Enfoque del tromboembolismo pulmonar agudo desde el momento inicial en el servicio de urgencias / Initial Approach to Acute Pulmonary Embolism since the Initial Moment in the Emergency Department / Abordagem para tromboembolismo pulmonar agudo desde o momento inicial no departamento de emergência

El tromboembolismo pulmonar es la manifestación más grave de la enfermedad tromboembólica venosa y la tercera causa de mortalidad cardiovascular. Su sintomatología puede ir desde un cuadro asintomático o con síntomas leves, hasta el paro cardiaco. Dentro del enfoque de esta patología es importante tener en cuenta escalas que permiten estimar la probabilidad de que determinado paciente con ciertos signos, síntomas y factores de riesgo presente un tromboembolismo pulmonar, así como escalas diseñadas para valorar el riesgo de morir, en pacientes en los que ya se estableció este diagnóstico. Los pilares del tratamiento son la anticoagulación y la trombólisis, sin embargo, esta última está indicada únicamente en algunos casos. La presente revisión tiene como objetivo presentar una actualización de la evidencia sobre el enfoque diagnóstico y terapéutico del tromboembolismo pulmonar agudo, desde el ingreso del paciente al servicio de urgencias.

Pulmonary embolism is the most severe manifestation of venous thromboembolic disease and the third cause of cardiovascular mortality. Its symptoms can range from asymp-tomatic or mild symptoms to cardiac arrest. The approach to patients with suspected pulmonary embolism includes scores that allow estimating the clinical probability that a certain patient with certain signs, symptoms and risk factors will present a pulmonary thromboembolism, as well as scores that classify patients by severity and risk of hemody-namic decompensation. Treatment is based on anticoagulation and thrombolysis, which is used only in certain patients. The goal of this review is to present updated evidence regarding diagnosis and treatment of acute pulmonary embolism from the moment the patient arrives at the emergency room.

A embolia pulmonar é a manifestação mais grave da doença tromboembólica venosa e a terceira principal causa de mortalidade cardiovascular. Seus sintomas podem variar de sintomas assintomáticos ou leves a parada cardíaca. No enfoque desta patologia, é importante levar em consideração escalas que permitem estimar a probabilidade de um determinado paciente com determinados sinais, sintomas e fatores de risco apresentar tromboembolismo pulmonar, bem como escalas destinadas a avaliar o risco de morrer, em pacientes nos quais esse diagnóstico já foi estabelecido. Os pilares do tratamento são a anticoagulação e a trombólise, porém, esta última está indicada apenas em alguns casos. A presente revisão tem como objetivo apresentar uma atualização das evidências sobre a abordagem diagnóstica e terapêutica do tromboembolismo pulmonar agudo, desde a admissão do paciente no pronto-socorro.

Coadministration of the Campylobacter jejuni N-Glycan-Based Vaccine with Probiotics Improves Vaccine Performance in Broiler Chickens.

Source attribution studies report that the consumption of contaminated poultry is the primary source for acquiring human campylobacteriosis. Oral administration of an engineered Escherichia coli strain expressing the Campylobacter jejuni N-glycan reduces bacterial colonization in specific-pathogen-free leghorn chickens, but only a fraction of birds respond to vaccination. Optimization of the vaccine for commercial broiler chickens has great potential to prevent the entry of the pathogen into the food chain. Here, we tested the same vaccination approach in broiler chickens and observed similar efficacies in pathogen load reduction, stimulation of the host IgY response, the lack of C. jejuni resistance development, uniformity in microbial gut composition, and the bimodal response to treatment. Gut microbiota analysis of leghorn and broiler vaccine responders identified one member of Clostridiales cluster XIVa, Anaerosporobacter mobilis, that was significantly more abundant in responder birds. In broiler chickens, coadministration of the live vaccine with A. mobilis or Lactobacillus reuteri, a commonly used probiotic, resulted in increased vaccine efficacy, antibody responses, and weight gain. To investigate whether the responder-nonresponder effect was due to the selection of a C. jejuni "supercolonizer mutant" with altered phase-variable genes, we analyzed all poly(G)-containing loci of the input strain compared to nonresponder colony isolates and found no evidence of phase state selection. However, untargeted nuclear magnetic resonance (NMR)-based metabolomics identified a potential biomarker negatively correlated with C. jejuni colonization levels that is possibly linked to increased microbial diversity in this subgroup. The comprehensive methods used to examine the bimodality of the vaccine response provide several opportunities to improve the C. jejuni vaccine and the efficacy of any vaccination strategy.IMPORTANCECampylobacter jejuni is a common cause of human diarrheal disease worldwide and is listed by the World Health Organization as a high-priority pathogen. C. jejuni infection typically occurs through the ingestion of contaminated chicken meat, so many efforts are targeted at reducing C. jejuni levels at the source. We previously developed a vaccine that reduces C. jejuni levels in egg-laying chickens. In this study, we improved vaccine performance in meat birds by supplementing the vaccine with probiotics. In addition, we demonstrated that C. jejuni colonization levels in chickens are negatively correlated with the abundance of clostridia, another group of common gut microbes. We describe new methods for vaccine optimization that will assist in improving the C. jejuni vaccine and other vaccines under development.

[Do our patients know the economic cost of medication of the chronic type? Are they interested?]. / Conocen nuestros pacientes el coste económico de la medicación que toman de forma crónica? Les interesa?

OBJECTIVES: To identify how much patients know about the cost of the long-term medication they take and what importance they give to its cost. DESIGN: Descriptive study with a questionnaire to people collecting their prescriptions for long-term treatment. SETTING: Patients of working age and pensioners of our health centre who take medication for chronic illnesses. PARTICIPANTS: 100 patients of working age and 100 pensioners who take medication for chronic illnesses. MEASUREMENTS: They were asked how much they thought each drug they picked up in CLT prescriptions cost. The figure given was compared with the real price. An opinion questionnaire, with 5 questions on the economic aspects of medication, was conducted. RESULTS: Patients of working age knew the price of 64% of their prescriptions with under 25% error. Pensioners only knew the cost of 27% of their prescriptions with under 25% error. 50% of patients of working age were very interested in the cost of what their doctor prescribed, whereas only 30.4% of pensioners were. CONCLUSIONS: Patients of working age know quite accurately how much the drugs they are prescribed for long-term treatment cost, but pensioners know a lot less. Patients believed that doctors were sufficiently sensitive to the cost of prescriptions.