RESUMO
Bilateral lung transplantation is the treatment of end-stage lung diseases. However, sometimes a single lung transplant is performed. The technique is not exempt from complications such as acute hyperinflation of the native lung and changes in the diaphragm, predisposing to atelectasis and respiratory failure that can lead to negative results. Therefore, spontaneous breathing trials may fail and delay the weaning process. The combination of advanced monitoring tools, such as electrical impedance tomography and ultrasonography, to diagnose the cause of this failure, recognizing and quantifying the distribution of lung volume and its dynamic behavior could be crucial to improve outcomes. We present the case of a patient with a one-lung transplant and prolonged mechanical ventilation who, after presenting successive failures in the weaning process, underwent advanced monitoring in order to find the causes of the failure.
El trasplante de pulmón bilateral es el tratamiento de las enfermedades pulmonares en su etapa terminal. Sin embargo, a veces se realiza el trasplante de un solo pulmón. La técnica no está exenta de complicaciones como la hiperinsuflación aguda del pulmón nativo y cambios en el diafragma, predisponiendo a atelectasias e insuficiencia respiratoria que pueden derivar en resultados negativos. Por lo tanto, las pruebas de respiración espontánea pueden fallar y retrasar el proceso de desvinculación de la ventilación mecánica. La combinación de herramientas de monitorización avanzadas, como la tomografía por impedancia eléctrica y la ecografía, para diagnosticar la causa de este fallo, reconociendo y cuantificando la distribución del volumen pulmonar y su comportamiento dinámico, podría ser crucial para mejorar los resultados. Presentamos el caso de un paciente con trasplante unipulmonar y ventilación prolongada que falla en repetidas ocasiones durante la desvinculación de la ventilación mecánica, donde utilizamos herramientas de monitoreo avanzado para detectar la causa de la falla.
Assuntos
Transplante de Pulmão , Respiração Artificial , Humanos , Desmame do Respirador/métodos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.
Assuntos
Hipertensão Pulmonar , Pré-Eclâmpsia , Gravidez , Humanos , Feminino , Adulto , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Altitude , Bolívia/epidemiologia , PulmãoRESUMO
Introduction: There is evidence that Mexican Americans are more likely to have cesarean birth than non-Hispanic White Americans. The purpose of this study was to identify factors related to acculturation along with psychological and sociodemographic factors associated with birth mode in a prospective cohort of Mexican American women in Texas. Methods: This secondary analysis included 244 Mexican American pregnant women. Women with a prior cesarean birth were excluded. Variable selection was guided by Berry's Theoretical Framework of Acculturation. Correlations and logistic regression were used to examine relationships and predict risk of cesarean birth. Mediators and moderators were also considered. Results: Eighty women birthed by cesarean. Analytic and parent samples were similar in all demographics. After controlling for parity in logistic regression, greater Spanish language-related acculturative stress (adjusted odds ratio [AOR], 1.06, 95% confidence interval [CI] [1.01, 1.11], p = .028) and experience of discrimination (AOR, 1.18, 95% CI [1.00, 1.38], p = .044) increased the odds of cesarean birth. The relationship between acculturative stress and birth mode was moderated by birth facility. Conclusion: Acculturative stress and discrimination may play a role in birth mode for Mexican American women birthing in Texas. Birth facility and acculturative stress may be interacting in ways that have clinical significance but are yet unexplored.
Assuntos
Aculturação , Cesárea , Americanos Mexicanos , Feminino , Humanos , Gravidez , Americanos Mexicanos/psicologia , Estudos Prospectivos , Estresse Psicológico , TexasRESUMO
INTRODUCTION: Cesarean rates are particularly high among Hispanic women in some regions of the United States, placing a disproportionate health burden on women and their newborns. This integrative review synthesized the literature on mode of birth (vaginal vs cesarean) and related childbirth complications (hemorrhage, surgical site infection, perineal trauma) among Mexican American women living in the United States. METHODS: Four electronic databases, PubMed, Embase, CINAHL, and SCOPUS, were searched to identify studies meeting the inclusion criteria, research studies that included Mexican American women who were pregnant or postpartum. Results were limited to English language and publications that were peer-reviewed and published before May 2020. Covidence was used in article identification, screening, and assessment. Critical appraisal of the research was performed using the Quality Assessment Tool for Studies with Diverse Designs. RESULTS: Ten articles met inclusion criteria. In some studies, Mexican American women born in the United States were more likely to have cesareans than women born in Mexico; in other studies, these findings were reversed. Mexican American women often had lower unadjusted cesarean rates compared with non-Hispanic white women, but adjusting for birth facility (some facilities perform more cesareans than others), sociodemographic, and risk factors often revealed Mexican American women have a higher adjusted risk for cesarean birth. Women with higher socioeconomic status had higher cesarean rates compared with women with lower socioeconomic status. In studies of birth outcome by level of acculturation, women who were US-oriented had higher rates of cesarean and more frequent perinatal complications. By ethnic subgroup, rates of cesarean and complications varied among Hispanic women. DISCUSSION: Birth facility was associated with perinatal outcomes for Mexican American women; those who gave birth at higher-performing facilities had better outcomes when compared with women who gave birth at lower-performing facilities. After adjusting for pregnancy complications, Mexican American women had a greater risk for cesarean birth compared with non-Hispanic white women, a finding that may have clinical practice implications. Level of acculturation affected birth outcomes, but more research using precise instruments is needed.
Assuntos
Aculturação , Americanos Mexicanos , Cesárea , Feminino , Hispânico ou Latino , Humanos , Recém-Nascido , Parto , Gravidez , Estados Unidos/epidemiologiaRESUMO
Crocodylus moreletii and Crocodylus acutus are two endangered crocodile species endemic to Mexico. In this descriptive cross-sectional study, a total of 58 crocodiles (30 females and 28 males) were examined to determine and evaluate 24 blood biochemical indicators associated with energy, lipid, protein, mineral and enzymatic metabolic processes. Most of the serum biochemistry parameters were similar among sexes by species. However, male crocodiles showed higher triacylglycerol concentration and alkaline phosphatase activity, and lower globulin concentration than females. There were some significant differences between species. Total bilirubin, triacylglycerol, carbon dioxide, and hydrogen carbonate were higher in Crocodylus moreletii, and urea nitrogen, creatinine, alanine aminotransferase, and aspartate aminotransferase were higher in Crocodylus acutus. These reference values are very important for the protection of crocodiles. The calculated confidence intervals could be used to detect alert situations when at least 5% of the sampled crocodiles would fall outside of the calculated reference interval for a given parameter.
Crocodylus moreletii e Crocodylus acutus são duas espécies de crocodilos ameaçadas de extinção endêmicas do México. Neste estudo transversal descritivo, um total de 58 crocodilos (30 fêmeas e 28 machos) foi examinado para determinar e avaliar 24 indicadores da bioquímica sanguínea associados a processos metabólicos energéticos, lipídicos, proteicos, minerais e enzimáticos. A maioria dos parâmetros bioquímicos séricos foram semelhantes entre os sexos da espécie. No entanto, os crocodilos machos apresentaram maior concentração de triacilgliceróis e atividade de fosfatase alcalina do que as fêmeas. Com uma concentração de globulina mais baixa do que as fêmeas, houve algumas diferenças significativas entre as espécies. A bilirrubina total, os triacilgliceróis, o dióxido de carbono e o bicarbonato de sódio foram maiores em Crocodylus moreletii, e o nitrogênio ureico, a creatinina, a alanina aminotransferase e o aspartato aminotransferase foram maiores em Crocodylus acutus. Esses valores de referência são muito importantes para a proteção dos crocodilos. Os intervalos de confiança calculados podem ser usados para detectar situações de alerta quando pelo menos 5% dos crocodilos amostrados estiverem fora do intervalo de referência calculado para um determinado parâmetro.
Assuntos
Animais , Padrões de Referência , Fatores Sexuais , Jacarés e Crocodilos/sangue , Análise Química do Sangue/veterinária , MéxicoRESUMO
Introducción: La enfermedad de Alzheimer (EA) es la principal causa de demencia, caracterizada por pérdida progresiva de memoria. Principal fuente de morbimortalidad en mayores de 65 años. En los últimos 20 años las muertes por EA han aumentado un 145% en el mundo. En Chile no hay estudios actuales que describan mortalidad por EA. El objetivo del presente trabajo es analizar y comparar las tasas de mortalidad (TM) por EA según sexo y grupo etario en Chile entre 2017-2021. Materiales y métodos: Estudio descriptivo, ecológico, sobre defunciones por EA entre 2017-2021 en Chile según sexo y grupo etario (n=10.223). Información obtenida de la base de datos del Departamento de Estadísticas e Información de Salud. Se realizó estadística descriptiva y cálculo de TM. No se requiere comité de ética. Resultados: La máxima TM del periodo fue 11,74 por cada 100.000 habitantes en 2021. El sexo femenino logró la mayor TM en este periodo. El grupo etario con mayor cantidad de defunciones fue el de 81 o más años con 76.6% (7.829) de las defunciones totales. Discusión: Se evidenció mantención y luego ascenso de TM por EA, podría deberse al aumento en la esperanza de vida. La mayor frecuencia de defunciones según sexo y edad, podría explicarse por mayor vulnerabilidad femenina a desarrollar EA y a cambios fisiológicos del envejecimiento. En conclusión, la TM por EA en Chile ha aumentado, probablemente secundario al aumento en la esperanza de vida. Se hace un llamado a continuar el estudio de la patología.
Introduction: Alzheimer's disease (AD) is the most common cause of dementia, characterized by progressive memory loss. It is the main source of morbidity and mortality in individuals over 65 years of age, with age being its primary non-modifiable risk factor. In the last 20 years, deaths from AD have increased by 145% worldwide. However, there are no current studies in Chile that describe mortality from AD. The objective of this study is to analyze and compare mortality rates due to AD according to sex and age group in the Chilean population during the years 2017-2021. Material and Methods: Descriptive, ecological study on deaths from AD between 2017-2021 in Chile, categorized by sex and age group (n=10,223). The database was obtained from the Department of Health Statistics and Information. Descriptive statistics and mortality rate calculations were performed. No ethics committee approval was required. Results: The maximum mortality rate (MR) was observed in 2021 with a value of 11.74 per 100,000 inhabitants. Women had the highest MR in this period. The age group with the highest number of deaths was 81 years or older, accounting for 76.6% (7,829) of the total deaths. Discussion: A plateau and subsequent increase in MR due to AD were observed, possibly explained by the increase in life expectancy. The higher frequency of deaths in women and specific age groups may be attributed to the higher vulnerability of women to developing AD and physiological changes related to aging. In conclusion, the MR from AD has increased in Chile, likely due to the rise in life expectancy, emphasizing the importance of continued research on this pathology.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Doença de Alzheimer/mortalidade , Doença de Alzheimer/epidemiologia , Chile/epidemiologia , Epidemiologia Descritiva , Distribuição por Idade e SexoRESUMO
Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.
Assuntos
Malformações Arteriovenosas/cirurgia , Retalhos de Tecido Biológico/cirurgia , Deformidades Congênitas da Mão/cirurgia , Salvamento de Membro/métodos , Coxa da Perna/cirurgia , Adolescente , Malformações Arteriovenosas/diagnóstico por imagem , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Mãos/irrigação sanguínea , Mãos/diagnóstico por imagem , Mãos/cirurgia , Deformidades Congênitas da Mão/diagnóstico por imagem , Humanos , Microcirurgia/métodos , Coxa da Perna/irrigação sanguíneaRESUMO
AIMS: To test a model of psychosocial/cultural/biological risk factors for poor birth outcomes in Latina pregnant women. DESIGN: An observational study measuring acculturation, progesterone, cortisol, cotinine, age, marital status, income, stress, depressive symptoms and coping. We tested a structural equation model to predict risk. METHODS: We obtained a convenience sample (N = 515) of low medical risk pregnant Mexican American Hispanic women at 22-24 weeks of gestation. Bilingual research nurses collected data from blood, urine and questionnaires. Self-report measures were the Beck Depression Inventory-II, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II and the Brief Cope. We measured progesterone and cortisol in plasma and cotinine levels in urine by enzyme-linked immunoassays. RESULTS: A PLS-SEM model revealed that Mexican American Hispanic pregnant women who were younger, single, lower income, more acculturated and who had greater negative coping, stress and depression were most at risk for having earlier and smaller babies.
Assuntos
Hispânico ou Latino , Americanos Mexicanos , Complicações na Gravidez , Aculturação , Feminino , Humanos , Lactente , Gravidez , Resultado da Gravidez , Gestantes , Fatores de RiscoRESUMO
Hyperinflammation distinguishes COVID-19 patients who develop a slight disease or none, from those progressing to severe and critical conditions. CIGB-258 is a therapeutic option for the latter group of patients. This drug is an altered peptide ligand (APL) derived from the cellular stress protein 60 (HSP60). In preclinical models, this peptide developed anti-inflammatory effects and increased regulatory T cell (Treg) activity. Results from a phase I clinical trial with rheumatoid arthritis (RA) patients indicated that CIGB-258 was safe and reduced inflammation. The aim of this study was to examine specific biomarkers associated with hyperinflammation, some cytokines linked to the cytokine storm granzyme B and perforin in a cohort of COVID-19 patients treated with this peptide. All critically ill patients were under invasive mechanical ventilation and received the intravenous administration of 1 or 2 mg of CIGB-258 every 12 h. Seriously ill patients were treated with oxygen therapy receiving 1 mg of CIGB-258 every 12 h and all patients recovered from their severe condition. Biomarker levels associated with hyperinflammation, such as interleukin (IL)-6, IL-10, tumor necrosis factor (TNF-α), granzyme B, and perforin, significantly decreased during treatment. Furthermore, we studied the ability of CIGB-258 to induce Tregs in COVID-19 patients and found that Tregs were induced in all patients studied. Altogether, these results support the therapeutic potential of CIGB-258 for diseases associated with hyperinflammation. Clinical trial registry: RPCEC00000313.
Assuntos
Anti-Inflamatórios/uso terapêutico , Tratamento Farmacológico da COVID-19 , Chaperonina 60/uso terapêutico , Síndrome da Liberação de Citocina/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/química , COVID-19/sangue , COVID-19/complicações , Chaperonina 60/química , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/complicações , Feminino , Humanos , Inflamação/sangue , Inflamação/complicações , Inflamação/tratamento farmacológico , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/efeitos dos fármacos , Linfócitos T Reguladores/efeitos dos fármacos , Fator de Necrose Tumoral alfa/sangue , Adulto JovemRESUMO
Lactose intolerance is a condition with an elevated prevalence worldwide, especially in Latin American, Asian, and African countries. The aim of the present narrative review was to highlight the importance of accurately diagnosing lactose intolerance to prevent self-diagnosis that results in the unnecessary elimination of milk and dairy products from the diet and the consequent deprivation of nutrients that could be essential at certain stages of life. The pathophysiologic mechanism of deficient lactose absorption in the intestine can be primary, secondary to other enteropathies, or coexistent with other intestinal diseases with similar symptoms, such as irritable bowel syndrome, bacterial overgrowth syndrome, or celiac disease, causing confusion in relation to diagnosis and treatment. Lactose intolerance consists of a set of symptoms attributed to the consumption of milk and dairy products that are assumed to be due to deficient digestion of that disaccharide. A wide range of tests have been validated to detect deficient digestion that include blood tests, genetic mutation analyses, breath tests, and recently, a urine test, all of which are described in the present article. Nevertheless, there are few validated questionnaires for symptom evaluation and measurement, partly due to the heterogeneity of concepts and the subjectivity of each of the symptoms.