Manejo del edema pulmonar agudo cardiogénico en el servicio de urgencia / Review of Acute Cardiogenic Pulmonary Edema Management in the Emergency Department

El Edema Pulmonar Agudo Cardiogénico es un cuadro clínico frecuente en los servicios de urgencia y conlleva una alta mortalidad, y junto a otras complicaciones de la insuficiencia cardíaca podría continuar incrementándose con los años. Los avances en la evaluación y el manejo de esta patología en el Servicio de Urgencia se centran en la utilidad de la ultrasonografía al lado del paciente, en la utilización apropiada de la farmacoterapia existente y la aplicación de herramientas de soporte ventilatorio que anticipen y eviten la necesidad de intubación oro-traqueal y ventilación mecánica.

Acute cardiogenic pulmonary edema is a medical condition often seen in the emergency department. It has high mortality and, as with other complications of heart failure, its incidence may continue to rise in the future. Advances in the evaluation and management of this pathology in the emergency department focus on the benefit of bedside ultrasound, the appropriate use of existing pharmacotherapy and the use of ventilation support equipment that anticipate and avert the need for orotracheal intubation and mechanical ventilation.

Manejo del edema pulmonar agudo cardiogénico en el servicio de urgencia / Management of acute cardiogenic pulmonary edema in an emergency service

El Edema Pulmonar Agudo Cardiogénico es un cuadro clínico frecuente en los servicios de urgencia y conlleva una alta mortalidad, y junto a otras complicaciones de la insuficiencia cardíaca podría continuar incrementándose con los años. Los avances en la evaluación y el manejo de esta patología en el Servicio de Urgencia se centran en la utilidad de la ultrasonografía al lado del paciente, en la utilización apropiada de la farmacoterapia existente y la aplicación de herramientas de soporte ventilatorio que anticipen y eviten la necesidad de intubación oro-traqueal y ventilación mecánica.

Acute cardiogenic pulmonary edema is frequently seen in the emergency services and has a high mortality and, as with other complications of heart failure, it may increase over the years. Advances in its evaluation and management in the emergency services are centered on bedside ultrasonography, appropriate use of available drugs and early ventilation support that anticipates and avoids the need for endotracheal intubation and mechanical ventilation.

Expresión diferencial de reactantes de fase aguda en distintos tipos celulares de pacientes con enfermedad pulmonar obstructiva crónica / Differential expression of acute phase reactants for various cell types in patients with chronic obstructive pulmonary disease

INTRODUCCIÓN: la presencia de valores aumentados de marcadores inflamatorios plasmáticos se ha asociado a la presencia de muchos de los procesos extrapulmonares relacionados con la enfermedad pulmonar obstructiva crónica (EPOC). El tejido pulmonar es capaz de sintetizar reactantes de fase aguda (RFA), cuya secreción puede estar relacionada con variables clínicas de la enfermedad. En el presente estudio nos planteamos el análisis de diversos grupos celulares con objeto de evaluar qué células están implicadas en esta síntesis pulmonar de RFA. MÉTODO: estudio analítico observacional de caso-control, en el que se compararon los niveles de distintos RFA en células epiteliales, macrófagos y fibroblastos pulmonares humanos de muestras quirúrgicas de tejido pulmonar de pacientes fumadores o exfumadores con EPOC en fase estable frente a pacientes sin EPOC. RESULTADOS: la muestra estaba compuesta por 74 sujetos, divididos en 39 pacientes EPOC y 35 fumadores sin la enfermedad. Tanto fibroblastos, células epiteliales y macrófagos pulmonares son capaces de sintetizar estos reactantes de fase aguda. A pesar de que las diferencias entre casos y controles no son llamativas, en sujetos control parece que la producción de PCR estaría más elevada en células epiteliales, mientras que los diversos genes de amiloide A sérico (AAS) estarían elevados en las células epiteliales y macrófagos. CONCLUSIONES: los hallazgos del presente estudio señalan la capacidad de las células del aparato respiratorio en sintetizar reactantes de fase aguda en los pacientes con EPOC. Nuestros resultados nos permiten valorar esta producción y sugerir que es probable que no sean los únicos tipos celulares implicados

INTRODUCTION: the presence of increased values for plasma inflammatory markers has been associated with the presence of extra-pulmonary processes linked to Chronic Obstructive Pulmonary Disease (COPD). Lung tissue is able to synthesize Acute Phase Reactants (APR), and this secretion could be linked to clinical variables of the disease. In this study, we contemplate analyzing a number of cell groups to assess which cells are involved in this pulmonary synthesis of APR. METHOD: control case, analytical, observational study that compares the levels of various APR in human lung epithelial, macrophage and fibroblast cells of surgical lung tissue samples from patients with a stable phase of COPD who were either smokers or ex-smokers, and compare these with patients without COPD. RESULTS: the sample was composed of 74 subjects, divided into groups with 39 COPD patients, and 35 smokers without the disease. Both the lung fibroblast, epithelial and macrophage cells are able to synthesize these acute phase reactants. Although the differences between the cases and the control group are not significant, in the control subjects it seems that the production of PCR would be higher in the epithelial cells, while several serum Amyloid A genes would be overexpressed in the epithelial and macrophage cells. CONCLUSIONS: the findings of this study point out the ability of respiratory system cells to synthesize acute phase reactants in patients with COPD. Our results allow us to assess this production and suggest that these are not the only cells involved

Estudio de la asociación de los polimorfismos de laglutation -S-transferasa y la enfermedad pulmonar obstructiva crónica en la raza caucásica / Study of the association of polymorphisms of glutathione-s-transferase and chronic obstructive pulmonary disease in caucasians

Introducción: Diversos estudios previos han encontrado una asociación no consistente entre los polimorfismos de la Glutation-S-transferasa (GST) y la enfermedad pulmonar obstructiva crónica (EPOC), con una asociación diferente según el área geográfica estudiada a nivel mundial. El objetivo del presente trabajo fue estudiar esa relación en una muestra caucásica española. Método: Estudio observacional analítico de casos-control en el que se incluyeron pacientes con EPOC y sujetos fumadores sin la enfermedad. A cada sujeto incluido se le recogieron sus datos sociodemográficos y clínicos mediantes un cuestionario estandarizado y se les extrajo una muestra de sangre para el estudio de los polimorfismos GSTP1 Ile105Val (A131G) Exon5, GSTP1 Ala114Val exón 6, GSTM1 de elección y GGSTT1delección.Resultados: La muestra estaba compuesta por 143 casos (64años, FEV1 69%) y 55 controles. El polimorfismo más asociado fue el GSTT que en el análisis bivariante se acercó a la significación estadística, alcanzándola en el análisis de regresión ajustado por sexo, paquetes-año e IMC (p = 0,031). El análisis (..) (AU)

Introduction: Various previous studies have found a non consistent association between polymorphisms of Glutathione-S-transferase (GST) and chronic obstructive pulmonary disease (COPD), with a different association according to the geographic area studied at global level. The objective of the present work was to study that relationship in a Spanish Caucasian sample. Method: Analytical observational case-control study including patients with COPD and smokers without the disease. Socio-demographic and clinical data were recorded by means of a standardized questionnaire, and a blood sample extracted from each participant for the study of the polymorphisms (..) (AU)

Antibacterial activity of reactive quaternary ammonium compounds in solution and in nonleachable coatings.

Antibacterial polymers suitable for coating applications without leaching of the biocidal component have been obtained by UV copolymerization of acrylic resins with acrylic monomers containing quaternary ammonium moieties. Suitable reactive biocides, based on quaternary ammonium monomers (QAMs), endowed with undecylacryloyl group and alkyl chains with 2 (QAM-C2), 8 (QAM-C8), and 16 (QAM-C16) carbon atoms have been synthesized. Aqueous solutions of QAMs showed biocidal activity against Escherichia coli, Staphylococcus aureus, and Listeria monocytogenes strains both in suspension and adhered to stainless steel surfaces. QAM-C16 and QAM-C8 evidenced higher activity toward bacteria in suspension and on stainless steel, respectively. The QAMs have shown sufficient reactivity to be copolymerized, by UV irradiation, with a commercial urethane acrylic resin for coating. Bioactivity tests, performed on free films of crosslinked coatings containing 1% of copolymerized QAM, have shown an increasing inactivation effect in the order of magnitude L. monocytogenes, E. coli, S. aureus with a maximum activity of the QAM-C8.

Expresión local de reactantes de fase aguda en la enfermedad pulmonar obstructiva crónica / Local expression of acute-phase reactants in chronic obstructive pulmonary disease

Objetivo: Determinar la expresión de ARN, de proteína-C-reactiva (PCR) y amiloide-A-sérico (AAS) en parénquima pulmonar y tejido bronquial de pacientes EPOC en fase estable. Comparar dicha expresión de ARNm con la de sujetos fumadores sin la enfermedad. (..) (AU)

Objective: To determine the mRNA expression of C-reactive protein (CPR) and serum amyloid-A (SAA) in pulmonary parenchyma and (..) (AU)

Effect of isometric exercise on pain perception and blood pressure in men and women.

PURPOSE: To examine the influence of isometric handgrip exercise (ISO EX) on pain perception and blood pressure in men and women. METHODS: Fifteen men and 16 women completed max and submax ISO EX consisting of squeezing a hand dynamometer with the right hand as hard as possible for the max session, and squeezing between 40% and 50% of max for 2 min for the submax session. Pain thresholds (PT), pain ratings (PR), blood pressure (SBP and DBP), and heart rate (HR) were assessed while a noxious pressure stimulus was applied to the right forefinger for 2 min before and after ISO EX. Data were analyzed with a 2 (gender) x 2 (trials) ANOVA. RESULTS: Results indicated a significant trials effect and a significant gender by trials interaction (P < 0.05) for PT for the max and submax sessions. Women had lower PT before ISO EX in comparison with the men. In addition, PT for the women increased significantly after ISO EX but did not change for the men. There were significant gender and trials effects (P < 0.05) for SBP for the submax session. Women had lower SBP before ISO EX, and SBP increased after ISO EX. DBP was also found to be lower (P < 0.05) in women before max and submax ISO EX, with DBP increasing after submax ISO EX in men and women. PR were found to be lower after max ISO EX in men and women, whereas PR were found to be lower in women after submax ISO EX. CONCLUSION: It is concluded that: 1) men and women differed in PT, SBP, and DBP before ISO EX; and 2) analgesia after ISO EX is observed more consistently in women.