Impact of Study Design on Reported Incidences of Acute Mountain Sickness: A Systematic Review.

AIMS: Published incidences of acute mountain sickness (AMS) vary widely. Reasons for this variation, and predictive factors of AMS, are not well understood. We aimed to identify predictive factors that are associated with the occurrence of AMS, and to test the hypothesis that study design is an independent predictive factor of AMS incidence. We did a systematic search (Medline, bibliographies) for relevant articles in English or French, up to April 28, 2013. Studies of any design reporting on AMS incidence in humans without prophylaxis were selected. Data on incidence and potential predictive factors were extracted by two reviewers and crosschecked by four reviewers. Associations between predictive factors and AMS incidence were sought through bivariate and multivariate analyses for different study designs separately. Association between AMS incidence and study design was assessed using multiple linear regression. RESULTS: We extracted data from 53,603 subjects from 34 randomized controlled trials, 44 cohort studies, and 33 cross-sectional studies. In randomized trials, the median of AMS incidences without prophylaxis was 60% (range, 16%-100%); mode of ascent and population were significantly associated with AMS incidence. In cohort studies, the median of AMS incidences was 51% (0%-100%); geographical location was significantly associated with AMS incidence. In cross-sectional studies, the median of AMS incidences was 32% (0%-68%); mode of ascent and maximum altitude were significantly associated with AMS incidence. In a multivariate analysis, study design (p=0.012), mode of ascent (p=0.003), maximum altitude (p<0.001), population (p=0.002), and geographical location (p<0.001) were significantly associated with AMS incidence. Age, sex, speed of ascent, duration of exposure, or history of AMS were inconsistently reported and therefore not further analyzed. CONCLUSIONS: Reported incidences and identifiable predictive factors of AMS depend on study design.

Clave para la determinación de exuvias pupales de los quironómidos (Diptera: Chironomidae) de ríos altoandinos tropicales

The Chironomidae is a cosmopolitan family of Nematoceran flies with more than 20 000 species described. However the diversity of genera and species of the family in the Andean region beyond the 2 000m.a.s.l are scarcely known. We conducted faunal surveys and biomonitoring research in different streams of Colombia, Ecuador and Peru from May 2005 to October 2011. Based on specimens collections, and a taxonomic key was developed to identify pupae and pupal exuviae of 46 genera of midges (Diptera, Chironomidae) collected from streams at high altitude areas on the Andean tropical mountains. We included illustrations and brief taxonomic descriptions for all genera, of which several ones have not yet been formally described; in this latter case we used the nomenclature of Roback & Coffman (1983). For two genera, Cricotopus and Genus 1, keys to the most common morphospecies were provided. Results showed that in this area the chironomid assemblages are dominated by the members of the subfamily Orthocladiinae (22 genera) followed by the Chironominae (13). Six genera of Tanypodinae were identified, while only three and two genera were present from subfamilies Podonominae and Diamesinae. This key may be very useful for both studies about drift in streams, and for biomonitoring purposes.

Rock outcrop vegetation in Brazil: a brief overview

This paper overviews the special issue of the Brazilian Journal of Botany dedicated to "Rock outcrop vegetation in Brazil". The main topics covered by this issue are phytogeography and vegetation ecology, plant life on shallow soils, plant reproduction and auto-ecology, morpho-physiology and plant adaptation, and finally conservation and global change. This collection of studies, in addition to other recent publications on Brazilian rocky outcrop vegetation, show that measurements of most of the relevant ecological and evolutionary parameters are under way and that scientific attention is now given to most Brazilian regions. However, there are still several gaps to be bridged: 1) inselbergs and high mountains in the Amazon and the Brazilian northeast, in particular, are still largely unknown to science; 2) long-term studies are almost totally unavailable, which hinders global change monitoring and assessment; 3) national and international networking are urgently needed to speed up scientific production about such habitats.

Soils associated with rock outcrops in the Brazilian mountain ranges Mantiqueira and Espinhaço

Espinhaço and Mantiqueira are two mountain ranges of great importance in Brazil. In the uppermost parts of these areas, unique ecosystems occur, generally associated with rock outcrops, they are collectively called High Altitude Rocky Complexes. These environments show distinct soil and biota characteristics in relation to the surrounding biome. The soils are generally shallow, coarse textured, with high Al3+ and varying amounts of organic matter. Entisols, Inceptsols and Histosols are dominant, directly associated with the rock outcrops, and forming a complex mosaic of soils. Some of these soils are endemic, based on peculiar conditions of parent materials, topography and vegetation, and this pedodiversity is important for detecting unique and endangered soils. In these soils, organic matter is highly humified, with a great amount of soluble forms and conspicuous presence of charcoal. Spodic horizons and dark water rivers are typically associated with quartzite and quartzite outcrops, formed by illuviation of organic compounds, being less common in granitic rocks. The very low nutrient content of these soils and other environmental limitations required the development of specific physiological and morphological plant adaptations. Most high altitude environments are unstable under current climatic conditions, and anthropic interventions may be accelerating this process. Detailed soil surveys are necessary for a better understanding of the role of these soils in ecological processes and for the development of adequate conservation policies.

Structural analysis of the vegetation on a highland granitic rock outcrop in Southeast Brazil

Granitic rock outcrops of the Brazilian southeast are either coastal or inland. The latter can often have high altitudes, such as in the summits of "Serra do Mar" and "Serra da Mantiqueira", where they are known as "Campos de Altitude". The landscape on these high altitude plateaux is often a mosaic of shrubs and treelets within a bunchgrass matrix, with sparse pteridophytes and other herbs, interspersed with variable extensions of rock outcrops. Despite the pervasiveness of rock outcrops in the Brazilian landscape, studies on the structural analysis of the vegetation on such formations are scarce. This study aimed to analyze the structure of the vegetation on a highland granitic rock outcrop in "Parque Estadual da Serra do Brigadeiro", state of Minas Gerais, Southeast Brazil (42°20' - 42°40' S and 20°20' - 21°00' W, 1,722 m of elevation ). Quantitative parameters of absolute and relative frequency and dominance (cover) were estimated. The group analysis used the Jaccard similarity index. Trilepis lhotzkiana, Panicum sp. 1, and Vellozia variegata presented the highest relative frequencies, relative dominances and importance values. These three species, along with Dyckia bracteata, Rhynchospora emaciate, and Tibouchina cf. manicata, represented 98.3% of the relative dominance. The remaining 1.7% referred to 22 remaining species. The distinction among quadrats within formed groups by cluster analysis was due to the great number of low frequency species.

Floristic composition and phytogeography of the tree component of Araucaria Forest fragments in southern Brazil

The present study examined the floristic composition of three fragments of Araucaria Forest (AF) in the Planalto Catarinense region of southern Brazil as well as the floristic contextualization of these areas in relation to other remnant AF sites. Three AF fragments at different altitudes were analyzed in the municipalities of Campos Novos, Lages, and Painel. Fifty 200 m² plots were examined in each fragment and all of the trees with CBH (circumference at breast height) > 15.7 cm were identified. In order to floristically contextualize the study fragments, comparisons were made with other remnant AF sites by way of dendrograms and NMDS (Non-metric multidimensional scaling). Environmental and spatial variables were plotted on the diagram produced by the NMDS to evaluate their influence on the floristic patterns encountered. The forest fragments studied demonstrated high floristic heterogeneity, indicating that AFs cannot be considered homogeneous formations and they could be classified into 3 phytogeographical categories: i) high altitude areas influenced by cloud cover/fog, including the Painel region; ii) areas of lesser altitude and greater mean annual temperatures situated in the Paraná River basin, and iii) areas situated in the Paraná and Upper-Uruguay river basins and the smaller basins draining directly into the southern Atlantic, near Campos Novos and Lages. The environmental variables most highly correlated with species substitutions among the sites were altitude, mean annual temperature, and the mean temperature of the most humid trimester.

Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia). The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD) and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS). The objective of the present study was to perform a quantitative analysis of the histology of carotid bodies collected from patients who died of ARDS. A morphometric study of carotid bodies collected during routine autopsies was carried out on three groups: patients that died of non-respiratory diseases (controls, N = 8), patients that presented COPD and died of its complications or associated diseases (N = 7), and patients that died of ARDS (N = 7). Morphometric measurements of the volume fraction of clusters of chief cells were performed in five fields on each slide at 40X magnification. The numerical proportion of the four main histological cell types (light, dark, progenitor and sustentacular cells) was determined analyzing 10 fields on each slide at 400X magnification. The proportion of dark cells was 0.22 in ARDS patients, 0.12 in controls (P<0.001), and 0.08 in the COPD group. The proportion of light cells was 0.33 (ARDS), 0.44 (controls) (P<0.001), and 0.36 (COPD). These findings suggest that chronic and acute hypoxia have different effects on the histology of glomic tissue.

Approche cartésienne pour le calcul du vent en terrain complexe avec application à la propagation des feux de forêt

La méthode de projection et l'approche variationnelle de Sasaki sont deux techniques permettant d'obtenir un champ vectoriel à divergence nulle à partir d'un champ initial quelconque. Pour une vitesse d'un vent en haute altitude, un champ de vitesse sur une grille décalée est généré au-dessus d'une topographie donnée par une fonction analytique. L'approche cartésienne nommée Embedded Boundary Method est utilisée pour résoudre une équation de Poisson découlant de la projection sur un domaine irrégulier avec des conditions aux limites mixtes. La solution obtenue permet de corriger le champ initial afin d'obtenir un champ respectant la loi de conservation de la masse et prenant également en compte les effets dûs à la géométrie du terrain. Le champ de vitesse ainsi généré permettra de propager un feu de forêt sur la topographie à l'aide de la méthode iso-niveaux. L'algorithme est décrit pour le cas en deux et trois dimensions et des tests de convergence sont effectués.

Modélisation de l'irradiance solaire totale et spectrale et applications à la chimie stratosphérique terrestre

Cette thèse présente des reconstructions de l'irradiance totale et spectrale durant les 400 dernières années à l'aide des modèles pour l'irradiance totale et l'irradiance spectrale dans l'ultraviolet développés à l'Université de Montréal. Tous deux sont basés sur la simulation de l'émergence, de la fragmentation et de l'érosion des taches solaires, qui permet d'obtenir une distribution de l'aire des taches sombres et des facules brillantes en fonction du temps. Ces deux composantes sont principalement responsables de la variation de l'irradiance sur l'échelle de temps de la décennie, qui peut être calculée en sommant leur émissivité à celle de la photosphère inactive. La version améliorée du modèle d'irradiance solaire spectrale MOCASSIM inclut une extension de son domaine spectral entre 150 et 400 nm ainsi que de son domaine temporel, débutant originalement en 1874 et couvrant maintenant la période débutant en 1610 jusqu'au présent. Cela permet de reconstruire le spectre ultraviolet durant le minimum de Maunder et de le comparer à celui du minimum de 2009. Les conclusions tirées de cette étude spécifient que l'émissivité dans l'ultraviolet était plus élevée en 2009 que durant le minimum de Maunder, que le niveau de base de la photosphère non magnétisée contribuait pour environ les deux tiers de cette différence et que les structures magnétiques restantes étaient responsables pour le tiers restant. Le modèle d'irradiance totale a vu son domaine temporel étendu sur la même période et une composante représentant le réseau magnétique de façon réaliste y a été ajoutée. Il a été démontré que les observations des 30 dernières années ne sont bien reproduites qu'en incluant la composante du Soleil non magnétisé variable à long terme. Le processus d'optimisation des paramètres libres du modèle a été effectué en minimisant le carré de la somme de l'écart journalier entre les résultats des calculs et les données observées. Les trois composites disponibles, soit celui du PMOD (Physikalisch Meteorologisches Observatorium Davos), d'ACRIM (ACtive Radiometer Irradiance Monitor) et du IRMB (Institut Royal Météorologique de Belgique), ne sont pas en accord entre eux, en particulier au niveau des minima du cycle d'activité, et le modèle permet seulement de reproduire celui du PMOD avec exactitude lorsque la composante variable à long terme est proportionnelle au flux radio à 10.7 cm. Toutefois, en utilisant des polynômes de Lagrange pour représenter la variation du Soleil inactif, l'accord est amélioré pour les trois composites durant les minima, bien que les relations entre le niveau minimal de l'irradiance et la longueur du cycle précédent varient d'un cas à l'autre. Les résultats obtenus avec le modèle d'irradiance spectrale ont été utilisés dans une étude d'intercomparaison de la réponse de la photochimie stratosphérique à différentes représentations du spectre solaire. Les simulations en mode transitoire d'une durée de 10 jours ont été effectuées avec un spectre solaire constant correspondant soit à une période d'activité minimale ou à une période d'activité maximale. Ceci a permis d'évaluer la réponse de la concentration d'ozone à la variabilité solaire au cours d'un cycle et la différence entre deux minima. En plus de ceux de MOCASSIM, les spectres produits par deux modèles ont été utilisés (NRLSSI et MGNM) ainsi que les données de SIM et SOLSTICE/SORCE. La variabilité spectrale de chacun a été extraite et multipliée à un spectre de base représentant le minimum d'activité afin de simuler le spectre au maximum d'activité. Cela a été effectué dans le but d'isoler l'effet de la variabilité seule et d'exclure celui de la valeur absolue du spectre. La variabilité spectrale d'amplitude relativement élevée des observations de SORCE n'a pas provoqué l'inversion de la réponse de l'ozone à hautes altitudes obtenues par d'autres études, ce qui peut être expliqué par la nature même du modèle utilisé ainsi que par sa limite supérieure en altitude. Finalement, la réponse de l'ozone semble être à peu près proportionnelle à la variabilité de l'intégrale du flux pour lambda<241 nm. La comparaison des concentrations d'ozone obtenues avec les spectres originaux au minimum d'activité démontre que leur différence est du même ordre de grandeur que la variabilité entre le minimum et le maximum d'un cycle typique. Le problème du choix de la reconstruction de l'irradiance à utiliser pour les simulations climatiques dans le passé demeure non résolu.

The Corticiaceae (Basidiomycetes) in Taiwan

Geographically, Taiwan is an Island and situated in the northeast of Asia, on the western side of the Pacific Basin, at the southeast of main China, south of Japan, and north of the Philippines. The main topographic character is the longitudinally oriented mountainous area. More than 200 peaks rise above 3000 m. They departed Taiwan into two lowland areas, an eastern and western plain. Taiwan is departed into subtropical (north area) and tropical zone (south area), which have a warm and humid climate, due to the Tropic of Cancer passing through. The average annual temperature in the lowland amounts to 28°C (7~38°C). The temperate climate also presents in the mountainous areas. The tropical typhoons usually come in summer and bring heavy rain, while the monsoon seasons have an important effect on the regional rainfall distribution. The mean annual rainfall of Taiwan is about 2600 mm (1000~6700 mm); the mountainous areas receive more rain than the lowlands. In Taiwan, according to different temperature and vegetation, the ecological environments were given rise to vertical biotic zonations, and form five major types: highland snowfield, highland meadow, coniferous forest, deciduous forest, and tropical forest. Six National Parks in Taiwan are located in the mountainous areas, in the north, the south, and on Jinmen Island. The National Parks represent about 8.4% of the country area. In this study, the collection sites are situated in Yangmingshan, Shei-Pa, Yushan, and Kenting National Park. Due to the island isolation, the proportions of endemic species are great in Taiwan, which also presents a high biodiversity. There are 4255 species of vascular plants including 1133 endemic. 5936 species in 1276 genera of fungi are hitherto reported in Taiwan. Among them, 233 Corticiaceae species were recorded, over one third (79 species) of them are known only from Taiwan. The first fungal report in Taiwan is about Phytophthora cyperi, published by the Japanese researcher T. Kawakami in 1904. Therefore, the history of research about fungi in Taiwan is more than one hundred years old. An eminent Japanese mycologist K. Sawada made an intensive survey from 1919 to 1959, and reported 2464 fungi species in his eleven volumes of “Descriptive Catalogue of Formosan Fungi”. However, only a few species (21 species in 9 genera) of Corticiaceae were recorded. From 1973, Chen and Lin resumed the study on Corticiaceae, and also some other foreign mycologists contributed for this field after 1980. The German research group lead by Franz Oberwinkler from Tübingen University collected in Taiwan several times. They published a number of new species and new records. Since 1989, S. H. Wu, a Taiwanese mycologist, has published a great amount of reports on corticioid fungi from Taiwan. Corticioid fungi were made up by the large and heterogeneous unnatural family Corticiaceae and other resupinate fungi belonging to other natural families in the Agaricomycetes. Molecular studies have shown that corticioid genera are distributed across all major clades of Agaricomycetes indicating that the corticioid fungi represent a polyphyletic group. They have resupinate fruitbodies and similar habitats. Species are characterized by simple fruitbody, more or less effused, and present smooth, porioid, grandinioid to odontioid hymenial surface. The fruitbodies are differently colored and usually soft to tough. Most of the Corticiaceae species are wood-saprobic organisms and gain the energy from the decomposing of wood-substrate such as cellulose or lignin. Materials for this study were collected by the author and other mycologists in Taiwan during surveys in April and May 1996, and March 2007, using the spring season with its high humidity and warm climate which are optimal conditions for the development of fungi. For assembling, the convenience sampling method was used in this study. This approach was chosen because it enables to detect a high biodiversity in a short time, and also to find species with rare or patchy distribution. The collecting sites from the North to the South include four National Parks and some preserved forests. They cover many different habitats such as low lands and high mountains. Fresh specimens were dried and analysed with a light microscope. 265 specimens belonging to Corticiaceae were studied in this research. Among them, 50 species in 21 genera including 11 new records and 10 new species were described with text and drawing. Four new species are belonging to Hyphodontia (H. sp. nov. 1, H. sp. nov. 2, H. sp. nov. 3, and H. sp. nov. 4), four to Schizopora (Sch. sp. nov. 1, Sch. sp. nov. 2, Sch. sp. nov. 3, and Sch. sp. nov. 4), one in Trechispora (T. sp. nov. 1), and one in Tubulicrinis (T. sp. nov. 1). Species recorded as new are Aleurodiscus amorphus, Botryohypochnus isabellinus, Hyphodontia cineracea, Hyphodontia palmae, Hypochnicium vellereum, Merulius tremellosus, Metulodontia nivea, Paullicorticium ansatum, Phlebia radiata, Phlebiella ardosiaca, and Xylobolus frustulatus. Besides, Botryohypochnus, Merulius, Metulodontia, Paullicorticium, and Xylobolus are also newly recorded genera in Taiwan. The genus Hyphodontia presents the highest diversity with 20 out of 50 species recorded. The second important genus is Hyphoderma, however with only 5 species. This indicates that Hyphodontia and Hyphoderma have a higher ability to develop in variable environments and approximately shows the predominance of these two genera in Taiwanese Corticiaceae. There are 11 new records out of the 50 species recorded, representing 22%. Some species, e.g. Hypochnicium vellereum and Paullicorticium ansatum were in the past recorded only in Europe and North America with cold and temperate climate. The samples of them are for the first time found in the subtropical belt, and display some difference from those of temperate regions. These collections should be molecularly investigated to clarify if they represent the same species of temperate areas. Patchily distributed species, for example Phlebiella ardosiaca, previously known only in Europe, and Hyphodontia palmae collected only in Brazil, were first recorded in different continents. Two possibilities are indicated by these new records: they are worldwide species but very rare to be found, or the Taiwanese specimens are taxonomically different. More survey from other continents and molecular study for these collections should be done in the future to solve this question. The distribution of Corticiaceae in Taiwan presents the variations in the north, central, and south areas and shows the diversity in lowlands and high mountains. The results of this study provide the evidence that the temperate Corticiaceae species displays a wider distribution. Subtropical and tropical taxa probably have also high dispersal capacities, and could possibly be found in the future in neighboring areas such as China, Japan, Korea or South Asia, but this needs further researches. In the total of 50 species, 10 new taxa were described in this study, giving about 20%. Some new species (e.g. Hyphodontia sp. 1, Hyphodontia sp. 2, and Hyphodontia sp. 3) are very similar to known species (Hyphodontia sambuci and Hyphodontia formosana), and the distinctive characters of Schizopora sp. nov. 1 are intermediate between those of Schizopora paradoxa and Hyphodontia flavipora. Thus, these small differences between the new and known species, suggest that the speciation occurred when the fungi migrated into Taiwan, due to the high diversity of environment, and amounts of the endemic plants. Taiwan is an intermediate place for the south (tropical) fungal species to migrate and adapt to north (temperate) regions. The middle and high altitude environments in Taiwan offer good conditions for the fungal speciation and possibly the occurrence of physiological changes to adapt to the temperate climate. Thus Taiwan has an important position for the biogeography of Asia mycobiota. 5936 known species in Taiwan represent about only 20% of the estimated number (24000) of Taiwanese fungal taxa. In this study, the findings (22% new records and 20% new species) indicate that amounts of unknown fungi species are expected in Taiwan. The lack of knowledge indicates that many new species are awaiting description, and fungal survey in Taiwan remains in a Pioneer phase. The last three wide surveys of Corticiaceae researches took place 20 years before this study (Chen & Lin 1977, Lin & Chen 1989, Wu 1990). After previous important contributions, the present taxonomic study comprising 21 genera is the most extensive on Corticiaceae of Taiwan.

Comparación entre los pacientes con diagnóstico clínico de EPOC vs los confirmados por Espirometría en un hospital de segundo nivel en Bogotá DC, 2011

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), está caracterizada por la limitación del flujo aéreo, de forma progresiva y casi irreversible, asociada a la reacción inflamatoria atribuida a diferentes factores, principalmente a la exposición al humo de tabaco. Es considerada un problema de salud pública en Colombia y en el mundo, con un aumento acelerado de la condición crónica en la actualidad. Objetivo: Identificar las diferencias sociodemográficas, clínicas y de tratamiento, entre los pacientes con diagnóstico clínico y espirométricos de EPOC vs los pacientes con diagnóstico clínico y descartados por espirometría en el Hospital de Suba. Material y Métodos: Estudio observacional, descriptivo, retrospectivo como un componente exploratorio para comparar los grupos con diagnóstico de EPOC clínico y confirmado o descartado por espirometría, entre Enero y Agosto del 2011. Se utilizó estadística descriptiva para calcular las medidas de tendencia central, los datos cuantitativos se expresaron como la media de la variable ± desviación estándar, y los cualitativos como porcentaje, la t de Student para analizar diferencia de las variables cuantitativas de medias entre grupos y la prueba de Pearson para analizar la relación entre los datos cualitativos para aquellos con valores esperados menores a 5 se aplicó test exacto de Fisher, tuvimos en cuenta un α de 0.05 para el análisis bivariado y medidas de asociación. Todos los análisis se realizaron con el paquete estadístico SPSS 19,0 Versión corporativa. Resultados: De los 398 pacientes, solo 287 cumplían con criterios de inclusión. El promedio de edad del total de los pacientes fue de 70,29 + 11,18 años, y 59,5% de la población fue de sexo femenino. Del total de pacientes evaluados, 171 pacientes (59.6%) se descartó el diagnóstico de EPOC (VEF1/ VEC > 0,70). Al comparar los grupos de pacientes a los que se les confirmo el diagnóstico de EPOC contras los descartados por espirometría se encontró que no hay diferencias estadísticamente significativas entre la edad; en los pacientes con EPOC predomino el sexo femenino (p 0.02); en los factores de riesgo existe clara asociación entre EPOC y la exposición a humo de leña (p <0.001), y en cuanto al tabaquismo solo se encontró asociación con ex fumador (p 0,011). Para analizar las diferencias en el tratamiento se estratifico por las posible combinaciones de inhaladores con o sin teofilina, encontrando una diferencia estadísticamente significativa para los tratamientos de tres inhaladores (p 0,015), dos inhaladores + teofilina (p 0,05), tres inhaladores + teofilina (p <0.001), y en los pacientes no tratados (p <0,001).

Diferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónica

La EPOC es una causa importante de morbilidad y mortalidad en el mundo y su prevalencia en Bogotá alcanza hasta 8,5%. Las exacerbaciones están asociadas a deterioro funcional y de la calidad de vida por lo que se consideran un factor cardinal de la enfermedad. En la literatura se ha descrito que las infecciones por bacterias y/o virus son las responsables del 78% de las exacerbaciones. Estos datos han sido descritos en poblaciones diferentes y no hay datos en la literatura que muestren cual es la epidemiología local de las exacerbaciones de EPOC y menos aún de aquellas que se asocian a consolidaciones neumónicas. Objetivo: Comparar la microbiología de las exacerbaciones severas de la EPOC que requieren ingreso a UCI con y sin infiltrados alveolares. Materiales y métodos: Estudio de corte transversal en el que se estudiaron pacientes con EPOC que ingresaron a la UCI Médica de la FCI-IC por exacerbación severa, asociada o no a infiltrados alveolares. Se tomaron muestras de microbiología, serológicas y radiografía de tórax para evaluar la etiología de la exacerbación, si se asocia a coinfección viral y a consolidación neumónica o no. Resultados: No se encontró una diferencia estadísticamente significativa en la microbiología de los diferentes grupos evaluados. Se encontró un resistencia global del 24% y llama la atención que hay una alta prevalencia de Serratia Marcescens AMPc entre los 2 grupos, germen que no está descrito como patógeno común en la literatura. Se encontraron diferencias en cuanto a factores de riesgo para presentar neumonía asociada como lo son un mayor índice de paquetes/año (55.1.6 vs. 36.3 paq/año, sig.=0.021). Así mismo se demostró que los pacientes con neumonía asociada presentan mayor necesidad de IOT (48.9 vs. 23.9, sig.=0.013). No hay diferencia significativa en desenlaces como mortalidad (20.5 vs. 13.0, sig.=0.346). Conclusiones: A pesar de no haber diferencia microbiológica entre los 2 grupos se encontraron variables como factores de riesgo y variables clínicas que pueden ayudar a proponer planes de manejo en los dos escenarios. El hecho de encontrar un paciente con neumonía asociada al cuadro de exacerbación no debe afectar en la toma de decisiones en relación al tratamiento antibiótico.

Alteraciones respiratorias durante el sueño en niños con Síndrome Down a la altura de Bogotá

Objetivo: determinar la frecuencia de las diferentes alteraciones respiratorias durante el sueño (ARS) e hipertensión pulmonar (HTP) y establecer la saturación de oxígeno (SpO2) en vigilia, sueño y durante los eventos en niños con Síndrome Down (SD) a la altura de Bogotá (2640m) de acuerdo a grupos de edad e IMC. Métodos: estudio descriptivo de corte transversal, se incluyeron todos los niños con SD con sospecha de ARS remitidos a polisonograma (PSG) de octubre de 2011 a enero de 2013 a la Fundación Neumológica Colombina (FNC). Se dividieron en 3 grupos: apnea obstructiva, apnea obstructiva y central, sin apneas. Resultados: 74 niños, el 36,5% mujeres, edad media 4 años. 47,3% presento apnea obstructiva, más frecuente en >2 años, 35,1% apnea obstructiva y central, más frecuente en < 2 años y 17,6 % sin apnea. SpO2 promedio en apnea obstructiva 84,63%, apnea obstructiva y central: 81,8% y sin apnea: 86,85% (p 0,058). 23% presento obesidad, 16% con apnea obstructiva. 53 pacientes tenían ecocardiograma: 28% HTP, 53,3% tuvo apnea obstructiva y 26,7 apnea obstructiva y central, no diferencias significativas. SpO2 promedio en HTP 88,3% vigilia, 86,2% sueño REM, 85,7 % sueño no REM, no diferencia significativa comparada con pacientes sin HTP. Conclusiones: Las ARS son frecuentes en los niños con SD, La desaturación está presente en los niños con SD independiente del tipo de apnea. A todos los niños SD se les debe practicar un PSG en el primer año de vida.

Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.