Relacion entre la diferencia veno-arterial de CO2 y la disfunción miocárdica en niños con sepsis

58 PáginasLa sepsis constituye una de las principales causas de morbilidad y mortalidad en la población pediátrica y una de las principales causas de ingreso a unidades de cuidado intensivo en Colombia y en todo el mundo, con grandes costos para los sistemas de salud (1, 2, 3,4). A nivel mundial, se reportan alrededor de 7,5 millones de niños con sepsis, siendo las principales causas de mortalidad neumonía, diarrea, malaria y sarampión. (5) En Colombia, un estudio multicentrico en unidades con cuidado intensivo pediátrico en población pediátrica con diagnóstico de sepsis, describían que cerca al 48% de los ingresos estaban relacionados al diagnóstico de choque séptico, encontrando entre los focos más frecuentes infecciones respiratorio 54%, abdominal 18% y en el sistema nervioso central 7%. Con una mortalidad final descrita en un 18%% relacionados con infección

The effect of skin-to-skin contact at birth, early versus immediate, on the duration of exclusive human lactancy in full-term newborns treated at the Clínica Universidad de La Sabana: study protocol for a randomized clinical trial

9 páginasBackground Human lactancy is a simple and cost-effective strategy that influences infant and maternal mortality rates. Skin-to-skin contact (SSC) is an immediate postpartum period strategy that has proven to benefit the initiation and continuation of human lactation and to decrease hospitalization during the first week of life. This study aims to determine the effect of SSC initiation at birth (immediate versus early) in healthy, full-term newborns treated at the Universidad de La Sabana Clinic on the duration of exclusive human lactation

Eficacia diagnostica del ácido láctico en liquido cefalorraquídeo en meningitis postclipaje de aneurisma cerebral y hemorragia subaracnoidea

La concentración de ácido láctico en LCR en pacientes con sospecha de meningitis postquirúrgica luego de clipaje de aneurisma cerebral y hemorragia subaracnoidea espontánea se midió prospectivamente por un período de tres años. Se analizaron un total de 32 muestras de líquido cefalorraquídeo, se midió la concentración de ácido láctico y se comparó con el cultivo de LCR. Los cultivos fueron positivos en cinco pacientes, con una prevalencia de infección del 15%. Se utilizó un valor umbral de ácido láctico de 4 mmol/L. y se encontró una sensibilidad del 80%, especificidad del 52%, VPP del 23%, VPN del 93%, y likelihood ratio (LHR) positivo de 1,66 con una probabilidad post test de 15% de la concentración del ácido láctico en el diagnóstico de meningitis postquirúrgica en pacientes con hemorragia subaracnoidea aneurismática. La concentración de ácido láctico en LCR tiene un desempeño limitado en el diagnóstico de meningitis postquirúrgica en pacientes con hemorragia subaracnoidea aneurismática.The lactic acid concentration in cerebrospinal fluid (CSF) was measured in patients with suspected meningitis after aneurysmal clipaje for spontaneous subarachnoid hemorraghe. It was measured in a prospective way during a three years period time. In total were analyzed 32 samples of CSF, the lactic acid concentration was compared against culture of CSF. The CSF culture was positive in 5 patients, with a meningitis prevalence of 15%. We use a cut-off value of 4 mmol/L for lactic acid and we find a sensitivity of 80%, specificity of 52%, VPP of 23%, VPN of 93% and a positive LHR of 1.66 with a posttest probability of 15% for the lactic acid concentration in CSF for the diagnosis of meningitis in patients with aneurysmal clipaje and subarachnoid hemorrhage. The acid lactic concentration in CSF has a limited diagnostic efficacy in patients with subarachnoid hemorrhage and suspected postquirurgical meningitis

Eficacia diagnostica del ácido láctico en liquido cefalorraquídeo en meningitis postclipaje de aneurisma cerebral y hemorragia subaracnoidea

La concentración de ácido láctico en LCR en pacientes con sospecha de meningitis postquirúrgica\ud luego de clipaje de aneurisma cerebral y hemorragia subaracnoidea espontánea se midió\ud prospectivamente por un período de tres años. Se analizaron un total de 32 muestras de líquido\ud cefalorraquídeo, se midió la concentración de ácido láctico y se comparó con el cultivo de LCR. Los\ud cultivos fueron positivos en cinco pacientes, con una prevalencia de infección del 15%. Se utilizó un\ud valor umbral de ácido láctico de 4 mmol/L. y se encontró una sensibilidad del 80%, especificidad\ud del 52%, VPP del 23%, VPN del 93%, y likelihood ratio (LHR) positivo de 1,66 con una probabilidad\ud post test de 15% de la concentración del ácido láctico en el diagnóstico de meningitis postquirúrgica\ud en pacientes con hemorragia subaracnoidea aneurismática. La concentración de ácido láctico en\ud LCR tiene un desempeño limitado en el diagnóstico de meningitis postquirúrgica en pacientes con\ud hemorragia subaracnoidea aneurismática.The lactic acid concentration in cerebrospinal fluid (CSF) was measured in patients with\ud suspected meningitis after aneurysmal clipaje for spontaneous subarachnoid hemorraghe. It was measured\ud in a prospective way during a three years period time. In total were analyzed 32 samples of CSF,\ud the lactic acid concentration was compared against culture of CSF. The CSF culture was positive in 5\ud patients, with a meningitis prevalence of 15%. We use a cut-off value of 4 mmol/L for lactic acid and\ud we find a sensitivity of 80%, specificity of 52%, VPP of 23%, VPN of 93% and a positive LHR of 1.66\ud with a posttest probability of 15% for the lactic acid concentration in CSF for the diagnosis of meningitis\ud in patients with aneurysmal clipaje and subarachnoid hemorrhage. The acid lactic concentration\ud in CSF has a limited diagnostic efficacy in patients with subarachnoid hemorrhage and suspected\ud postquirurgical meningitis

Studies on the organization of the docking complex involved in matrix protein import into glycosomes of Trypanosoma brucei.

Trypanosoma brucei contains peroxisome-like organelles designated glycosomes because they sequester the major part of the glycolytic pathway. Import of proteins into the peroxisomal matrix involves a protein complex associated with the peroxisomal membrane of which PEX13 is a component. Two very different PEX13 isoforms have recently been identified in T. brucei. A striking feature of one of the isoforms, TbPEX13.1, is the presence of a C-terminal type 1 peroxisomal-targeting signal (PTS1), the tripeptide TKL, conserved in its orthologues in all members of the Trypanosomatidae family so far studied, but absent from TbPEX13.2 and the PEX13s in all other organisms. Despite their differences, both TbPEX13s function as part of a docking complex for cytosolic receptors with bound matrix proteins to be imported. We further characterized TbPEX13.1's function in glycosomal matrix-protein import. It provides a frame to anchor another docking complex component, PEX14, to the glycosomal membrane or information to correctly position it within the membrane. To investigate the possible function of the C-terminal TKL, we determined the topology of the C-terminal half of TbPEX13.1 in the membrane and show that its SH3 domain, located immediately adjacent to the PTS1, is at the cytosolic face

Ubiquitination of the glycosomal matrix protein receptor PEX5 in Trypanosoma brucei by PEX4 displays novel features.

Trypanosomatids contain peroxisome-like organelles called glycosomes. Peroxisomal biogenesis involves a cytosolic receptor, PEX5, which, after its insertion into the organellar membrane, delivers proteins to the matrix. In yeasts and mammalian cells, transient PEX5 monoubiquitination at the membrane serves as the signal for its retrieval from the organelle for re-use. When its recycling is impaired, PEX5 is polyubiquitinated for proteasomal degradation. Stably monoubiquitinated TbPEX5 was detected in cytosolic fractions of Trypanosoma brucei, indicative for its role as physiological intermediate in receptor recycling. This modification's resistance to dithiothreitol suggests ubiquitin conjugation of a lysine residue. T. brucei PEX4, the functional homologue of the ubiquitin-conjugating (UBC) enzyme responsible for PEX5 monoubiquitination in yeast, was identified. It is associated with the cytosolic face of the glycosomal membrane, probably anchored by an identified putative TbPEX22. The involvement of TbPEX4 in TbPEX5 ubiquitination was demonstrated using procyclic ∆PEX4 trypanosomes. Surprisingly, glycosomal matrix-protein import was only mildly affected in this mutant. Since other UBC homologues were upregulated, it might be possible that these have partially rescued PEX4's function in PEX5 ubiquitination. In addition, the altered expression of UBCs, notably of candidates involved in cell-cycle control, could be responsible for observed morphological and motility defects of the ∆PEX4 mutant

Venous-arterial CO2 difference in children with sepsis and its correlation with myocardial dysfunction

Objective: This study aimed to determine the association between venous-arterial CO2 difference (Pv-aCO2) and clinical outcomes of interest in children with severe sepsis and septic shock. Design: An analytical observational study of a prospective cohort was conducted. Setting: The study was carried out from January 2015 to January 2018 in the pediatric intensive care unit of a referral hospital. Materials and methods: Of a total of 1159 patients who were admitted to pediatric critical care, 375 had severe sepsis and septic shock, of which 67 fulfilled the inclusion criteria. Arterial and venous gases were drawn simultaneously with a transthoracic echocardiogram, Pv-aCO2, and other measures of tissue perfusion such as arterial lactate, venous, and evolution to multiple organ failure. Measurements and main results: Half (53.7%) of the patients were under 24 months old, with a slight predominance of male patients. The main site of infection was the lungs in 56% of the cases, with a 91.2% survival rate. Patients who died had a higher venous lactate level (interquartile range 16.2-33.6, p = 0.02). However, there was no correlation between myocardial dysfunction seen on echocardiogram and a Pv-aCO2 greater than 6 mm Hg in children with severe sepsis and septic shock (r = 0.13). Pv-aCO2 and central venous saturation had low sensitivity to detect multiple organ failure and poor correlation with the number of compromised systems (r = 0.8). Conclusion: Pv-aCO2 was not associated with myocardial dysfunction, measured by echocardiogram, in children with severe sepsis and septic shock. It also did not correlate with the number of organs involved or mortality. © 2019 Fernández-Sarmiento, Carcillo, Eraso-Díaz del Castillo, Barrera, Orozco, Rodríguez, Gualdrón, licensee HBKU Press

Venous-arterial CO2 difference in children with sepsis and its correlation with myocardial dysfunction

Objective: This study aimed to determine the association between venous-arterial CO2 difference (Pv-aCO2) and clinical outcomes of interest in children with severe sepsis and septic shock. Design: An analytical observational study of a prospective cohort was conducted. Setting: The study was carried out from January 2015 to January 2018 in the pediatric intensive care unit of a referral hospital. Materials and methods: Of a total of 1159 patients who were admitted to pediatric critical care, 375 had severe sepsis and septic shock, of which 67 fulfilled the inclusion criteria. Arterial and venous gases were drawn simultaneously with a transthoracic echocardiogram, Pv-aCO2, and other measures of tissue perfusion such as arterial lactate, venous, and evolution to multiple organ failure. Measurements and main results: Half (53.7%) of the patients were under 24 months old, with a slight predominance of male patients. The main site of infection was the lungs in 56% of the cases, with a 91.2% survival rate. Patients who died had a higher venous lactate level (interquartile range 16.2-33.6, p = 0.02). However, there was no correlation between myocardial dysfunction seen on echocardiogram and a Pv-aCO2 greater than 6 mm Hg in children with severe sepsis and septic shock (r = 0.13). Pv-aCO2 and central venous saturation had low sensitivity to detect multiple organ failure and poor correlation with the number of compromised systems (r = 0.8). Conclusion: Pv-aCO2 was not associated with myocardial dysfunction, measured by echocardiogram, in children with severe sepsis and septic shock. It also did not correlate with the number of organs involved or mortality. © 2019 Fernández-Sarmiento, Carcillo, Eraso-Díaz del Castillo, Barrera, Orozco, Rodríguez, Gualdrón, licensee HBKU Press

Additional file 2: of The effect of skin-to-skin contact at birth, early versus immediate, on the duration of exclusive human lactancy in full-term newborns treated at the Clínica Universidad de La Sabana: study protocol for a randomized clinical trial

List of data collection in the valuation call. (DOCX 13 kb