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Varios trastornos hereditarios ocasionan el desarrollo de quistes renales. La forma más común, la enfermedad renal poliquística autosómica dominante (PQRAD), es un trastorno que se diagnostica con mayor frecuencia en adultos y es causado por una mutación en los genes PKD1, mutación más frecuente, (85 % de los casos) o PKD2. Esta enfermedad no solo se limita a los riñones, sino también al hígado, el páncreas y, de manera infrecuente, el corazón y el cerebro. A continuación, presentamos el caso de una paciente mujer, de 66 años, con poliquistosis renal y hepática en tratamiento dialítico, que desarrolló cuadro de choque séptico, que fue superado con posterior seguimiento en hospitalización.

La autofagia constituye un mecanismo altamente especializado de adaptación celular que se encarga de degradar y reciclar organelas disfuncionales, para lo que utiliza estructuras especializadas (autofagosoma, autofagolisosoma), con el fin de mantener la homeostasis metabólica, calidad de las organelas citoplasmáticas y una respuesta regulada al estrés, cuya finalidad es proteger a la célula, limitando el daño y muerte celular. Existen procesos de autofagia selectiva que eliminan organelas específicas como acontece con la mitocondria, recibiendo el nombre de mitofagia, que se encarga del control de calidad mitocondrial, selecciona e ingiere mitocondrias dañadas para luego degradarlas, impidiendo de esta manera la liberación de patrones de daño molecular (DNA mitocondrial), ya sea hacia el citosol o hacia el espacio extracelular, y evitando de esta forma respuestas inmunes exageradas. La autofagia interviene en muchos mecanismos fisiológicos de nuestro organismo, por lo tanto, la desregulación de este proceso está involucrada en la fisiopatología de un buen número de enfermedades que podrían beneficiarse de su modulación. En el presente trabajo de investigación se describen los procesos fisiológicos y fisiopatológicos involucrados con la autofagia y mitofagia; analizaremos el papel que desempeñan en determinadas patologías.

Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 >45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration >9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19.

In human clinics, pathologies as diverse as cancer, sepsis, autoimmune diseases, among others; of different etiology and a different pathophysiological behavior, converge in a failure of gene repression that allows the phenotypic expression of the disease; The possibility of having a biological marker that shows these events to the clinician is desirable since it would allow early diagnostic and therapeutic strategies. Micro RNAs are small and non-coding RNAs that fulfill that “genetic silencing” role, however, the step from basic research to clinical applicability, that is, their translational utility is still little diffused in specialties other than oncology. The objective of this review is to explain in a more precise way.

El arte de hacer medicina es producto de un intrincado y complejo proceso de razonamiento, conjuga los conocimientos básicos, que mediante la fisiopatología buscan explicar las manifestaciones clínicas que presenta un enfermo y con ello determinar un diagnóstico, tratamiento y pronóstico. El avance vertiginoso en el conocimiento médico, ha revolucionado la práctica sanitaria y ha permitido un crecimiento exponencial de información, cada vez más precisa y molecular; esto, aunque indudablemente es beneficioso, ha abierto importantes brechas entre los hallazgos en ciencias básicas y su aplicación en la práctica clínica. La pandemia actual, por COVID-19, ha sido la vitrina más clara sobre lo escrito en líneas anteriores, en dónde, fue dificultoso amalgamar los descubrimientos y publicaciones que diariamente eran mostrados sobre el impacto del virus a nivel molecular e inmunológico, con el manejo clínico asistencial. En el libro “TÓPICOS SELECTOS EN CIENCIAS BÁSICAS APLICADOS AL ENFERMO CRÍTICO”, planteamos temáticas que a nuestro juicio permitirán anclar conceptos inmunológicos claves, al arsenal de conocimientos de los médicos clínicos, con la finalidad de lograr un manejo holístico, razonado y basado en la evidencia. En siete capítulos, escribimos sobre temas como algunas de las distintas formas de muerte celular: la NETosis, la autofagia y la piroptosis; también, encontraran un espacio para los receptores de reconocimiento de patrón, de ellos, los de tipo TOLL y tipo NOD son explicados a profundidad; la vía JAK/STAT, se analiza con practicidad y se expone los blancos terapéuticos que de ella derivan, muchos ya en aplicación clínica. Finalmente, un tema de interés investigativo extremo, la microbiota y su rol en la enfermedad crítica y en patología humana en general, es abordado. Palabras clave: ciencias básicas, enfermedad crítica, muerte celular, microbiota, receptores de reconocimiento de patrón.

Endothelial glycocalyx is an undefined structure covering the luminal layer of the vascular endothelium and consisting mainly of three elements: proteoglycans, glycosaminoglycans and glycoproteins. It has different functions, such as the regulation of vascular permeability to liquids and molecules; transduction of the mechanical forces of vascular tension; regulation of coagulation and fibrinolysis cascades; and protection of leukocyte, platelet and pathogen adhesion. The determinants of a glycocalyx lesion can be of several types―e.g., increased tensile forces; reactive oxygen (O2) species; increased plasma level of substances such as sodium (hypernatremia), glucose (hyperglycemia) and cholesterol (hypercholesterolemia); and pro-inflammatory molecules. Any of the above-mentioned noxas, alone or combined, injure the glycocalyx. Its dysfunction will be clinically expressed as endothelial dysfunction, increased vascular permeability, filtration of lipoproteins to the subendothelium, activation of coagulation, or increased adhesion of leukocytes and platelets to the endothelium

Background Since its molecular isolation on January 7, 2020, the novel coronavirus SARS-CoV-2 has spread rapidly, taking governments worldwide off-guard. The virus arrived in low and middle-income countries violently, especially in Latin America. Ecuador received the worst outbreak in the world if we count excess mortality per capita. Although one study has reported the epidemiological impact of COVID-19 in Ecuador, there is no clinical course or outcome data among intensive care patients with COVID-19 in Ecuador. This study describes the clinical, epidemiological, and therapeutical features of 89 patients hospitalized in a secondary-level hospital in Quito, Ecuador. Methods We did a retrospective cohort study. We collected health records data from adult patients with severe COVID-19 admitted to the intensive care unit (ICU) in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak in Ecuador. All patients had a confirmed SARS-CoV-2 RNA infection diagnostic, a positive real-time RT-PCR, and pulmonary imaging suggesting COVID-19. We used the Chi-square test or a Fisher's exact statistic to analyze risk and associations between survivors and non-survivors due to COVID-19. We used the ROC curve analysis to predict mortality, determining cut-off points for the parameters related to mechanical, analytical, and cytometry ventilation. At the multivariate level, we used the Wald test to evaluate model categorical predictors during the regression analysis. Results 89 patients with COVID-19 were recruited during the study. The average age of the patients was 54.72 years. Man represented 68.54% (n = 61) and women 31,46% (n = 28). Significant differences were observed in terms of mortality (men 40.98% vs. women 17.76%). Serological parameters demonstrated that LDH and IL-6 at 24 hours were higher among non-survivors when compared with survivors. Persistent hypercapnia ( > > 45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and a positive end-expiratory pressure (PEEP) titration greater than nine mmHg were also associated with higher mortality. Conclusions Increased levels of LDH at 24 hours, IL-6, the lymphocyte and platelet count at 48 hours, the neutrophil count at 48 hours, and the INL are factors associated with higher motility, increased risk of failed extubation and reintubation