Citrulline supplementation improves spatial memory in a murine model for Alzheimer's disease.

OBJECTIVES: Alzheimer's disease (AD) correlates with the dysfunction of metabolic pathways that translates into neurological symptoms. An arginine deficiency, a precursor of nitric oxide (NO), has been reported for patients with AD. We aimed to evaluate the effect of citrulline oral supplementation on cognitive decline in an AD murine model. METHODS: Three-month citrulline or water supplementation was blindly given to male and female wild-type and 3 × Tg mice with AD trained and tested in the Morris water maze. Cerebrospinal fluid and brain tissue were collected. Ultra-performance liquid chromatography was used for arginine determinations and the Griess method for NO. RESULTS: Eight-month-old male 3 × Tg mice with AD supplemented with citrulline performed significantly better in the Morris water maze task. Arginine levels increased in the cerebrospinal fluid although no changes were seen in brain tissue and only a tendency of increase of NO was observed. CONCLUSIONS: Citrulline oral administration is a viable treatment for memory improvement in the early stages of AD, pointing to NO as a viable, efficient target for memory dysfunction in AD.

[Ogilvie syndrome. Report of two cases]. / Pseudoobstrucción colónica aguda (síndrome de Ogilvie). Informe de dos casos.

Acute colonic pseudo-obstruction or "Ogilvie syndrome (OS)," is a gastrointestinal motility disorder characterized by marked dilatation of the colon in the absence of mechanical obstruction. It occurs most commonly in the postoperative state or with severe medical illness; it has been associated with a wide range of comorbidities, including trauma, pelvic surgery (orthopedic, gynecologic, urologic), metabolic disorders, central nervous system disorders, and prostaglandin abnormalities. OS may also be drug induced or idiopathic. Left untreated, it can progress to perforation, peritonitis, and death. Definitive management of OS traditionally has consisted of mechanical decompression. However, neostigmine, an acetyl-cholinesterase inhibitor, has recently emerged as a safe and effective pharmacologic alternative in the adult population. We present two cases of OS attended in the intensive care unit treated with colonoscopy and cecostomy respectively.

Reduction of No Reflow with a Loading Dose of Atorvastatin before Primary Angioplasty in Patients with Acute ST Myocardial Infarction.

BACKGROUND: No reflow defined as an altered myocardial reperfusion and failure at microvascular level is a frequent complication in acute myocardial infarction that attenuates beneficial effect of reperfusion therapy leading to poor outcomes. There is not enough evidence to support that previous use of statins improves coronary flow in patients undergoing primary percutaneous coronary intervention (PCI). AIM OF STUDY: To determine if a loading dose of 80 mg of atorvastatin before primary angioplasty reduces the frequency of no reflow, hs-CRP, IL6 intracoronary levels, and major combined cardiovascular events at 30 d. METHODS: In this controlled clinical trial, we randomly assigned 103 adult patients within the 12 h of acute ST-elevation myocardial infarction (STEMI) to receive 80 mg of atorvastatin additional to standard treatment (AST) before performing primary PCI versus standard treatment (ST) alone. The primary outcomes were the occurrence of no reflow and high sensitivity C-reactive protein (hs-CRP) and interleukin 6 levels and secondary outcomes were major adverse cardiovascular events at 30 d. RESULTS: 103 patients were analyzed, 49 (48%) received AST, 54 (52%) ST. Frequency of no reflow among groups was 27 vs. 63% respectively, p ≤0.0001. hs-CRP level was 2.69 mg/dL for AST vs. 2.2 mg/dL in ST, meanwhile IL-6 levels were 5.2 pg/mL vs. 6.35 pg/mL respectively, p = ns. Cox regression model demonstrated that the treatment assigned is an independent predictor for no reflow occurrence (HR 0.34 95%, CI 0.18-0.61, p ≤0.001). CONCLUSION: The administration of a loading dose of 80 mg atorvastatin before primary PCI is an effective strategy for prevention of no reflow improving also clinical outcomes and free survival rate for the presentation of major adverse cardiovascular events at 30 d.

Healthcare-associated infections: Appropriate empirical antibiotic treatment / Infecciones asociadas a la atención de la salud: tratamiento antibiótico empírico apropiado

Background: Health-care Associated Infections (HAI) are one of the main causes of death in critically ill patients. The aim of this paper is to establish an appropriate empirical antibiotic treatment for the main HAI in an Intensive Care Unit (ICU). Methods: A retrospective, observational, descriptive and analytical study of the culture results from January, 2014 to December, 2015. The causative microorganisms were identified, as well as sensitivity and antibiotic resistance. Results: Of the three main HAI in the ICU were Ventilator Associated Pneumonia (VAP), whose most common germs were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa; Urinary Tract Infection Associated with Urinary Catheter (IVU-CU), Escherichia coli BLEE and Pseudomonas aeruginosa were isolated in 70%, and 56% of the bloodstream infections of the germs that caused this infection were three, the most frequent being Escherichia coli, followed by Klebsiella oxytoca and methicillin-resistant Staphylococcus aureus. Conclusions: VAP was the most frequent HAI and resistant methicillin Staphylococcus aureus was the most prevalent in this type of infection. The proposed empiric antibiotic treatment was as follows: VAP (vancomycin plus amikacin plus meropenem), IVU-CU (meropenem) and STIs (vancomycin plus cefepime).

Introducción: Las infecciones asociadas a la atención de la salud (IAAS) son una de las principales causas de muerte en pacientes en estado crítico. El objetivo de este trabajo fue identificar los gérmenes más frecuentemente asociados a las IAAS en la Unidad de Cuidados Intensivos (UCI) y determinar el tratamiento antibiótico empírico apropiado. Métodos: Estudio retrospectivo, observacional, descriptivo y analítico de los cultivos de enero de 2014 a diciembre de 2015. Se identificaron los microorganismos causantes de las IAAS, la sensibilidad y la resistencia antibiótica. Resultados: Las tres principales IAAS en la UCI fueron: la neumonía asociada a ventilador (NAV), y los gérmenes más habituales fueron Staphylococcus aureus meticilino resistente, Acinetobacter baumannii y Pseudomonas aeruginosa; la infección de vías urinarias asociada a catéter urinario (IVUCU) la Escherichia coli BLEE y Pseudomonas aeruginosa fueron aisladas en el 70% y en las infecciones del torrente sanguíneo (ITS) el 56% de los gérmenes fueron Escherichia coli, Klebsiella oxytoca y Staphylococcus aureus meticilino resistente. Conclusiones: La NAV fue la IAAS más frecuente y el Staphylococcus aureus meticilino resistente fue el más prevalente en este tipo de infección. La propuesta de tratamiento antibiótico empírico es: para NAV (vancomicina más amikacina más meropenem), IVU-CU (meropenem) y las ITS (vancomicina más cefepime).

Valor pronóstico de la microalbuminuria en el paciente con infarto agudo del miocardio con elevación del ST / Prognostic value of microalbuminuria in ST-elevation myocardial infarction

Introducción: La microalbuminuria (MA) es un marcador de disfunción endotelial, y se ha asociado con mayor morbimortalidad en la enfermedad cardiovascular. En México, las enfermedades isquémicas del corazón ocupan los primeros lugares de mortalidad, por lo que resulta necesario estudiar marcadores que puedan proporcionar pronóstico en los sujetos con síndrome coronario agudo. Objetivo: Determinar el valor pronóstico de la microalbuminuria sobre la evolución de los pacientes con infarto agudo del miocardio con elevación del segmento ST (IAMST). Material y métodos: Estudio de cohorte, observacional, longitudinal, prospectivo y analítico. Se incluyeron pacientes consecutivos con diagnóstico de IAM en las primaras 24 horas de evolución, de cualquier género, mayores de 18 años, que ingresaron a la Unidad de Cuidados Cardiovasculares de un Hospital de Tercer Nivel. Se definió la cohorte expuesta a microalbuminuria en orina de 24 horas (albúmina > 20 µg/min) dentro de las primeras 72 horas de su ingreso, y se dio seguimiento a 30 días registrando la presentación de eventos cardiovasculares. Resultados: Se estudiaron a 99 pacientes, 51 (51.5%) sujetos presentaron MA. Las características basales no presentaron diferencias significativas. Los pacientes con MA tuvo mayor puntuación de las escalas APACHE II, TIMI, GRACE y EUROSCORE (todos p < 0.05). La presentación de Killip-Kimball ≥ III, arritmias, bloqueo atrioventricular avanzado, choque cardiogénico, reinfarto y muerte, se asociaron significativamente con la presencia de MA (todos p < 0.05), y esta asociación es independiente para la presencia de muerte ajustado para las puntuaciones de TIMI, GRACE y la presencia de infarto ventricular derecho. De la misma manera, los sujetos con IAM portadores de MA tienen una supervivencia significativamente menor que aquellos sin MA, p = 0.002. Conclusiones: La microalbuminuria se asocia de manera independiente con muerte a 30 días, y puede ser un biomarcador a medirse rutinariamente en los pacientes con síndrome coronario agudo con elevación del ST.

Introduction: Microalbuminuria (MA) is an endothelial dysfunction biomarker, and has been associated to higher morbidity and mortality in cardiovascular disease. The ischemic heart disease is among the leading causes of death, and it's necessary to study new risk and prognostic biomarkers in patients with ST-elevation acute myocardial infarction (ST-AMI). Objective: To determine the predict value of microalbuminuria in patients with ST-AMI. Material and methods: We developed an observational, longitudinal, prospective and analytical cohort study, patients older than 18 years old, any sex, within 24 hours evolution ST-AMI were included. Exposed cohort was defined as MA > 20 µg/min in a 24-hour urine sample within 72 hour of myocardial infarction, and were followed for 30 days and cardiovascular events were recorded. Results: We studied 99 patients; 51 (51.5%) presented MA. Basal clinical features were not significantly different. MA subjects had higher APACHE II, TIMI, EUROSCORE and GRACE scores (p < 0.05 for all). Killip-Kimball ≥ III, arrhythmia, advanced atrioventricular block, cardiogenic shock, re-infarction and death were significantly associated to MA (p < 0.05 for all), and this association remains as an independent death predictor adjusted to TIMI and GRACE scores and right ventricle infarction. In the same way, MA is associated with lower survival rate at 30 day, p = 0.002. Conclusions: Microalbuminuria is an independent risk factor for death at 30 days, and should be included as part of biochemical markers in patients with ST elevation acute myocardial infarction.