Perfil hepático en adultos aparentemente sanos nativos de altura, Junín, 4105 msnm

Biochemical tests were performed to assess the hepatic performance of 50 native subjects from highlands (Community Villa Junín, 4105 m) and a similar group from sea level (Lima, 150 m). In fasting state were determined albumin concentration and the performance of hepatic enzymes, GPT, GOT, ALP, GGT and LDH. Were found significant differences between these parameters; with major difference in albumin, GPT, LDH and lower for FA, comparing natives from highlands front to the ones from level of sea. We also found differences between enzymatic activities of GOT, GPT, LDH and FA according to gender, age and place of origin of the subjects at 95% confidence. Exists correlation between the values of GOT and GGT, and between GPT and GGT, for the native subjects from highlands. Likewise a correlation between GPT and FA, between GOT and GPT; and between albumin and GGT, for subjects from the level of the sea.Se realizaron pruebas bioquímicas para evaluar el estado hepático de 50 sujetos nativos de altura (Comunidad Villa Junín, 4105 m) y un grupo similar de personas nivel del mar (Lima, 150 m). En estado de ayuno se les determinó la concentración de albúmina y la actividad de las enzimas hepáticas: GPT, GOT, FA, GGT y LDH. Se encontró diferencias significativas entre éstos parámetros; siendo mayores en albúmina, GPT, LDH y menor en FA en los sujetos nativos de altura frente a los de nivel del mar. Asimismo se encontró diferencia entre las actividades enzimáticas de GOT, GPT, LDH y FA según el género, edad y lugar de procedencia de los sujetos de estudio al 95% de intervalo de confianza. Existe correlación entre los valores de GOT y GGT, y entre GPT y GGT, para los sujetos nativos de altura. Asimismo una correlación entre GPT y FA, entre GOT y GPT; y entre albúmina y GGT, para sujetos del nivel del mar

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease