The lung microbiome composition has critical implications in the regulation of innate and adaptive immune responses. Next-generation sequencing techniques have revolutionized the understanding of pulmonary physiology and pathology. Currently, it is clear that the lung is not a sterile place; therefore, the investigation of the participation of the pulmonary microbiome in the presentation, severity, and prognosis of multiple pathologies, such as asthma, chronic obstructive pulmonary disease, and interstitial lung diseases, contributes to a better understanding of the pathophysiology. Dysregulation of microbiota components in the microbiome–host interaction is associated with multiple lung pathologies, severity, and prognosis, making microbiome study a useful tool for the identification of potential therapeutic strategies. This review integrates the findings regarding the activation and regulation of the innate and adaptive immune response pathways according to the microbiome, including microbial patterns that could be characteristic of certain diseases. Further studies are required to verify whether the microbial profile and its metabolites can be used as biomarkers of disease progression or poor prognosis and to identify new therapeutic targets that restore lung dysbiosis safely and effectively.

El ayuno preoperatorio tiene como objetivo reducir el riesgo de aspiración pulmonar; sin embargo, no siempre permite predecir de manera confiable el contenido gástrico, particularmente en pacientes con riesgo de vaciamiento gástrico retardado. Las terapias basadas en incretinas, incluida la tirzepatida, un agonista dual de los receptores del polipéptido insulinotrópico dependiente de glucosa y del péptido similar al glucagón tipo 1, se han asociado con retraso del vaciamiento gástrico y persistencia de contenido gástrico a pesar del cumplimiento de las recomendaciones de ayuno. Presentamos el caso de una mujer de 41 años con obesidad sometida a aspiración folicular bajo sedación. A pesar de un ayuno prolongado y de haber suspendido la tirzepatida dos semanas antes del procedimiento, el ultrasonido gástrico realizado antes de la sedación mostró una pequeña cantidad de líquido claro, compatible con un perfil gástrico de bajo riesgo para aspiración. La sedación se realizó mediante infusión controlada por objetivo de propofol, complementada con fentanilo y sulfato de magnesio, y el procedimiento concluyó sin complicaciones. Este caso pone de manifiesto las limitaciones del ayuno convencional para estimar el contenido gástrico en pacientes tratados con terapias basadas en incretinas y destaca el potencial del ultrasonido gástrico en el punto de atención como herramienta complementaria para individualizar la evaluación del riesgo de aspiración y apoyar la toma de decisiones anestésicas.

Chronic Shoulder Pain (CSP) is a health problem that affects almost 67% of the general population. Almost a third of patients with acute shoulder pain syndrome don’t respond to initial therapy with analgesics and need interventional therapy. Corticosteroid injection is the standard therapy. Prolotherapy has been demonstrated to be effective in other chronic pain syndromes, but not in CSP. The aim of this study was to determine the effectiveness of prolotherapy compared to local anesthetic injection in the treatment of chronic shoulder pain METHODS Retrospective and comparative study of 77 patients from the National Institute of Oncology in Mexico City who received treatment for Chronic Shoulder Pain guided by ultrasound between 2017-2019. 57 patients were kept in the study for further analysis. 39 received infiltration with corticosteroids and 17 prolotherapy. Effectiveness of therapies was determined based on the decrease in VAS score in next follow-up session. Statistical analysis were performed with SPSS and RStudio Software. RESULTS 51% of patients with Chronic Shoulder Pain were unemployed. 84% of the patients needed 3 different types of analgesics before they received ultrasound guided local treatment. Prolotherapy was as efficient as local anesthetic injection, no matter basal pain severity or underlying shoulder diagnosis, despite prolotherapy being more used as treatment for Rotator Cuff Tendinopathy. CONCLUSIONS Prolotherapy and corticosteroid injection guided by ultrasound have the same efficacy in pain relief for chronic shoulder pain in oncologic patients.