Abstract-In previous studies, mechanical support of medically refractory hearts with a left ventricular assist device (LVAD) has induced regression of many morphological and functional abnormalities characteristic of failing human hearts. To identify transcriptional adaptations in failing and LVAD-supported hearts, we performed a comprehensive transcription analysis using the Affymetrix microarray platform and 199 human myocardial samples from nonfailing, failing, and LVAD-supported human hearts. We also used a novel analytical strategy that defines patterns of interest based on multiple intergroup comparisons. Although over 3088 transcripts exhibited significantly altered abundance in heart failure, most of these did not exhibit a consistent response to LVAD support based on our analysis. Of those 238 with a consistent response to LVAD support, more than 75% exhibited persistence or exacerbation of HF-associated transcriptional abnormalities whereas only 11%, 5%, and 2% exhibited partial recovery, normalization, and overcorrection responses, respectively. Even among genes implicated by previous reports of LVAD-associated myocardial improvements, partial or complete normalization of transcription did not predominate. The magnitude of differences in transcript abundance between nonfailing and failing hearts, and between failing an LVAD-supported hearts, tended to be low with changes greater than or equal to 2-fold infrequently observed. Our results indicate that morphological or functional myocardial improvements may occur without widespread normalization of pathological transcriptional patterns. These observations also suggest that many failure-associated transcriptional changes have only a limited role in regulating cardiac structure and function and may represent epiphenomena and/or nonspecific myocardial plasticity responses. Differences in mRNA localization, translation efficiency, and posttranslational protein modifications or interactions may be more pivotal in regulating myocardial structure and function. (Circ Res. 2005;96:592-599.)

Los calcio antagonistas son fármacos usados para diferentes patologías médicas; sin embargo la intoxicación puede ser grave. Presentamos el caso de una mujer joven intoxicada por amlodipino quien cursó con choque vasodilatado y disfunción multiorgánica, en quien se usó vasopresores múltiples a dosis por encima de las habituales para estabilizarla.

General characterization of COPd patients from the Maule Region, Chile: Preliminary results of the MaulEPOC study (IC 95% 67,28

RESUMENMetformina es una biguanida usada como agente antihiperglicemiante, que promueve la euglicemia; su principal toxicidad es acidosis láctica. Se reporta el caso de un varón, adulto mayor, diabético e hipertenso quien se automedicó con 10 tabletas de metformina 850 mg; presentando acidosis láctica severa y choque distributivo requiriendo soporte y manejo en la Unidad de Cuidados Intensivos.PALABRAS CLAVE: Metformina, acidosis láctica, choque. (Fuente: DeCS BIREME). SUMMARYMetformin is a biguanide drug used as an oral antidiabetic medication whose main toxicity is lactic acidosis. We report the case of an old adult male diabetic and hypertensive patient who self prescribed 10 tablets of metformin 850mg presenting lactic acidosis and distributive shock requiring treatment in the intensive care unit.KEYWORDS: Metformin, lactic, acidosis, shock. (Source: MeSH NLM). INTRODUCCIÓNLas biguanidas son agentes antihiperglicemiantes, que promueven la euglicemia, pueden usarse solos o con otros agentes hipoglucemiantes; con quienes si puede favorecer la hipoglicemia. Se usan desde los '50, su principal toxicidad es la acidosis láctica, la cual puede ser severa y fatal, por este motivo en 1976 se retiró del mercado a la fenformina; actualmente se tiene en uso clínico a la metformina.Se presenta el caso de un paciente diabético, hipertenso en tratamiento y control irregular quien se automedicó con 10 tabletas de metformina 850 mg, cursando con acidosis láctica y choque distributivo que requirió soporte y manejo en la unidad de cuidados intensivos (UCI). Siendo el uso de metformina común en el manejo de diabetes y estados de hiperglicemia y habiéndose reportado casos y series de toxicidad, se decidió reportar el caso para entender la magnitud y gravedad de la acidosis láctica en pacientes con predisposición. PRESENTACIÓN DEL CASOVarón de 66 años, con antecedente de diabetes mellitus e hipertensión arterial desde hace 20 años en tratamiento con metformina 850 mg cada 12 h,