Angiogenic and inflammatory markers in acute respiratory distress syndrome and renal injury associated to A/H1N1 virus infection.

Acute kidney injury (AKI) is often associated to acute respiratory distress syndrome (ARDS) due to influenza A/H1N1 virus infection. The profile of angiogenic and inflammatory factors in ARDS patients may be relevant for AKI. We analyzed the serum levels of several angiogenic factors, cytokines, and chemokines in 32 patients with A/H1N1 virus infection (17 with ARDS/AKI and 15 ARDS patients who did not developed AKI) and in 18 healthy controls. Significantly higher levels of VEGF, MCP-1, IL-6, IL-8 and IP-10 in ARDS/AKI patients were detected. Adjusting by confusing variables, levels of MCP-1 ≥150 pg/mL (OR=12.0, p=0.04) and VEGF ≥225 pg/mL (OR=6.4, p=0.03) were associated with the development of AKI in ARDS patients. Higher levels of MCP-1 and IP-10 were significantly associated with a higher risk of death in patients with ARDS (hazard ratio (HR)=10.0, p=0.02; HR=25.5, p=0.03, respectively) even taking into account AKI. Patients with influenza A/H1N1 infection and ARDS/AKI have an over-production of MCP-1, VEGF and IP-10 possibly contributing to kidney injury and are associated to a higher risk of death.

Mitochondrial haplogroups associated with end-stage heart failure and coronary allograft vasculopathy in heart transplant patients.

AIMS: Mitochondrial haplogroups are known to influence individual predisposition to a wide spectrum of metabolic and degenerative diseases, including ischaemic cardiovascular diseases. We have examined the influence of the mitochondrial DNA (mtDNA) background on the development of human end-stage heart failure (HF) in patients undergoing heart transplantation. The influence of mtDNA haplogroups on the incidence of transplant-related complications, mainly cardiac allograft vasculopathy (CAV), and on post-transplant survival was also studied. METHODS AND RESULTS: The most common mitochondrial haplogroups in European populations were genotyped in 450 heart transplant recipients, 248 heart transplant donors, and 206 healthy controls. Mitochondrial haplogroups were determined by PCR amplification of short mtDNA fragments, followed by restriction fragment length polymorphism analysis. After adjustment for age and sex the frequency of haplogroup H was significantly higher in heart transplant recipients than in controls [OR: 1.86 (95% confidence intervals, CI: 1.27-2.74), P= 0.014], and in heart donors [OR: 1.47 (95% CI: 0.99-2.19), P= 0.032]. Likewise, haplogroup Uk was found significantly more frequently among CAV patients than in non-CAV heart allograft recipients [OR: 4.1 (95% CI: 1.51-11.42), P= 0.042]. Finally, heart donor haplogroups had no influence on the morbidity or mortality after heart transplantation. CONCLUSIONS: Mitochondrial haplogroups behave like risk factors for the progress to end-stage HF in a Spanish cardiac transplant population. Mitochondrial DNA variants may have some influence on the appearance of cardiac transplant complications.

Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery.

STUDY OBJECTIVES: To determine the analgesic efficacy of dexmedetomidine in the early postoperative period. DESIGN: Randomized, double-blind, double placebo-controlled clinical trial. SETTING: University medical center. PATIENTS: 30 ASA physical status I, II, and III patients with cruciate ligament lesion and joint fibrosis who were scheduled for knee arthroscopy. INTERVENTIONS: Patients were prospectively randomized to receive dexmedetomidine one mcg/kg(-1) intravenously (IV), for 10 minutes followed by dexmedetomidine 0.3 mcg/kg(-1) for 50 minutes or propacetamol two g, IV, for 10 minutes. MEASUREMENTS: Pain scores, time to onset analgesia, and morphine consumption were measured. Open-label rescue morphine 5 mg IV was available as needed during the postdosing evaluation period of 8 hours. Hemodynamic data, sedation scores, and renal and hepatic function were assessed for control of adverse events. MAIN RESULTS: Pain scores with dexmedetomidine and propacetamol were similar. There were no differences in the number of patients who required supplemental rescue analgesia (7/15 vs 4/15; P = 0.44), but total morphine requirements were higher with dexmedetomidine (45 mg) versus propacetamol (20 mg) in the 8-hour follow-up (P < 0.05). The most frequent adverse events with dexmedetomidine were bradycardia and hypertension. CONCLUSIONS: Dexmedetomidine provides a modest analgesic effect after knee arthroscopy, but the side effects of this drug, such as hypertension and bradycardia, may restrict the use of large bolus doses.

Antimicrobial susceptibility and tetracycline resistance determinant genotyping of Gallibacterium anatis.

The present investigation was undertaken to assess the antimicrobial susceptibility of a collection of 58 Gallibacterium isolates. All strains were tested by the broth dilution method using the veterinary fastidious medium. A total of 46 field strains were tested, whereof 23 were clinical isolates from 10 Mexican layer flocks and another 23 isolates originated from 13 clinically healthy poultry flocks in Denmark. In addition, 12 Gallibacterium reference strains that had been isolated some 30-40 years ago were included. The 58 strains were tested against 23 compounds of different classes. Multidrug resistance (resistance towards≥three drugs) was observed for 65% of the field strains and only two strains were susceptible to all compounds. Most prominently, resistance to tetracycline and sulfamethoxazole was observed in 92% and 97% of the field strains, respectively. For comparison these figures were 67% and 42%, respectively, for the reference strains. Genotyping of tetracycline resistance determinants was performed with primers specific for tet(A-E, H, K-M, O). Strains positive for tet(B), tet(H) and tet(L) were identified, however, in 20 out of 49 tetracycline resistant strains no determinant was identified. This is the first study to determine the antimicrobial susceptibility of Gallibacterium anatis by MIC revealing that multidrug resistance is very common among G. anatis field isolates. tet(B) was by far the most common determinant identified but future work should aim at identifying the tetracycline resistance determinants in the remaining 41% of strains where no determinant was assigned.

Genetic basis of end-stage hypertrophic cardiomyopathy.

AIMS: Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous presentation and clinical course. A minority of HCM patients develop end-stage HCM and require cardiac transplantation. The genetic basis of end-stage HCM is unknown but small series, isolated case reports and animal models have related the most aggressive heart failure course with the presence of multiple mutations. METHODS AND RESULTS: Twenty-six patients (age 40.4 ± 14.5 years; 46% male) transplanted for end-stage HCM underwent genetic screening of 10 HCM-related genes (MYH7, MYBPC3, TNNT2, TNNI3, TPM1, TNNC1, MYL3, MYL2, ACTC, LDB3). Additional genetic screening of LAMP2/PRKAG2 and mitochondrial DNA (mtDNA) was performed in four and three cases, respectively. Findings were correlated with clinical and histological features. Pathogenic mutations were identified in 15 patients (58%). Thirteen patients (50%) had mutations in sarcomeric genes (six in MYH7, three in MYBPC3, two in MYL2, one in TNNI3, and one in MYL3) and two patients had mutations in LAMP2. Only three patients (13%) had double mutations and all in homozygosis. Except for a more frequent family history of HCM, patients with mutations in sarcomeric genes did not show any clinical feature that distinguished them from patients without mutations in these genes. Evaluation of 44 relatives from 12 families identified 13 mutation carriers, 9 of whom had an overt HCM phenotype. CONCLUSION: Heart transplanted HCM has a heterogeneous genetic background where multiple mutations are uncommon. The clinical course of HCM is not primarily dependent on the presence of multiple sarcomeric mutations. Clinical and genetic evaluation of relatives does not support differential clinical management in HCM based on genetics.

Experiencias en la Endoscopía de urgencia en el sangramiento digestivo alto / Experiences in emergency endoscopy for upper gastrointestinal bleeding

Se estudiaron mediante endoscopía de urgencia los pacientes afectados de sangramiento digestivo alto en el período de 1991 a 1993, con el fin de conocer la importancia y valorar pronóstico de la endoscopía temprana, mortalidad, letalidad, necesidad quirúrgica y afecciones sangrantes más frecuentes. De las 662 urgencias realizadas, el 4,6 por ciento fueron pacientes con sangramiento digestivo alto y de éstos, el 61 por ciento presentaron úlcera péptica, el 34 por ciento duodenales y el 26 por ciento gástricas, que constituyeron las afecciones más frecuentemente diagnosticadas. La letalidad global por sangramiento digestivo alto fue de 16 por ciento; la mortalidad, de 4,1 por ciento y el sangramiento como primera causa de muerte, de 3,9 por ciento. En los pacientes con úlceras sangrantes, la letalidad fue de 9,9 por ciento y la mortalidad de 1,5 por ciento. La necesidad de intervención quirúrgica en los pacientes con sangramiento fue de 20,7 por ciento y en los de úlcera 27,2 por ciento. La estadía hospitalaria promedio fue de 14 días. Se definió la importancia de la endoscopia precoz como diagnóstico y pronóstico en el sangramiento digestivo alto, pero ella sola no es suficiente para disminuir la mortalidad y la letalidad. Se puso de manifiesto la necesidad de la endoscopía terapéutica en estos casos, para lograr cifras por debajo del 4 por ciento de mortalidad