Proteína C Reactiva en la EPOC y su relación con la gravedad de la enfermedad, las exacerbaciones y las comorbilidades / C-Reactive protein levels in patients with chronic obstructive pulmonary disease

Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated serum levels of ultrasensitive C reactive protein (CRPus). This raise may be related directly to COPD and its associated systemic inflammation or secondary to other factors such as smoking status, disease severity, acute exacerbations, or associated complications. Aim: To evaluate the potential causes of raised levels of CRPus in stable COPD patients. Patients and Methods: Cohorts of 133 mild-to-very severe COPD patients (41 current smokers), 31 never-smokers, and 33 current smoker controls were compared. Clinical assessments included body mass index (BMI), fat (FM) and fat-free mass (FFM) measurement by DEXA, forced expiratory volume in one second (FEV1), arterial oxygen tension (PaO2), six-minute walking test (SMWT), emphysema (EMPH) and right thigh muscle cross-sectional area (TMCSA), both quantified by high resolution computed tomography. Results: Serum CRPus levels were significantly higher in COPD patients than in controls (7 ± 4.2 and 3.7 ± 2.7 mg/L respectively; p < 0.0001). Being smoker did not influence CRPus levels. These levels were significantly correlated with FM (r = 0.30), BMI (r = 0.21), FEV1 (r = -0.21), number of acute exacerbations of the disease in the last year (r = 0.28), and PaO2 (r = -0.27). Using multivariate analysis FM, PaO2, and number of acute exacerbations of the disease in the last year had the strongest association with CRPus levels. Conclusions: CRPus is elevated in COPD patients, independent of smoking status. It is weakly associated with fat mass, arterial oxygen tension and frequency of exacerbations.

Comportamiento de las fracturas maxilofaciales atendidas en el Hospital Universitario de Maabar, República de Yemen / Behavior of the maxillofacial fractures in the Maabar's University Hospital, Yemen Republic

Introducción: las fracturas maxilofaciales constituyen más del 50 porciento del total de fracturas, y en muchas ocasiones están asociadas a otras fracturas del cuerpo humano. Objetivos: estudiar el comportamiento de estas lesiones en el Hospital Universitario de Maabar, de la Universidad de Thamar (Yemen), determinar su relación con la edad, sexo, etiología y localización, y compararlo con los resultados de otros estudios realizados en Cuba y en otros países. Métodos: se realizó un estudio estadístico descriptivo retrospectivo de las fracturas maxilofaciales atendidas por la brigada de profesores cubanos en este hospital entre los años 2006 y 2009. Las variables estudiadas fueron: sexo, edad, causa de la fractura y región afectada, así como el tipo de fractura y los traumatismos asociados. Resultados: el sexo masculino fue mucho más afectado que el femenino. Los accidentes del tránsito fueron la causa más común (más del 50 por ciento de los casos). La fractura nasal fue la más frecuente, y en más de 150 casos se detectaron traumatismos asociados, muchos muy graves, como fracturas de cráneo, de miembros y heridas de partes blandas. Conclusiones: se confirman los resultados que el sexo masculino es el más afectado, y que los accidentes del tránsito son la principal causa de fracturas en la cara. La fractura nasal es la más frecuente de todas las de los huesos faciales (más del 50 por ciento de los casos), pero otros registran la mandíbula o la región zigomática como la zona más frecuente. Impresionaron las fracturas mandibulares en niños, lo cual no es frecuente en Cuba(AU)

Introduction: the maxillofacial fractures account for more than the 50 percent of the total of fractures and often are associated with other fractures of the human body. Objectives: to study the behavior of these lesions in patients from the Maabar's University Hospital of the Thamar's University (Yemen), to determine its relation to age, sex, etiology and location and to compare it with the results of other studies conducted in Cuba and other countries. Methods: a retrospective, descriptive and statistic study was conducted on the maxillofacial fractures seen by the Cuban professor brigade in this hospital between 2006 and 2009. The study variables were: sex, age, cause of the fracture and involved region, as well as the type of fracture and associated traumata. Results: the male sex was more involved that the female one. The road accidents were the commonest cause (more than the 50 percent of cases). The nose fracture was the more frequent and in more than of 150 cases there were associated traumata much of them very severe including skull fracture, of extremities and soft tissue wounds. Conclusions: the results confirm that the male sex is the more involved one and that the road accidents are the leading cause of face fractures. The nose fracture is the more frequent of all that of facial bones (more than 50 percent of cases), but others register the mandible or the zygomatic region as the more frequent involved zone. The mandibular fractures were impressive in children, something not frequent in Cuba(AU)

Trasplante hepático en Chile: Aspectos generales, indicaciones y contraindicaciones (Documento de consenso) / General considerations, indications and contraindications for liver transplantation in Chile: A multicenter consensus development document

Liver transplantation is an excellent therapeutic option for terminal liver disease. During the last decades the results of liver transplantation have improved significantly with a patient survival rate of nearly 90 percent at one year and 80 percent at 5 years of follow-up. The main indications for liver transplantation include: end-stage liver disease associated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). The absolute contraindications for a transplant are less frequent than in the past, and include: severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepatic malignancy. This document presents a Consensus of the main groups performing liver transplantation in Chile, about its indications and contraindications. It also reviews general aspects of liver transplantation, including the selection and referral of liver transplant candidates, allocation of organs and the evaluation of severity of liver disease.