RESUMEN

Algunos pacientes con EPOC tienen una inflamación eosinofílica de las vías aéreas, tanto en la fase estable como durante las exacerbaciones, lo que ha llevado a sugerir que la EPOC eosinofílica podría ser un fenotipo diferente de la enfermedad. A pesar de ello, existe controversia sobre el papel que desempeña el recuento de los eosinófilos en sangre como un biomarcador en la EPOC. Algunos estudios avalan su uso en la predicción de exacerbaciones y en la evaluación de la capacidad de respuesta a los corticosteroides inhalados. Sin embargo, otros estudios contradicen total o parcialmente estas observaciones. Se han intentado buscar justificaciones para explicar las diferencias observadas en los distintos estudios. En primer lugar, existe variabilidad en el nivel de eosinófilos en sangre en un mismo individuo a lo largo del tiempo. En segundo lugar, aun no se ha establecido el umbral óptimo que permite separar un recuento alto y bajo de eosinófilos en sangre para su uso como un biomarcador, ni la mejor forma de expresarlo, en valor absoluto o en forma de porcentaje. Por otra parte, el recuento de eosinófilos en sangre puede no reflejar fielmente la eosinofilia tisular. Estos factores limitan el empleo aislado de este parámetro en la toma de decisiones

Some patients with COPD have eosinophilic inflammation of the airways, both in the stable phase and during exacerbations, which has led to suggest that eosinophilic COPD could be a different phenotype of the disease. Despite this, there is controversy about the role played by the counting of eosinophils in blood as a biomarker in COPD. Some studies support its use in the prediction of exacerbations and in the evaluation of the ability to respond to inhaled corticosteroids. However, other studies totally or partially contradict these observations. Attempts have been made to look for justifications to explain the differences observed in the different studies. First, there is variability in the level of eosinophils in blood in the same individual over time. Secondly, the optimal threshold for separating a high and low count of eosinophils in blood for use as a biomarker has not yet been established, nor the best way to express it, in absolute value or as a percentage. On the other hand, the eosinophil count in blood may not faithfully reflect tissue eosinophilia. These factors limit the isolated use of this parameter in decision making

Asunto(s)

Asunto(s)

RESUMEN

La Diabetes Mellitus y la Enfermedad Pulmonar Obstructiva Crónica, EPOC, hacen parte de las patologías que clásicamente se han definido como degenerativas y crónicas. La mortalidad en Risaralda reporta la EPOC sistemáticamente entre las tres primeras causas de defunción en la serie desde 1997. La tendencia es al descenso y aunque que la mortalidad por Diabetes Mellitus parece tener una tendencia al descenso, en el último año presenta alza en las tasas de mortalidad. A pesar que existe un sistema de información de morbilidad y mortalidad para la Secretaría Departamental de Salud de Risaralda, no son suficientes las políticas de promoción de la salud con la información reportada por los certificados de defunción, al punto que actualmente se desconocen las características de los factores de riesgo de las personas con diagnóstico de DIABETES y/o EPOC, registrados en las Empresas Sociales del Estado de la red pública del departamento Risaralda.

Asunto(s)

RESUMEN

PURPOSE OF REVIEW: Recently antenatal infection and inflammation have received significant attention because of their potential role in promoting premature labour and in causing morbidity in preterm infants including the development of chronic lung disease of prematurity and cerebral white matter changes. This review highlights recent developments in this field. RECENT FINDINGS: Recent reports have improved our understanding of the inflammatory responses to antenatal infection although questions remain about the exact relationship between antenatal infection and inflammation. Although microbial invasion of the intrauterine cavity is confirmed, strategies to prevent onset of premature labour have not been successful. The association between antenatal infection and development of chronic lung disease has been confirmed and many mechanisms further explored for development of chronic lung disease and cerebral white matter changes. Ureaplasma species have been revisited for their role in both preterm labour and neonatal morbidity, especially as modern molecular methods have eased their identification. SUMMARY: Antenatal infection and inflammation are strongly implicated in the pathogenesis of preterm labour and in the development of neonatal morbidity, specifically chronic lung disease and white matter damage. Ureaplasma species are being increasingly studied for their role in these disorders. The challenge is to develop effective therapies to prevent these conditions.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. PATIENTS: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.

Asunto(s)