Rendimiento diagnóstico de CGH-­arrays en pacientes pediátricos con retraso en desarrollo y/o dismorfias

Los estudios mediante CGH-­arrays (Comparative Genomic Hybridization) han aumentado el diagnóstico de cromosomopatías por alteración en número de copias. Estos cuadros muestran como síntomas principales una combinación de rasgos dismórficos con Retraso en Desarrollo en los primeros años de vida o evolución hacia Discapacidad Intelectual (DI) o Trastorno de Espectro Autista (TEA).Grado en Medicin

Influence of renal dysfunction on the differential behaviour of procalcitonin for the diagnosis of postoperative infection in cardiac surgery

Producción CientíficaBackground: procalcitonin is a valuable marker in the diagnosis of bacterial infections; however, the impairment of renal function can influence its diagnostic precision. The objective of this study is to evaluate the differential behaviour of procalcitonin, as well as its usefulness in the diagnosis of postoperative pulmonary infection after cardiac surgery, depending on the presence or absence of impaired renal function. Materials and methods: A total of 805 adult patients undergoing cardiac surgery with extracorporeal circulation (CBP) were prospectively recruited, comparing the behaviour of biomarkers between the groups with and without postoperative pneumonia and according to the presence or absence of renal dysfunction. Results: Pulmonary infection was diagnosed in 42 patients (5.21%). In total, 228 patients (28.32%) presented postoperative renal dysfunction. Procalcitonin was significantly higher in infected patients, even in the presence of renal dysfunction. The optimal procalcitonin threshold differed markedly in patients with renal dysfunction compared to patients without renal dysfunction (1 vs. 0.78 ng/mL p < 0.05). The diagnostic accuracy of procalcitonin increased significantly when the procalcitonin threshold was adapted to renal function. Conclusions: Procalcitonin is an accurate marker of postoperative infection in cardiac surgery, even in the presence of renal dysfunction. Renal function is an important determinant of procalcitonin levels and, therefore, its diagnostic thresholds must be adapted in the presence of renal dysfunction.Instituto de Salud Carlos III - (grant COV20/00491, PI18/01238, CIBERINFEC CB21/13/00051)Junta de Castilla y León - (grant VA321P18, GRS 1922/A/19, GRS 2057/A/19)Junta de Castilla y León, Consejería de Educación - (grant VA256P20)Fundación Ramón Areces - (grant CIVP19A5953)Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER)/Fondo Social Europeo - (grant CM20/00138

Shock séptico: abordaje y tratamiento

Video explicativo sobre cómo abordar la sepsis y los distintos tratamientos que se pueden aplicar

Sepsis fisiopatología

Video explicativo sobre la sepsis en el que describe los modelos que han justificado el desarrollo del shock séptico, su fisiopatología, las alteraciones inflamatorias/inmunológicas y los tipos de sepsis que existen

Sepsis concepto

Video explicativo sobre en qué consiste la sepsis desde un punto de vista conceptual y su nueva definición actual

Impact of oxygen delivery on the development of acute kidney injury in patients undergoing valve heart surgery

One of the strongest risk factors for death in individuals undergoing cardiac surgery is Cardiac Surgery Associated-Acute Kidney Injury (CSA-AKI). Although the minimum kidney oxygen delivery index (DO2i) during cardiopulmonary bypass (CPB) has been reported, the optimal threshold value has not yet been established. A prospective study was conducted from June 2012 to January 2016 to asses how DO2i influences the pathogenesis of CSA-AKI, as well as its most favorable cut-off value. DO2 levels were recorded at the beginning, middle, and end of the CPB. The association between DO2i and CSA-AKI was investigated using multivariable logistic regression analysis. The optimal cut-off of DO2i as a predictor of CSA-AKI was determined using Classification and Regression Tree (CART) analysis. A total of 782 consecutive patients were enrolled. Of these, 231 (29.5%) patients developed AKI. Optimal DO2i thresholds of 303 mL/min/m2 during the CPB and 295 mL/min/m2 at the end of the intervention were identified, which increased the odds of CSA-AKI almost two-fold (Odds Ratio (OR), 1.90; 95% CI, 1.12-3.24) during the surgery and maintained that risk (OR 1.94; 95% CI, 1.15-3.29) until the end. Low DO2i during cardiopulmonary bypass is a risk factor for CSA-AKI that cannot be ruled out. Continuous renal oxygen supply monitoring for adult patients could be a promising method for predicting AKI during CPB