a decrease in hepatocyte ballooning and liver fat amount, but an increase in GPX activity, and a marked increase in serum and liver selenium. The present study demonstrates that selenium, added to the diet of rats in the form of seleniomethionine, prevents the appearance of early signs of ethanol-mediated liver injury under the conditions of the Lieber-DeCarli experimental design.

Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis.

Cytokine levels are raised in acute alcoholic hepatitis. However, there are disparate results regarding the duration of altered plasma levels, and there are also discrepancies about the relation of changes during the first 15 days after admission with short-term (in-hospital) or long-term mortality. In 56 patients with acute alcoholic hepatitis we found that IL-8, IL-4, Interferon-γ (IFN-γ), malondialdehyde and C-reactive protein remained higher in patients than in 18 age- and sex-matched controls at admission, at the 7th day and at the 15th day after admission. Moreover, IL-4 levels (and to a lesser extent, IL-10 and IFN-γ ones) increased along the three determinations. However, comparing patients who died during the admission with those who did not, there were no statistically significant differences, but there was a nearly significant trend for MDA (Z=1.89; p=0.059), with higher levels among those who died. When changes between the first and the second determinations were compared with long-term survival, only IL-8 and IFN-γ showed a relation with mortality. IFN-γ values increased among those who survived and decreased among those who died (p=0.048). IFN-γ values at the first determination also showed a relation with long-term mortality, especially when patients with IFN-γ values in the first quartile were compared with those of the 4th one (log rank=5.64; p=0.018; Breslow=4.64; p=0.031). Besides Interferon-γ, only C-reactive protein showed differences between the first and the 4th quartile regarding mortality (Log rank=4.50; p=0.034; Breslow 4.33; p=0.038). In contrast with other studies, no relation was found between TNF-α or IL-6 and mortality.

Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio / No disponible

Objetivo: Evaluar si el tamaño del infarto agudo de miocardio (IAM) presenta variabilidad circadiana. Diseño: Estudio prospectivo observacional. Ámbito: Unidad coronaria de 12 camas. Pacientes: Enfermos consecutivos con diagnóstico de IAM con elevación del segmento ST sometidos a intervención coronaria percutánea primaria. Intervenciones: Se dividió a los pacientes en 2 grupos, dependiendo del horario de inicio de los síntomas del IAM (grupo A: 0-12 h; grupo B: 12-24 h). Variables de interés principales: Edad, sexo, factores de riesgo cardiovascular, anatomía coronaria, fracción de eyección del ventrículo izquierdo, localización del infarto, tiempo de inicio de los síntomas y reperfusión, presencia de insuficiencia cardiaca al ingreso, pico de troponina I. Resultados: Se incluyeron un total de 108 pacientes con diagnóstico de IAM con elevación del segmento ST. Los pacientes del grupo A presentaron concentración de troponina I mayor con respecto al grupo B (70,85±16,38 frente a 60,90±22,92 ng/ml, p=0,003). En el análisis multivariado el inicio del IAM entre las 0-12 h se mostró como un predictor independiente del tamaño del infarto (OR: 1,133, IC del 95% 1.012-1,267; p=0,01). Conclusiones: El inicio del IAM entre las 0-12 h resulta en un tamaño necrótico final significativamente mayor que cuando se inicia en cualquier otro momento del día (AU)

Objective: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. Design: An observational, prospective study. Setting: A 12-bed coronary care unit. Patients: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Interventions: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24 hours). Main variables of interest: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. Results: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12 hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). Conclusions: An onset of AMI between 0-12 hours results in a significantly larger final size of necrosis compared with any other time of presentation (AU)

[Influence of diurnal variation in the size of acute myocardial infarction]. / Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio.

OBJECTIVE: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. INTERVENTIONS: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24hours). MAIN VARIABLES OF INTEREST: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. RESULTS: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). CONCLUSIONS: An onset of AMI between 0-12hours results in a significantly larger final size of necrosis compared with any other time of presentation.

Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST / Differential characteristics of patients with acute coronary syndrome without

ObjetivoEvaluar características diferenciales de los pacientes con síndrome coronario agudo (SCA) sin elevación del segmento ST en comparación con elevación transitoria del segmento ST.DiseñoEstudio prospectivo observacional.ÁmbitoUnidad coronaria de 12 camas.PacientesEnfermos consecutivos de SCA sin elevación persistente del segmento ST.Principales variables de interésLa población se dividió en 2 grupos, en función de la presencia de elevación transitoria del segmento ST. Las variables de interés fueron: edad, factores de riesgos cardiovasculares, concentraciones de troponina I y glucemia al ingreso, anatomía coronaria, fracción de eyección del ventrículo izquierdo, mortalidad intrahospitalaria y fármacos intrahospitalarios.ResultadosLos pacientes identificados con SCA y elevación transitoria del segmento ST eran significativamente más jóvenes, fumadores y con predominio del sexo masculino. A su vez, presentaban una elevación pico de troponina I menor, mayor fracción de eyección y principalmente enfermedad coronaria de un vaso.ConclusionesLos pacientes con SCA con elevación transitoria del segmento ST presentan diferencias en cuanto al tipo de población, daño miocárdico y resultados angiográficos con respecto a los pacientes con SCA sin elevación del segmento ST. Son necesarias más investigaciones para esclarecer si dichas diferencias implicarían un manejo terapéutico diferente (AU)

AbstractObjective: To evaluate different characteristics of patients with acute coronary syndrome (ACS)without ST-segment elevation compared with transient St-segment elevation.Design: An observational, prospective study.Setting: A 12-bed coronary care unit.Patients: Consecutive patients of ACS without persistent ST-segment elevation.Main variables of interest: The population was divided intro 2 groups according to the presenceof transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors,troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejectionfraction, inhospital mortality and drugs.Results: Patients identified as ACS with transient ST-segment elevation were significantly younger,smokers and predominantly male. At the same time, they showed a minor peak elevationof troponin I, a higher ejection fraction and, mainly single-vessel coronary disease.Conclusions: Patients with ACS with transient ST-segment elevation differ in the type of population,myocardial damage and coronary angiographic results with respect to patients with ACSwithout ST-segment elevation. More research is needed to clarify whether these differencesimply a different therapeutic approach (AU)

El ligando soluble CD40 en pacientes con síndrome coronario agudo consumidores de cocaína / Soluble CD40 ligand in acute coronary syndrome in cocaine users

Objetivo: El ligando soluble CD40 (sCD40L) es una molécula que se expresa en el proceso de activación plaquetaria. Analizamos la concentración sérica de dicha molécula en pacientes consumidores de cocaína con síndrome coronario agudo (SCA).Método: Se realizó un análisis retrospectivo de 40 pacientes con SCA y test de cocaína positiva en orina, quienes se compararon con 40 pacientes con este diagnóstico y sinconsumo de cocaína. Resultados: Los valores del sCD40L en los pacientes con SCA y cocaína negativa fueron más bajos que los consumidores de cocaína (110 ± 41,1 frente a 135,7 ± 65,3pg/ml; p = 0,03). En el análisis multivariable y tras ajustar por la edad y los factores deriesgo coronario, los pacientes con SCA y cocaína positiva se relacionaron de forma independiente con niveles séricos más elevados de sCD40L. Conclusiones: El sCD40L está implicado en el proceso proinflamatorio-trombótico de los pacientes consumidores de cocaína y SCA (AU)

Background and objectives: The soluble CD40 ligand (sCD40L) expressed on platelets is released in the activation process. We analyzed the sCD40L serum concentration in cocaine users with acute coronary syndrome (ACS).Patients and methods: Retrospective comparison of sCD40L serum concentration between 40 patients with ACS and apositive test for cocaine in urine and 40 ACS patients with a negative cocaine test.Results: The mean (SD) sCD40L serum concentration in the patients with ACS and a negative cocaine test was lower(110 [41.1] pg/mL) than in patients who were not cocaine users (65.3 pg/mL) (P=.03). In the multivariable analysis, after adjustment for age and coronary risk in these patients with ACS, a positive cocaine test remained associated withs CD40L concentration. Conclusions: The sCD40L plays a part in the proinflammatory thrombotic process in cocaine users who develop ACS (AU)