Consideraciones radiológicas del cáncer de pulmón y Covid-19: una mirada oncológica / Radiological considerations of lung cancer and Covid-19: a oncology look

Patients with SARS-Cov-2 infection and lung cancer have an unfavorable prognosis, characterized by higher rates of respiratory failure, use of invasive mechanical ventilation and higher mortality rates. Due to similarities in affected organs in Covid-19 and lung cancer, the radiological accurate diagnosis has become a challenge for physicians. Radiologic findings of lung cancer, such as parenchymal consolidation, spiculation and microlobulations are not specific. Imaging findings of Covid-19 in patients with lung cancer consist of multiple patchy multifocal bilateral ground-glass opacities and consolidations, being hardly distinguishable from an underlying lung malignancy. Differential radiological diagnosis in patients with lung cancer and Covid-19 must include pneumonitis and lung toxicity caused by chemotherapy, target therapies and radiotherapy. Follow-up and simulation tomography in radiotherapy have become an unexpected ally in the early detection of Covid-19 in asymptomatic stages in lung cancer patients. Patients with lung cancer should have particular considerations due to their high risk and the adverse effects of systemic therapies and radiotherapy. (AU)

Perfil clínico y adherencia al tratamiento farmacológico en pacientes hipertensos de Llay-Llay / Clinical characteristics and medication adherence of Llay-Llay’s hypertensive patients

La hipertensión arterial (HTA) es el principal factor de riesgo para enfermedad cardiovascular, que es la principal causa de morbimortalidad en Chile. La falta de adherencia a terapia es la principal causa de fracaso al tratamiento anti-hipertensivo. El objetivo de este estudio es construir un perfil clínico y de adherencia al tratamiento de pacientes hipertensos controlados en el Centro de Salud Familiar (CESFAM) Llay-Llay, determinando las variables que inciden en la adherencia. METODOLOGÍA: Estudio descriptivo, observacional, con muestreo no probabilístico. Se revisaron datos epidemiológicos y clínicos de pacientes hipertensos controlados en CESFAM Llay-Llay (n=2331). Se aplicó test de Morisky-Green-Levine a 167 pacientes que consultaron al CESFAM entre Mayo-Junio del 2012, para determinar adherencia al tratamiento. Significancia con p<0,05 (t-Student). RESULTADOS: Del total de hipertensos, 37,4 por ciento son hombres y 62,6 por ciento mujeres, edad promedio: 64,71 años. En promedio utilizan 1,39 fármacos, sin diferencias entre sexos. Existe relación directa entre edad y número de fármacos utilizado. De la población estudiada con test de Morisky-Green-Levine, 42 por ciento (n=70) se clasificó como adherente (0 puntos) y 58 por ciento (n=97) como no adherente (mayor o igual a 1 punto). No hubo diferencias significativas en edad promedio, sexo ni cantidad de fármacos entre ambos grupos. Hubo diferencias significativas en cifras de presión arterial entre ambos grupos (120/71 vs. 130/77, p<0,05). CONCLUSIONES: La población hipertensa de Llay-Llay es de predominio femenino y edad avanzada. Tiene buena adherencia al tratamiento, independiente de edad, sexo y número de fármacos utilizados, lo que tiene repercusión positiva en sus cifras de presión arterial...

Hypertension is the main risk factor for cardiovascular disease, which in turn is a major cause of morbidity and mortality in Chile. Non-adherence to therapy is an important cause of antihypertensive treatment failure. The aim of this study is to build a profile of the clinical features and treatment adherence of hypertensive patients from Llay-Llay’s family health center (CESFAM), and to determine variables that affect adherence. METHODOLOGY: A descriptive, observational study with non-probability sampling. We reviewed epidemiological and clinical data of hypertensive patients from Llay-Llay’s CESFAM (n=2331). Morisky-Green-Levine test was applied to 167patients admitted to CESFAM between May and June of 2012, to determine adherence to treatment. Significance with p < 0.05 (t-test). RESULTS: Among hypertensive patients, 37.4 percent were men and 62.6 percent women, mean age 64.71 years. On average, 1.39 drugs were used with no gender differences. A direct relationship between age and number of drugs used was observed. For the population studied with Morisky-Green-Levine test, 42 percent (n=70) was classified as adherent (0 points) and 58 percent (n = 97) as non-adherent (greater than or equal to 1 point). No significant differences in mean age, sex or number of drugs between these two groups. There were significant differences in blood pressure between the two groups (120/71 vs.130/77, p<0.05). CONCLUSIONS: The hypertensive population of Llay-Llay corresponds mostly to women and the elderly. It had good adherence to treatment, regardless of age, sex and number of drugs used, which has a positive impact on blood pressure...

Rabdomiolisis asociada a torniquete en cirugía de rodilla: importancia del estrés oxidativo y el rol del alopurinol en su prevención / Rhabdomyolysis associated with tourniquet in knee surgery: importance of oxidative stress and the role of allopurinol in the prevention

Orthopedic knee surgery using a tourniquet has allowed surgeons to operate with a bloodless field. Nevertheless, tourniquet application produces an ischemia-reperfusion cycle in the skeletal muscle. As a consequence of the reoxygenation of the muscle, an enhancement on the production of reactive oxygen species leads to cell dysfunction, apoptosis and necrosis. A mild rhabdomyolisis is ascertained from the average 7-fold increase in plasma creatine phosphokinase and myoglobin in these patients, with release of intracellular content such as uric acid and phosphate. Altogether, these factors ascertain a distant response, determined by systemic inflammation and renal involvement by means of glomerular and tubular damage. In contrast, it is likely that acute kidney injury remains under diagnosed due to the recent change in acute kidney failure diagnostic paradigm. As a plausible evidence-based intervention, a diminution on the production of reactive oxygen species seems the pathophysiological treatment. Indeed, allopurinol supplementation constitutes a reasonable, innocuous and cheap alternative for these patients, because of inhibition of xanthine oxidase, the latter being the main source of reactive oxygen species in the setting of ischemia-reperfusion. This review focuses on the pathophysiology of rhabdomyolisis and acute kidney injury in the context of tourniquet knee surgery and therapeutics on allopurinol.

VEGF en capa muscular de vasos placentarios: expresión en preeclampsia y asociación con status antioxidante / VEGF in muscular layer of placental vessels: expression in preeclampsia and its association with the antioxidant status

Introducción: La preeclampsia es una enfermedad gestacional de origen placentario, de alta prevalencia y morbi-mortalidad materna y fetal. Su patogenia es desconocida, aunque sabemos que en ella ocurre placentación anómala e isquemia placentaria, que conlleva desarrollo de estrés oxidativo (EO) y disfunción endotelial. En condiciones normales la perfusión placentaria es regulada fundamentalmente por óxido nítrico (NO). El factor de crecimiento vascular endotelial (VEGF) es clave en su modulación, aumentando la actividad de enzimas productoras de NO, manteniendo una perfusión placentaria y gestación normales. Objetivo: Caracterizar el perfil de parámetros oxidativos en preeclampsia, asociado con expresión de VEGF en capa muscular de vasos placentarios (CMVP). Metodología: Estudio analítico, observacional, transversal. Se tomaron muestras placentarias y plasmáticas de embarazadas con preeclampsia (n=12) y embarazos normales (n=15). En placenta se determinó: expresión de VEGF en CMVP, malondialdehído y actividad enzimática antioxidante–superóxido dismutasa, glutatión peroxidasa y catalasa. En plasma materno se determinó: F2-isoprostanos y capacidad plasmática antioxidante total (FRAP). Resultados: Pacientes con preeclampsia mostraron mayor expresión de VEGF en CMVP y reducción del FRAP, incremento de F2-isoprostanos y malondialdehído, y menor actividad de superóxido dismutasa (p<0.05). Discusión: Expresión de VEGF en CMVPy parámetros de EO aumentan en preeclampsia. En condiciones normoxémicas, VEGF en CMVP estimula la producción de NO, manteniendo una perfusión placentaria y gestación normales. En condiciones de hipoxia, EO y bajas defensas antioxidantes, como la preeclampsia, VEGF en CMVP favorecería la producción de pro-oxidantes en desmedro de la de NO, lo que contribuiría a explicar la fisiopatología de esta enfermedad.

Introduction: Preeclampsia is a systemic pregnancy disorder, which has high prevalence and high maternal and fetal mortality associated. Its pathogenesis is unknown, but is thought to occur in three phases: abnormal placentation, placental ischemia, which involves development of oxidative stress (OS), and endothelial dysfunction. During normal placental perfusion is regulated primarily by nitric oxide (NO). The vascular endothelial growth factor (VEGF) is a key modulator, increasing the activity of enzymes producing NO, maintaining placental perfusion and normal pregnancy. Objective: To characterize the profile of oxidative parameters in Preeclampsia, associated with VEGF expression in muscular layer of placental vessels (MLPV).Methodology: Analytical, observational, transversal study. Placental and blood plasma samples were taken of pregnant women with preeclampsia (n=12) and normal pregnancies (n=15). In placenta was determined: expression of VEGF in MLPV, malondialdehyde and antioxidant enzyme activity - superoxide dismutase, glutathione peroxidase and catalase. Was determined in maternal plasma F2-isoprostanes and plasma total antioxidant capacity (FRAP). Results: Patients with preeclampsia showed higher expression of VEGF in MLPV and reduced FRAP, increased F2-isoprostanes and malondialdehyde, and decreased activity of superoxide dismutase (p <0.05). Discussion: VEGF expression in MLPV and parameters of OS are both increased in preeclampsia. In normal, VEGF in MLPV stimulates NO production, maintaining a normal pregnancy and placental perfusion. Under hypoxic conditions, OS and low antioxidant defenses, as in preeclampsia, VEGF in MLPV favors the production of pro oxidant agents, at the expense of NO, which would help explain the pathophysiology of this disease.

Nueva estrategia para preacondicionamiento miocárdico en pacientes sometidos a cirugía cardíaca con circulación extracorpórea / Reduction of postoperative atrial fibrillation through antioxidant supplementation

INTRODUCCION: El estrés oxidativo (EO) es importante en la génesis de diversas patologías. Su rol en patología cardiovascular es reconocido, particularmente en isquemia-reperfusión, fenómeno asociado al uso de circulación extracorpórea (CEC) en cardiocirugía. Complicación frecuente es la fibrilación auricular post-operatoria(FAPO), que ha demostrado participación del EO. Estrategias que lo atenúen podrían reducir incidencia de FAPO. Este trabajo busca determinar efectos de un esquema de suplementación para prevenir el EO y FAPO. METODOLOGIA: Ensayo clínico, doble ciego, aleatorizado. A 80 pacientes programados para cardiocirugía con CEC se administró placebo (n=40) o suplementación(n=40), consistiendo desde 7 días antes de la cirugía ácidos grasos poli-insaturados omega-3 (n-3) (2 g/día), y 2 días pre-cirugía se agrega vitamina C (1 g/día) y E (400 UI/día), todo hasta el alta. Se obtuvieron muestras sanguíneas (al ingreso, en suplementación, en cirugía, en postoperatorio y al alta) y auriculares durante cirugía. El estado antioxidante fue medido por la habilidad plasmática para reducir hierro férrico (FRAP) y el índice GSH/GSSG. Se midió actividad de enzimas catalasa, superóxido-dismutasa y glutatión-peroxidasa. Lipoperoxidación fue medida por niveles de malondialdehído. Para variables paramétricas se usó t de student, entre grupos se usó ANOVA-Bonferroni. Significancia fue p<0.05. RESULTADOS: Suplementación con n-3 disminuyó índice GSH/GSSG en 25 por ciento. En postoperatorio hubo 21 por ciento menos de lipoperoxidación y niveles de FRAP 30 por ciento mayores. Actividad de enzimas mostró incremento significativo. Además disminuyó FAPO desde 25 por ciento a 7,5 por ciento. CONCLUSION: Suplementar con n-3 y vitaminas antioxidantes disminuye ocurrencia de FAPO evitando daño miocárdico bioquímico y funcional por EO.

INTRODUCTION: Oxidative stress is important in the genesis of several diseases. Their role in cardiovascular disease is recognized, particularly in ischemia-reperfusion, a phenomenon associated with the use of cardiopulmonary bypass (CPB) in cardiac surgery. Common complication is postoperative atrial fibrillation (FOAP), which has demonstrated participation of oxidative stress, strategies to mitigate what could reduce the occurrence of FOAP. This paper tries to determine the effect of a supplementation scheme to prevent oxidative stress and its consequences. MATERIALS AND METHODS: Randomized, double-blind, controlled trial. Eighty patients scheduled for CCEC received placebo (n = 40) or supplementation (n = 40). Inclusion criteria: Age 30-80 years, sinus rhythm. Exclusion criteria: previous cardiosurgery, paroxysmal atrial fibrillation, congenital heart disease, chronic diseases. The supplementation consisting of n-3 (2 g / day), vitamins C (1 g /day) and E (400 IU / day) from 7, 2 and 2 days before surgery, respectively, until discharge. In atrial tissue and blood samples the plasma ferric reducing ability (FRAP), index GSH/GSSG, activity of catalase, superoxide dismutase and glutathione-peroxidase, and malondialdehyde levels were measured. Protein carbonylationwas measured in atrial tissue. Parametric variables expressed as mean and standard error were analyzed with student’s t-test, groups were compared using ANOVA-Bonferroni. Significance was p <0.05. RESULTS: The supplementation reduced the incidence of FOAP, lipid peroxidation and protein carbonylation in 73, 21 and 19 percent (p <0.05), respectively, and increased the FRAP (30 percent) and activity of antioxidant enzymes (p <0.05). CONCLUSIONS: Antioxidant supplementation decreases FOAP probably avoiding damage by oxidative stress.