Current and research therapies for the prevention and treatment of delayed neurological syndrome associated with carbon monoxide poisoning: A narrative review.

Severe carbon monoxide (CO) poisoning causes fulminant deaths in common environment as well as neurological sequelae to survivors. Prevention of delayed neurological syndrome (DNS) after exposure to CO, the most important sequela, is based up to date on hyperbaric oxygen administration. Nevertheless, its use remains controversial due to the lack of evidence regarding its efficacy. The aim of this review is to report therapies under investigation for preventing or improving DNS, some of them with promising results in humans.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients / Ausencia de correlación entre la integral velocidad tiempo en el tracto de salida del ventrículo izquierdo y el índice volumen sistólico en pacientes en ventilación mecánica

Objective: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. Design: A prospective, descriptive, multicenter study was performed. Setting: Five intensive care units from university hospitals. Patients: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. Interventions: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO(R)) thermodilution methods. Main variables: The relation between LVOT VTI and SVI was tested by linear regression analysis. Results: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. Conclusions: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement

Objetivo: Evaluar la correlación entre la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (IVT TSVI) y el índice volumen sistólico (IVS) calculado por métodos de termodilución en pacientes ventilados críticamente enfermos. Diseño: Se realizó un estudio prospectivo, descriptivo y multicéntrico. Ámbito: Cinco unidades de cuidados intensivos de hospitales universitarios. Pacientes: Se incluyeron pacientes mayores de 17 años que necesitaron ventilación mecánica y monitorización hemodinámica invasiva. Intervenciones: La IVT TSVI se midió mediante Doppler pulsátil. Los cálculos de SVI se realizaron a través de un catéter de arteria pulmonar (CAP) o un método de Pulse index Contour Cardiac Output (PiCCO(R)), con métodos de termodilución. Variables principales: La relación entre IVT TSVI e IVS se evaluó mediante análisis de regresión lineal. Resultados: Se compararon 156 mediciones pareadas. La IVT TSVI media fue de 20,83±4,86cm y la media de IVS fue de 41,55±9,55ml/m2. El índice de correlación de Pearson para estas variables fue r=0,644, p<0,001; ICC fue 0,52 (IC 95%: 0,4-0,63). Cuando la IVT TSVI máxima se correlacionó con el IVS, el índice de correlación de Pearson fue r=0,62, p<0,001. La correlación empeoró para los valores extremos, especialmente para aquellos con mayor IVT TSVI. Conclusiones: La IVT TSVI podría ser una evaluación hemodinámica complementaria en pacientes seleccionados, pero no elimina la necesidad de un control invasivo en la actualidad. La débil correlación entre la IVT TSVI y la monitorización invasiva requiere estudios adicionales para identificar los factores que afectan a este desacuerdo

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. INTERVENTIONS: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO®) thermodilution methods. MAIN VARIABLES: The relation between LVOT VTI and SVI was tested by linear regression analysis. RESULTS: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. CONCLUSIONS: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.

Central bronchial reflex finding in pulmonary infarct / Hallazgo de reflejo central bronquial en el infarto pulmonar

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Subpleural artifact in lung pulse evidenced by M-mode ultrasound in a patient with atelectasis / Artefacto subpleural en pulso pulmonar evidenciado mediante ultrasonidos en modo M en un paciente con atelectasia

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Non-myeloablative hematopoietic stem cell transplantation is of limited value in advanced or refractory acute myeloblastic leukemia. The Mexican experience.

Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective strategy for preventing relapse of acute myelogenous leukemia (AML). We analyzed the outcome of 31 primary AML patients who received a reduced-intensity conditioning regimen for allogeneic HSCT in first or second remission. Thirty-one AML patients, 20 in first complete remission (FCR), 8 in second complete remission (SCR) and 3 in a partial remission (SPR) were included. All received busulfan 4 mg/kg/d/2 days, fludarabine 30 mg/m(2)/d/3 days and cyclophosphamide 350 mg/m(2)/d/3 days as conditioning regimen. The median number of CD34+ cells infused was 5.6 x 10(6)/kg and 5.2 x 10(6) in FCR and SCR group, respectively. All patients received cyclosporine-A (CsA) and methotrexate as graft vs. host disease (GvHD) prophylaxis. All patients showed myeloid engraftment (neutrophils >0.5 x 10(9)/l) after a median of 13 days in FCR group and 15 days in SCR group. Platelet recovery >20 x 10(9)/l was achieved after a median of 13 days in both groups. Relapse for 20 patients in FCR was 35% compared to 91% for 11 in SCR/SPR (p < 0.05). Conclusions. Reduced-intensity conditioning followed by allogeneic HSCT can induce stable remission in primary AML patients transplanted in FCR. A high relapse rate was documented in patients with refractory or relapsed AML.

[Pachydermoperiostosis (Touraine-Solente-Golé syndrome). Case report]. / Paquidermoperiostosis (síndrome de Touraine-Solente-Golé). Descripción de un caso.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Golé syndrome, is a rare process, frequently inherited. In its complete form it is characterized by pachydermia (thickening of the skin), skeletal changes (periostosis) and acropachia (digital clubbing). We report a patient that consulted for skeletal symptoms, as the acropachia and cutaneous manifestations (thickening of the skin of the face, scalp, hands and feet) went unnoticed due to their slow and progressive development. We review the characteristic features of this syndrome. We highlight the importance of ruling out secondary forms of hypertrophic osteoarthropathy and of a close follow-up of these patients because of complications that might develop on the long-term.

Paquidermoperiostosis (síndrome de Touraine-Solente-Golé). Descripción de un caso / Pachydermoperiostosis (Touraine-Solente-Golé syndrome). Case report

La paquidermoperiostosis u osteoartropatía hipertrófica primaria, también conocida por síndrome de Touraine-Solente-Golé, es un proceso infrecuente, a menudo hereditario. Se caracteriza en su forma completa por paquidermia (engrosamiento cutáneo), alteraciones óseas (periostosis) y acropaquia (dedos en palillo de tambor). Se presenta un caso, cuyo motivo de consulta fueron los síntomas óseos, habiendo pasado desapercibidas, por su desarrollo lento y progresivo, la acropaquia y las manifestaciones cutáneas (engrosamiento en la piel de la cara, cuero cabelludo, manos y pies). Revisamos los rasgos fundamentales de este síndrome. Destacamos la importancia de descartar las formas secundarias de osteoartropatía hipertrófica y hacer un seguimiento de estos pacientes por las complicaciones que, a largo plazo, pueden desarrollar

Pachydermoperiostosis or primary hypertrophic osteoarthropathy, also known as Touraine-Solente- Golé syndrome, is a rare process, frequently inherited. In its complete form it is characterized by pachydermia (thickening of the skin), skeletal changes (periostosis) and acropachia (digital clubbing). We report a patient that consulted for skeletal symptoms, as the acropachia and cutaneous manifestations (thickening of the skin of the face, scalp, hands and feet) went unnoticed due to their slow and progressive development. We review the characteristic features of this syndrome. We highlight the importance of ruling out secondary forms of hypertrophic osteoarthropathy and of a close follow-up of these patients because of complications that might develop on the long-term

Epidemiología del daño pulmonar agudo y síndrome de distrés respiratorio agudo / Epidemiology of acute pulmonary injury and acute respiratory distress syndrome

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Intestinal permeability in patients with ankylosing spondylitis and their healthy relatives.

Patients with AS were previously found to have increased intestinal permeability using the 51Cr-EDTA resorption test. In order to discover whether this alteration has taken place prior to, or as a consequence of the disease, we studied the intestinal permeability to 51Cr-EDTA in 20 patients with AS, 65 of their healthy relatives, and 25 normal volunteers. We also considered the HLA B27 antigen, the serum immunoglobulin A levels, the disease activity, the existence of peripheral arthritis, the ESR, the CRP values and the intake of drugs at the time of study. Gut permeability was found to have increased in the patients and their healthy relatives compared to the control group. No difference in gut permeability was found between patients and relatives regardless of whether they had the HLA B27 antigen or not. The increased intestinal permeability in the patients had no relation to the disease activity, to the presence of peripheral arthritis or to the intake of NSAIDs. Gut permeability was shown to bear no relation to IgA levels, ESR or CRP. Our findings suggest that the increase in gut permeability in AS patients and their relatives is a primary defect and may be an aetiologic factor in this disease.