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This review focuses on the structural and functional changes occurring in respiratory as well as peripheral muscles in COPD patients. These changes are particular for each muscle territory or compartment. Respiratory muscles predominantly... more
This review focuses on the structural and functional changes occurring in respiratory as well as peripheral muscles in COPD patients. These changes are particular for each muscle territory or compartment. Respiratory muscles predominantly undergo structural adaptive changes. However, they have to do their job in unfavourable mechanical conditions and thus their function is impaired. Peripheral muscles have to be grouped in at least two different compartments: upper and lower limb muscles. The structure and function are relatively preserved in the former, due to the maintenance of some daily activities involving the arms or even the use of some of these muscles in the ventilatory effort. Lower limb muscles in contrast undergo involute structural changes which result in an impairment in their function and in the global exercise capacity of the individual. Deconditioning due to a reduction in daily activities secondary to ventilatory impairment is probably the driving factor for these changes. Although the level of activity appears to be the main determining factor in changes occurring in different territories, this would be modulated by other local and systemic factors, such as inflammation, oxidative stress, drugs and nutritional abnormalities.
Research Interests: Skeletal muscle biology, Immunohistochemistry, Medicine, Biological Sciences, Humans, and 14 moreCOPD, Female, Pubmed, Male, Physical sciences, CHEMICAL SCIENCES, Respiratory Muscles, Sensitivity and Specificity, Reference Values, Peripheral, Respiratory Mechanics, Severity of Illness Index, Compartment syndromes, and Pulmonary Disease Chronic Obstructive
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Research Interests: Microbiology, Medical Microbiology, Medicine, Biological Sciences, Humans, and 15 moreMultidrug Resistance, Female, Male, Bacteria, Antibiotics, European, Aged, Middle Aged, Chi Square Distribution, Case Control Study, Antibiotic Use, Case Control Studies, Multiple Drug Resistance, Medical and Health Sciences, and Cross Infection
Background Epidemiological studies indicate a substantial excess familial recurrence of non-syndromic Tetralogy of Fallot (TOF), implicating genetic factors that remain largely unknown. The Rho induced kinase 1 gene (ROCK1) is a key... more
Background Epidemiological studies indicate a substantial excess familial recurrence of non-syndromic Tetralogy of Fallot (TOF), implicating genetic factors that remain largely unknown. The Rho induced kinase 1 gene (ROCK1) is a key component of the planar cell polarity signalling pathway, which plays an important role in normal cardiac development. The aim of this study was to investigate the role of genetic variation in ROCK1 on the risk of TOF. Results ROCK1 was sequenced in a discovery cohort of 93 non-syndromic TOF probands to identify rare variants. TagSNPs were selected to capture commoner variation in ROCK1. Novel variants and TagSNPs were genotyped in a discovery cohort of 458 TOF cases and 1331 healthy controls, and positive findings were replicated in a further 209 TOF cases and 1290 healthy controls. Association between genotypes and TOF was assessed using LAMP. A rare SNP (c.807C > T; rs56085230) discovered by sequencing was associated with TOF risk (p = 0.006) in th...
Research Interests: Genetics, Biology, Cell Biology, Medicine, Humans, and 15 moreSmooth muscle, Haplotypes, Pi, Clinical Sciences, Angioplasty, Single Nucleotide Polymorphism, Ablation, Cardiac failure, Neointima, Case Control Studies, Cohort Studies, Cell Growth, Cardiovascular medicine and haematology, Pharmacology and pharmaceutical sciences, and Genetic predisposition to disease
From a conceptual and clinical point of view, a comprehensive interpretation of risk factors leading to gastro-esophageal reflux (GER) is translated in this review into an “oil well” analogy: whereas gastric contents represent the oil... more
From a conceptual and clinical point of view, a comprehensive interpretation of risk factors leading to gastro-esophageal reflux (GER) is translated in this review into an “oil well” analogy: whereas gastric contents represent the oil deposit, groups of “on-off” events reflect the presence or absence of specific risk factors and events, respectively, similar to opening and closing a drilling tower. In this dynamic analogy for both the risk and magnitude of GER, we emphasize that generalization of GER risk factors in clinical settings is extremely relevant but fraught with complexity, difficulties and limitations. Therefore, the primary purpose of this review is to examine the effect of the interaction between body positioning, gastrointestinal function, tube feeding, drugs and additional factors on the aspiration risk in critically ill, tube-fed patients.
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Research Interests: Cardiology, Medicine, Humans, COPD, Internal Medicine, and 12 moreThorax, Male, Electromyography, Clinical Sciences, Middle Aged, Respiratory Muscles, Vital Capacity, Muscle Fatigue, Chronic obstructive pulmonary disease, Pulmonary disease, Physical Endurance, and Pulmonary Disease Chronic Obstructive
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Research Interests: Metabolism, Medicine, Humans, COPD, Glucose, and 15 moreBlood Glucose, Female, Male, Multimodal imaging, Aged, Middle Aged, Respiratory System, Carbohydrate metabolism, Radiopharmaceuticals, Glucose Uptake, Cross Sectional Studies, Rectus Abdominis, Quadriceps Muscle, diaphragm, and Pulmonary Disease Chronic Obstructive
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Research Interests: Medicine, Humans, Female, Male, Anesthesia, and 4 moreDrug Delivery Systems, Middle Aged, Oxygen, and Breathing
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Research Interests: Gastroenterology, Adolescent, Medicine, Lung Function, Humans, and 15 moreInternal Medicine, Female, Male, Dlco, Lung, Haematopoiesis, Clinical Sciences, Aged, Middle Aged, Adult, Proportional hazards model, Cohort Studies, Hematopoietic Cell Transplantation, Hematopoietic Stem Cell Transplantation, and hazard ratio
Patients with chronic obstructive pulmonary disease (COPD) frequently have skeletal muscle dysfunction, of either respiratory muscles or those located of the limbs. This dysfunction may appear even at relatively early stages and it... more
Patients with chronic obstructive pulmonary disease (COPD) frequently have skeletal muscle dysfunction, of either respiratory muscles or those located of the limbs. This dysfunction may appear even at relatively early stages and it conditions symptoms and patient’s quality of life. In the case of respiratory muscles, factors that seem to determine muscle dysfunction are, particularly, changes in thorax configuration and an unbalance between decreased energy availability and increased energy demands by the muscle. However, respiratory muscles show signs of structural and metabolic adaptation to this situation, partially compensating the above-mentioned deleterious effects. However, at muscles of the limbs, particularly of the lower limbs, dysfunction seems to be essentially due to deconditioning by physical activity reduction. Structural changes in these muscles are involutional in nature. At both respiratory and peripheral muscles, other factors such as nutritional impairments, inflammation, oxidative stress, some drugs, and the presence of comorbidity seem to play a relevant role. All of them will condition both dysfunction and structural changes, which will be heterogeneous for the different muscle groups in each patient.
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INTRODUCTION: Stroke induces several degrees of respiratory muscle dysfunction (RMdys). Nevertheless, potential benefits resulting from respiratory muscle training (RMT) on these patients remains unknown. The aims of this study were to... more
INTRODUCTION: Stroke induces several degrees of respiratory muscle dysfunction (RMdys). Nevertheless, potential benefits resulting from respiratory muscle training (RMT) on these patients remains unknown. The aims of this study were to assess prevalence of RMdys and to evaluate the benefits of a 3-week RMT in stroke patients. METHODS: The study, including 88 stroke patients (age 67±11 years; 59% male), contemplates two work packages: i) to determine the prevalence and severity of RMdys and; ii) a randomized clinical trial (RMT versus usual care) to assess the impact of a 3-week RMT using the Orygen-Dual Valve®. Main outcome was respiratory muscle strength estimated by the maximal inspiratory and expiratory pressures (PImax and PEmax, respectively). RMdys was considered when PImax or PEmax was under 70% of predicted values. RESULTS: At 12 days after stroke, 71 patients presented impairment in respiratory muscle strength (mean normalized PImax and PEmax were 44±22 and 43±21%, respecti...
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Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19 There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current... more
Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19 There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19 Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection;b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprop...
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Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una entidad de elevada prevalencia, con importantes consecuencias económicas y sanitarias, que derivan en gran parte de la limitación que la enfermedad comporta en la... more
Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una entidad de elevada prevalencia, con importantes consecuencias económicas y sanitarias, que derivan en gran parte de la limitación que la enfermedad comporta en la actividad y expectativas vitales del ...
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Research Interests: Medicine, Humans, COPD, Pulmonary Embolism, Specification Tests, and 15 moreFunctional impairment, Respiratory Failure, Respiratory Muscles, Function Point, Mechanical Stress, Respiratory System, Chronic obstructive pulmonary disease, Thoracic Surgery, Pulmonary ventilation, Mechanical Loading, Hospital Admission, Respiratory insufficiency, Medical and Health Sciences, diaphragm, and Pulmonary Disease Chronic Obstructive
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Queremos compartir este reencuentro de todas/os los colegas afiliados, así como de los múltiples aliados de ASONEUMOCITO en el marco del XIX Congreso Colombiano Neumología y Cirugía de Tórax “MEDICINA RESPIRATORIA DE LA VIDA REAL” en... more
Queremos compartir este reencuentro de todas/os los colegas afiliados, así como de los múltiples aliados de ASONEUMOCITO en el marco del XIX Congreso Colombiano Neumología y Cirugía de Tórax “MEDICINA RESPIRATORIA DE LA VIDA REAL” en Bucaramanga. El Palacio de Congresos de NEOMUNDO constituye un espacio ideal para que desde el 2 y hasta el 5 de marzo podamos compartir, planificar, discutir y avanzar en los objetivos transdisciplinares de nuestra asociación.
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Introduction: in patients with acute pulmonary embolism (PE), local arterial fibrinolysis can have a very favorable relationship between benefits and risks. Objective: to characterize the epidemiological and clinical conditions of... more
Introduction: in patients with acute pulmonary embolism (PE), local arterial fibrinolysis can have a very favorable relationship between benefits and risks. Objective: to characterize the epidemiological and clinical conditions of patients with intermediate-risk of acute PE who have received urgent fibrinolytic therapy directed by catheter. Methods: a descriptive study of a series of cases of patients treated at the Cardiovascular Foundation of Colombia (2012-2016 period) with a diagnosis of intermediate-risk PE who received fibrinolytic therapy using a pulmonary catheter. Results: 27 cases were included (26 patients, 57 ± 20 years, 52% women). Confirmation of acute pulmonary embolism was performed by angiotomography. 85% of the cases showed echocardiographic signs of right ventricular dysfunction, 74% elevation of troponins, and 82% elevation of BNP or pro-BNP. The door-needle time from diagnosis to fibrinolysis was 29 ± 31 hours (max-min, 2-120). The endovascular treatment include...
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Resumen La broncoaspiracion del reflujo gastroesofagico (RGE) es uno de los principales factores de riesgo para la neumonia intrahospitalaria (NIH) y la neumonia asociada a la ventilacion mecanica (NAVM). En el ambito clinico de la vida... more
Resumen La broncoaspiracion del reflujo gastroesofagico (RGE) es uno de los principales factores de riesgo para la neumonia intrahospitalaria (NIH) y la neumonia asociada a la ventilacion mecanica (NAVM). En el ambito clinico de la vida real, la identificacion de las causas del RGE implica una complejidad diagnostica indiscutible, que varia a medida que el paciente esta bajo el cuidado critico. El RGE es modificable en estos pacientes, pero las intervenciones terapeuticas exigen la consideracion de un diagnostico integral de sus causas. Nuestra impresion es que existe un conformismo que interpreta que «ya hacemos todo lo necesario» para prevenir la broncoaspiracion y el RGE en estos pacientes. Si esto fuese cierto, unicamente podemos tener la expectativa de que el efecto Pigmalion convierta nuestras acciones actuales en el «ideal de prevencion» ante el riesgo de NIH. El nombre del efecto Pigmalion surge de un mito griego. Pigmalion era un escultor que se enamoro de Galatea, una de sus obras. Su amor era tan intenso que la creia una mujer real. La escultura cobro vida despues de un sueno del escultor. Este suceso fue denominado efecto Pigmalion, en el cual se superaron las expectativas y creer que la estatua estaba viva llego efectivamente a darle vida. Este mito no resolvera el grave problema que representa la NIH en la realidad de todos los centros hospitalarios del planeta. Por ello, la analogia del «pozo de petroleo» permite interpretar integralmente las causas de RGE y puede ser util para mejorar y agilizar el proceso diagnostico y terapeutico en pacientes criticamente enfermos, y resalta el caracter dinamico de dichas causas de RGE. El tratamiento habitual de un simple procinetico o la posicion semirecumbente se muestran insuficientes para evitar la neumonia nosocomial (NN), por lo cual se han propuesto e identificado otras multiples estrategias adicionales de prevencion. La investigacion traslacional (no el efecto Pigmalion) debe identificar estrategias innovadoras adicionales como dispositivos de aspiracion continua o intermitente, inteligencia artificial, realidad aumentada, o aplicacion de las tecnologias de la informacion y comunicacion (TICs) entre otros, para disenar nuevas formas de intervencion preventiva y terapeutica ante el riesgo de NIH en pacientes hospitalizados en Unidad de Cuidados Intensivos (UCI) por diversas causas y sus graves consecuencias.
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La iniciativa de Red Colombiana de Hipertensión Pulmonar
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Introduction: the study of the causes of hemoptysis entails multiple diagnostic choices and tests. However, in 30% of the cases, a cause is not clearly identified (cryptogenic hemoptysis). Even though pulmonary arteriovenous malformations... more
Introduction: the study of the causes of hemoptysis entails multiple diagnostic choices and tests. However, in 30% of the cases, a cause is not clearly identified (cryptogenic hemoptysis). Even though pulmonary arteriovenous malformations are uncommon, they must be taken into account as possible causes of hemoptysis. Particularly, acquired systemic-to-pulmonary vascular fistulas are atypical and represent both diagnostic and