Manejo de la falla cardiaca aguda en urgencias: enfoque terapia farmacológica

Según la Sociedad Colombiana de Cardiología, la insuficiencia cardíaca es un síndrome que se caracteriza por alta mortalidad, hospitalizaciones frecuentes y mala calidad de vida, todo en un contexto de múltiples comorbilidades que generan, en su conjunto, un alto costo de atención, por tanto se diseñaron unas medidas farmacológicas, para el manejo de esta patología en el servicio de Urgencias, como pilar fundamental, para el personal médico cuando se enfrenta a un paciente con una crisis aguda. Se revisarán las indicaciones de las diferentes terapias, como son el uso de oxigenoterapia, diuréticos de asa, vasodilatadores, inotrópicos, vasopresores, como terapia inicial, y de otros complementarios como los opiáceos y beta-bloqueadores. El objetivo principal de este artículo es realizar una revisión bibliográfica, basándose principalmente en artículos y guías actualizadas, logrando recopilar la información, acerca del manejo ideal; identificando así, los grupos de fármacos de elección, precauciones y contraindicaciones de los mismos. (MÉD.UIS.2013;26(1):69-79).  According to Colombian society of cardiology, heart failure is a syndrome characterized by high mortality, frequent hospitalization and poor quality of life, particularly in the context of generating multiple comorbidities, overall, a high cost of care, thus pharmacological measures were designed for the management of this condition in the emergency department, as a fundamental pillar for medical staff when faced with a patient with an acute crisis. A review of the indications of different therapies, such as the use of oxygen therapy, loop diuretics, vasodilators, ionotropes, vasopressors, as initial therapy, and others such as opioids, beta-blockers. The main objective of this paper is to review literature, mainly based on articles and updated guidelines, gather information about the ideal management, this identifying the groups of drugs of choice, precautions and contraindications of these. (MÉD.UIS.2013;26(1):69-79).&nbsp

The Hydropathy Index of the HCDR3 Region of the B-Cell Receptor Identifies Two Subgroups of IGHV-Mutated Chronic Lymphocytic Leukemia Patients With Distinct Outcome

© 2021 Rodríguez-Caballero, Fuentes Herrero, Oliva Ariza, Criado, Alcoceba, Prieto, Pérez Caro, García-Montero, González Díaz, Forconi, Sarmento-Ribeiro, Almeida and Orfao.The HCDR3 sequences of the B-cell receptor (BCR) undergo constraints in length, amino acid use, and charge during maturation of B-cell precursors and after antigen encounter, leading to BCR and antibodies with high affinity to specific antigens. Chronic lymphocytic leukemia consists of an expansion of B-cells with a mixed immature and “antigen-experienced” phenotype, with either a mutated (M-CLL) or unmutated (U-CLL) tumor BCR, associated with distinct patient outcomes. Here, we investigated the hydropathy index of the BCR of 138 CLL patients and its association with the IGHV mutational status and patient outcome. Overall, two clearly distinct subgroups of M-CLL patients emerged, based on a neutral (mean hydropathy index of -0.1) vs. negatively charged BCR (mean hydropathy index of -1.1) with molecular features closer to those of B-cell precursors and peripheral/mature B-cells, respectively. Despite that M-CLL with neutral HCDR3 did not show traits associated with a mature B-cell repertoire, important differences in IGHV gene usage of tumor cells and patient outcome were observed in this subgroup of patients once compared to both U-CLL and M-CLL with negatively charged HCDR3 sequences. Compared to M-CLL with negatively charged HCDR3 sequences, M-CLL with neutral HCDR3 sequences showed predominance of men, more advanced stages of the disease, and a greater frequency of genetic alterations—e.g., del(17p)—together with a higher rate of disease progression and shorter time to therapy (TTT), independently of other prognostic factors. Our data suggest that the hydropathy index of the HCDR3 sequences of CLL cells allows the identification of a subgroup of M-CLL with intermediate prognostic features between U-CLL and the more favorable subgroup of M-CLL with a negatively charged BCR.This work was supported by the following grants: FS/37-2017, from the Fundación Memoria D. Samuel Solórzano, Universidad de Salamanca; FIS PI17/00399-FEDER, from the Fondo de Investigación Sanitaria of Instituto de Salud Carlos III, Madrid, Spain; 0639_IDIAL_NET_3_E, from cooperative network EPINTERREG V A España Portugal (POCTEP); and ECRIN-M3, Accelerator Award Full, Cancer Research UK, Fundación Cientıfíca de la Asociación Española Contra el Cáncer (AECC), Fondazione AIRC per la Ricerca sul Cancro.

Residual normal B-cell profiles in monoclonal B-cell lymphocytosis versus chronic lymphocytic leukemia

© The Author(s) 2018.Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries, which is characterized by the accumulation of mature CD5+/CD20lo/CD23+ clonal B-cells in peripheral blood (PB), bone marrow (BM), and other lymphoid tissues [1]. Currently, it is well-established that CLL is systematically preceded by a pre-leukemic stage, known as monoclonal B-cell lymphocytosis (MBL) [2]; MBL includes both low-count (MBLlo) and high-count MBL (MBLhi), depending on the number of PB clonal B-cells (70 y) [4, 5]. The biological and clinical significance of CLL-like clonal B-cells in PB of otherwise healthy individuals (MBLlo) has not been fully elucidated [6,7,8]. Recently, we have reported a very low rate of transformation of MBLlo to MBLhi/CLL, after 7 years of follow-up [8]. In contrast, we found a higher frequency of deaths in MBLlo subjects vs. age- and sex-matched non-MBL healthy adults from the same geographical area; among the former subjects, infection was an overrepresented cause of death (21% vs. 2%, respectively) [8]. This is in line with previous studies showing an ≈3-fold increased risk of infection in both MBLhi and CLL patients, in whom infections also represent a major cause of death [9, 10].This work was supported by the RD06/0020/0035 and RD12/0036/0048 grants from Red Temática de Investigación Cooperativa en Cáncer (RTICC), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, (Madrid, Spain and FONDOS FEDER); CB16/12/00400 and CB16/12/00233 grants, CIBERONC, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, (Madrid, Spain and FONDOS FEDER); the FIS PI06/0824-FEDER, PS09/02430-FEDER, PI12/00905-FEDER, DTS15/00119-FEDER, and PI17/00399-FEDER grants, from the Fondo de Investigación Sanitaria of Instituto de Salud Carlos III; the GRS206/A/08 grant (Ayuda al Grupo GR37 de Excelencia, SAN/1778/2009) from the Gerencia Regional de Salud (Consejería de Educación and Consejería de Sanidad of Castilla y León, Valladolid, Spain). MLG is supported by grant PTA2014-09963-I from the Instituto de Salud Carlos III and AR-C is supported by grant CB16/12/00400, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad

Intermediate Molecular Phenotypes to Identify Genetic Markers of Anthracycline-Induced Cardiotoxicity Risk.

Cardiotoxicity due to anthracyclines (CDA) affects cancer patients, but we cannot predict who may suffer from this complication. CDA is a complex trait with a polygenic component that is mainly unidentified. We propose that levels of intermediate molecular phenotypes (IMPs) in the myocardium associated with histopathological damage could explain CDA susceptibility, so variants of genes encoding these IMPs could identify patients susceptible to this complication. Thus, a genetically heterogeneous cohort of mice (n = 165) generated by backcrossing were treated with doxorubicin and docetaxel. We quantified heart fibrosis using an Ariol slide scanner and intramyocardial levels of IMPs using multiplex bead arrays and QPCR. We identified quantitative trait loci linked to IMPs (ipQTLs) and cdaQTLs via linkage analysis. In three cancer patient cohorts, CDA was quantified using echocardiography or Cardiac Magnetic Resonance. CDA behaves as a complex trait in the mouse cohort. IMP levels in the myocardium were associated with CDA. ipQTLs integrated into genetic models with cdaQTLs account for more CDA phenotypic variation than that explained by cda-QTLs alone. Allelic forms of genes encoding IMPs associated with CDA in mice, including AKT1, MAPK14, MAPK8, STAT3, CAS3, and TP53, are genetic determinants of CDA in patients. Two genetic risk scores for pediatric patients (n = 71) and women with breast cancer (n = 420) were generated using machine-learning Least Absolute Shrinkage and Selection Operator (LASSO) regression. Thus, IMPs associated with heart damage identify genetic markers of CDA risk, thereby allowing more personalized patient management.J.P.L.’s lab is sponsored by Grant PID2020-118527RB-I00 funded by MCIN/AEI/10.13039/ 501100011039; Grant PDC2021-121735-I00 funded by MCIN/AEI/10.13039/501100011039 and by the “European Union Next Generation EU/PRTR”, the Regional Government of Castile and León (CSI144P20). J.P.L. and P.L.S. are supported by the Carlos III Health Institute (PIE14/00066). AGN laboratory and human patients’ studies are supported by an ISCIII project grant (PI18/01242). The Human Genotyping unit is a member of CeGen, PRB3, and is supported by grant PT17/0019 of the PE I + D + i 2013–2016, funded by ISCIII and ERDF. SCLl is supported by MINECO/FEDER research grants (RTI2018-094130-B-100). CH was supported by the Department of Defense (DoD) BCRP, No. BC190820; and the National Cancer Institute (NCI) at the National Institutes of Health (NIH), No. R01CA184476. Lawrence Berkeley National Laboratory (LBNL) is a multi-program national laboratory operated by the University of California for the DOE under contract DE AC02-05CH11231. The Proteomics Unit belongs to ProteoRed, PRB3-ISCIII, supported by grant PT17/0019/0023 of the PE I + D +i, 2017–2020, funded by ISCIII and FEDER. RCC is funded by fellowships from the Spanish Regional Government of Castile and León. NGS is a recipient of an FPU fellowship (MINECO/FEDER). hiPSC-CM studies were funded in part by the “la Caixa” Banking Foundation under the project code HR18-00304 and a Severo Ochoa CNIC Intramural Project (Exp. 12-2016 IGP) to J.J.S

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Manejo de la falla cardiaca aguda en urgencias: enfoque terapia farmacológica

According to Colombian society of cardiology, heart failure is a syndrome characterized by high mortality, frequent hospitalization and poor quality of life, particularly in the context of generating multiple comorbidities, overall, a high cost of care, thus pharmacological measures were designed for the management of this condition in the emergency department, as a fundamental pillar for medical staff when faced with a patient with an acute crisis. A review of the indications of different therapies, such as the use of oxygen therapy, loop diuretics, vasodilators, ionotropes, vasopressors, as initial therapy, and others such as opioids, beta-blockers. The main objective of this paper is to review literature, mainly based on articles and updated guidelines, gather information about the ideal management, this identifying the groups of drugs of choice, precautions and contraindications of these. (MÉD.UIS.2013;26(1):69-79).Según la Sociedad Colombiana de Cardiología, la insuficiencia cardíaca es un síndrome que se caracteriza por alta mortalidad, hospitalizaciones frecuentes y mala calidad de vida, todo en un contexto de múltiples comorbilidades que generan, en su conjunto, un alto costo de atención, por tanto se diseñaron unas medidas farmacológicas, para el manejo de esta patología en el servicio de Urgencias, como pilar fundamental, para el personal médico cuando se enfrenta a un paciente con una crisis aguda. Se revisarán las indicaciones de las diferentes terapias, como son el uso de oxigenoterapia, diuréticos de asa, vasodilatadores, inotrópicos, vasopresores, como terapia inicial, y de otros complementarios como los opiáceos y beta-bloqueadores. El objetivo principal de este artículo es realizar una revisión bibliográfica, basándose principalmente en artículos y guías actualizadas, logrando recopilar la información, acerca del manejo ideal; identificando así, los grupos de fármacos de elección, precauciones y contraindicaciones de los mismos. (MÉD.UIS.2013;26(1):69-79)

Analysis of the livelihoods and the empowerment of peasant communities: an analysis of two rural areas in the department of Boyacá, Colombia

The analysis of the livelihoods and the empowerment of rural communities has become one of the main strategies for characterising and studying rural communities, even more so when, in different parts of the world, these communities are strongly affected by the dynamics of politics and economics. The research aims to analyse the livelihoods and empowerment of two rural communities in the department of Boyacá in Colombia. To this purpose, two communities were chosen, one each from the municipalities of Ventaquemada and Jericó. A case study method was applied, with information being collected through semi-structured interviews with 24 family units. The results allowed significant differences to be found in the progress of the development of livelihoods, which was mainly associated with natural capital. In addition, it was also possible to distinguish differential features between the two study areas, which were associated with the social, economic, and physical environment, and therefore determined the degree of empowerment of family unit members in following a productive vocation in the rural sector

The hydropathy index of the HCDR3 region of the B-Cell receptor identifies two subgroups of IGHV-mutated chronic lymphocytic leukemia patients with distinct outcome

The HCDR3 sequences of the B-cell receptor (BCR) undergo constraints in length, amino acid use, and charge during maturation of B-cell precursors and after antigen encounter, leading to BCR and antibodies with high affinity to specific antigens. Chronic lymphocytic leukemia consists of an expansion of B-cells with a mixed immature and "antigen-experienced" phenotype, with either a mutated (M-CLL) or unmutated (U-CLL) tumor BCR, associated with distinct patient outcomes. Here, we investigated the hydropathy index of the BCR of 138 CLL patients and its association with the IGHV mutational status and patient outcome. Overall, two clearly distinct subgroups of M-CLL patients emerged, based on a neutral (mean hydropathy index of -0.1) vs. negatively charged BCR (mean hydropathy index of -1.1) with molecular features closer to those of B-cell precursors and peripheral/mature B-cells, respectively. Despite that M-CLL with neutral HCDR3 did not show traits associated with a mature B-cell repertoire, important differences in IGHV gene usage of tumor cells and patient outcome were observed in this subgroup of patients once compared to both U-CLL and M-CLL with negatively charged HCDR3 sequences. Compared to M-CLL with negatively charged HCDR3 sequences, M-CLL with neutral HCDR3 sequences showed predominance of men, more advanced stages of the disease, and a greater frequency of genetic alterations-e.g., del(17p)-together with a higher rate of disease progression and shorter time to therapy (TTT), independently of other prognostic factors. Our data suggest that the hydropathy index of the HCDR3 sequences of CLL cells allows the identification of a subgroup of M-CLL with intermediate prognostic features between U-CLL and the more favorable subgroup of M-CLL with a negatively charged BCR.</p

La Rábida : Revista Colombina Iberoamericana. Número 88 - Año VIII

16 páginas12 de octubre.- Biografía del General Maroto.- Rodríguez Hidalgo, Federico: A la memoria de un ángel. Merceditas Terrades de Burgos.- Vázquez, José Andrés: Andalucía. La nueva ruta hacia dentro (del "Imperial" de Madrid).- ¿Día de la Raza?.- Criado, Eduardo: El "Metropolitan" museo de arte de New-York.- Pedro Luis de Gálvez: Poema (para la revista Rábida).- Movimiento americanista.- Fernández Pesquero, Javier: Museo americano.- El 12 de octubre en Huelva.- Ecos americanos.- Pereyra, Carlos: La tradición y la imitación en la vida publica de los países hispanoamericanos (de "Cultura Hispano-americana").- Violetas.- Conocimientos agrícolas.- Esteso y López de Haro, Luis: El Martirio (Poesía).- Curiosidades.