Mortality in patients with severe COVID-19 who underwent tracheostomy due to prolonged mechanical ventilation / Mortalidad en pacientes con COVID-19 grave sometidos a traqueostomía por ventilación mecánica prolongada

BACKGROUND: The usefulness of tracheostomy has been questioned in patients with COVID-19 and prolonged invasive mechanical ventilation (IMV). AIM: To compare the 90-day mortality rate of patients who underwent a tracheostomy due prolonged IMV with those that did not receive this procedure. MATERIAL AND METHODS: We studied a historical cohort of 92 patients with COVID-19 and prolonged IMV (> 10 days). The primary outcome was the 90-day mortality rate. Secondary outcomes included days on IMV, hospital/intensive care unit (ICU) length of stay, frequency of nosocomial infections, and thrombotic complications demonstrated by images. A logistic regression was performed to adjust the effect of tracheostomy by SOFA score and days on IMV. RESULTS: Forty six patients aged 54 to 66 years (72% males) underwent tracheostomy. They had a median of two comorbidities, and received the procedure after a median of 20.5 days on IMV (interquartile range: 17-26). 90-day mortality was lower in patients who were tracheostomized than in the control group (6.5% vs. 32.6%, p-value < 0.01). However, after controlling for confounding factors, no differences were found in mortality between both groups (relative risk = 0.303, p-value = 0.233). Healthcare-associated infections and hospital/ICU length of stay were higher in patients with tracheostomy than in controls. Thrombotic complications occurred in 42.4% of the patients, without differences between both groups. No cases of COVID-19 were registered in the healthcare personnel who performed tracheostomies. CONCLUSIONS: In patients with COVID-19 undergoing prolonged IMV, performing a tracheostomy is not associated with excess mortality, and it is a safe procedure for healthcare personnel.

ANTECEDENTES: La utilidad de la traqueostomía en pacientes COVID-19 sometidos a ventilación mecánica invasiva (VMI) prolongada ha sido cuestionada. OBJETIVO: Comparar la mortalidad a 90 días en estos pacientes, con y sin traqueostomía. MATERIAL Y MÉTODOS: Estudiamos una cohorte histórica de 92 pacientes COVID-19 con VMI prolongada (>10 días). El desenlace prima-rio fue mortalidad a 90 días. Se consideraron desenlaces secundarios los días en VMI, estadía hospitalaria/UCI, frecuencia de infecciones nosocomiales, y eventos trombóticos. Mediante regresión logística se ajustó el efecto de la traqueostomía en la mortalidad, por SOFA y días de VMI. RESULTADOS: Cuarenta y seis pacientes de 54 a 66 años (72% hombres) fueron traqueostomizados. Ellos tenían una mediana de dos comorbilidades, y recibieron el procedimiento luego de una mediana de 20,5 días en VMI (rango intercuartílico: 17-26). En el análisis crudo, la mortalidad a 90 días fue menor en los pacientes con traqueostomía que en el grupo control (6,5% vs. 32,6%; p < 0,001). No obstante, luego de controlar por factores de confusión, no se encontraron diferencias en mortalidad (riesgo relativo 0,303; p = 0,233). Las infecciones asociadas a la atención de salud y la estadía en hospital/UCI fueron mayores en los pacientes traqueostomizados que en los controles. Los eventos trombóticos ocurrieron en el 42,4% de los pacientes, sin diferencias entre grupos. No hubo casos de COVID-19 en el personal de salud que realizó las traqueostomías. CONCLUSIONES: En pacientes con COVID-19 sometidos a VMI prolongada, la realización de una traqueostomía no se asocia a un exceso de mortalidad, y es un procedimiento seguro para el personal sanitario.

Adherencia terapéutica en hemofilia, adaptación lingüística del VERITAS-Pro en población mexicana / Therapeutic adherence in hemophilia, linguistic adaptation of the VERITAS-Pro to the Mexican population

Introducción: La hemofilia es una enfermedad hemorrágica caracterizada por la deficiencia de alguno de los factores de la coagulación VIII o IX. Actualmente el estándar de oro en el tratamiento consiste en la aplicación periódica del factor (profilaxis), por lo que se vuelve indispensable contar con instrumentos especializadas, estandarizados y válidos para evaluar el grado de adherencia a los tratamientos. Objetivo: Adaptar lingüística y culturalmente a población mexicana la escala de adherencia al tratamiento profiláctico (VERITAS-Pro). Métodos: La escala VERITAS-Pro fue traducida al castellano de México, adaptada y retraducida al idioma original. La equivalencia conceptual de las versiones fue comprada por la autora original, posteriormente se sometió a escrutinio de un grupo de expertos en el tratamiento de personas con hemofilia, la claridad y pertinencia de la versión adaptada, el grado de acuerdo entre los jueces se evalúo con el estadígrafo de Aiken. Resultados: Se encontró adecuada la equivalencia conceptual entre las versiones original y adaptada de la prueba. Los jueces calificaron como adecuada la claridad (V=0,93, IC10 por ciento=0,92-0,95) y pertinencia (V=0,89, IC10 por ciento=0,86-0,91) de los reactivos. Conclusiones: La escala VERITAS-Pro, versión al castellano de México, es una herramienta válida para evaluar los niveles de adherencia a la profilaxis en hemofilia(AU)

Introduction: Hemophilia is a hemorrhagic disease characterized by the deficiency of either coagulation factor VIII or IX. Nowadays, the gold standard in treatment is the periodic application of the factor (prophylaxis), so it is indispensable to have specialized, standardized and valid instruments to evaluate the degree of adherence to treatment. Objective: To adapt linguistically and culturally to the Mexican population the Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro). Methods: The VERITAS-Pro scale was translated into Mexican Spanish, adapted, and re-translated into the original language. The conceptual equivalence of the versions was compared by the original author, subsequently, it was under scrutiny the clarity and relevance of the adapted version by a group of experts in the treatment of people with hemophilia, the degree of agreement between the judges was evaluated with the Aiken statistician. Results: The original and adapted versions of the test, show an adequate conceptual equivalence, judges were rated adequate clarity (V=0.93, IC10 percent=0.92-0.95) and relevance (V=0.89, CI10 percent=0.86-0.91) of the items. Conclusion: The scale Veritas-Pro, the Mexican Spanish version, is a valid tool to assess the levels of adherence to the prophylaxis in hemophilia(AU)

Efectividad de anticoagulación regional con citrato en terapia de reemplazo renal continua

Background: Anticoagulation in continuous renal replacement therapy (CRRT) is essential to counteract the coagulation cascade activation, induced by the dialysis circuit. Heparin is the most widely used anticoagulant, followed by regional citrate anticoagulation (RCA). Aim: To determine the effectiveness and safety of anticoagulant treatment with citrate in CRRT. Material and Methods: Retrospective study of adults in CRRT hospitalized between the years 2014 and 2020 in critical units, who required change to RCA according to established protocols. Results: We studied 24 patients aged 63 ± 13 years (12 females). The reasons for admission were acute kidney injury (AKI) in 80% and stage 5 chronic kidney disease in 20%. The indication of RCA in 75% of patients was by coagulation of more than 3 circuits in 24 hours. The duration of the circuit in RCA was 18.5 ± 4.8 hours versus 11.9 ± 4.9 hours with heparin (p < 0.0001). There were 19 mild complications that did not affect the RCA. Conclusions: RCA is feasible to perform, it is a safe and efficient procedure if it is protocolized, allowing a longer duration of the dialysis circuit.

Actualización en el tratamiento del síndrome de hipertensión intracraneana / Update on the management of intracranial hypertension syndrome

Elevated intracranial pressure (ICP) is a devastating complication, with great impact on neurological status and high morbidity and mortality. Intracranial hypertension (ICH) has multiple etiologies. The natural history of this condition can lead to brain death. The successful management of patients with elevated ICP (> 20-25 mmHg) requires fast and timely recognition, judicious use of invasive monitoring and therapies aimed to reversing its underlying cause. Therefore, it must be managed as a neurological emergency. The objective of this review is to present in a friendly way the diagnostic approach and the management of ICH, focused on general practitioners.

Minireview: Utilidad de las pruebas predictivas para parto pretérmino utilizadas en la práctica clínica / Minireview: Utility of predictive tests for preterm birth used in clinical practice

El parto prematuro, definido como el parto que ocurre antes de las 37 semanas de gestación, es una condición obstétrica grave que representa el 11% de los embarazos en todo el mundo. Las pruebas predictivas para parto prematuro son importantes, dado el impacto personal, económico y de salud del parto prematuro. Esta revisión explora la utilidad tanto de las pruebas predictivas actuales utilizadas en la práctica clínica (características maternas, longitud cervical y marcadores bioquímicos), así como nuevas pruebas emergentes. Se realizó una búsqueda electrónica en las bases de datos científicas en salud: PUBMED, COCHRANE, SCIELO, revisión de repositorios virtuales de universidades nacionales utilizando los siguientes ítems de búsqueda y sus combinaciones: parto pretérmino, longitud cervical, acortamiento cervical, cervicometría, fibronectina fetal, factores de riesgo, características maternas. Se incluyeron trabajos publicados en inglés y español, desde el año 2006 hasta el año 2020, que respondían al objetivo de la revisión: La utilidad de los diferentes predictores para parto pretérmino. En total se incluyeron 30 artículos en la presente revisión bibliográfica. Existen múltiples criterios científicos sobres las diferentes técnicas actuales para identificar pacientes de riesgo y lograr una prevención adecuada del parto pretérmino. La medición de la longitud cervical por ecografía transvaginal es el método más rentable en mujeres con historia de parto prematuro o síntomas de amenaza de parto prematuro; la evidencia actual permite sostener que también es indispensable realizar cervicometría de rutina a todas las pacientes, aún de bajo riesgo. Existen métodos ecográficos de predicción como la elastografía cervical y el índice de consistencia cervical que son prometedores, pero existen limitaciones en su implementación técnica y se propone que podrían ser una posible alternativa en el futuro, que puede combinarse con la longitud cervical. También, la adición de la medición de la longitud cervical a las pruebas bioquímicas parece mejorar la precisión predictiva(au)

Preterm labor, defined as delivery before 37 weeks of gestation, is a serious obstetric condition that accounts for 11% of pregnancies worldwide. Predictive tests for preterm birth are important, given the personal, economic, and health impact of preterm birth. This review explores the utility of both, the current predictive tests used in clinical practice (maternal characteristics, cervical length and biochemical markers), as well as the new emerging tests. An electronic search was carried out in the scientific health databases: PUBMED, COCHRANE, SCIELO, national universities virtual repositories were also reviewed, using the following search items and their combinations: preterm delivery, cervical length, cervical shortening, cervicometry, fetal fibronectin, risk factors, and maternal characteristics. We included papers in English and Spanish published from 2006 to 2020, which responded to the aim of the review: the utility of predictive test for preterm delivery. A total of 30 articles were included in this review. There are multiple scientific criteria on the different current techniques to identify patients at risk and achieve adequate prevention of preterm birth. Measurement of cervical length by transvaginal ultrasound is the most cost-effective method in women with a history of preterm labor or symptoms of preterm labor; the current evidence allows us to affirm that it is also essential to perform routine cervicometry in all patients, even with low risk. There are promising ultrasound predictive methods such as cervical elastography and cervical consistency index, but there are limitations in their technical implementation, it is proposed that they could be a possible alternative in the future, that can be combined with cervical length measurement. Also, adding cervical length easurement to biochemical tests appears to improve predictive accuracy.(au)

Prácticas nacionales de analgesia, sedación y delirium en las Unidades de Cuidados Intensivos de adultos en Chile / Analgesia, sedation, neuromuscular blockade and delirium management practices in Chilean intensive care units

Background: The appropriate use of analgesia, sedation, neuromuscular blockade and the diagnosis and prevention of delirium (ASBD) are associated with better outcomes in critically ill patients at Intensive Care Unit (ICUs). Aim: To know the practices about analgesia, sedation, delirium, and neuromuscular blockade use among healthcare professionals working in adult ICUs in Chile. Material and Methods: An electronic survey was sent to 812 professionals working in ICUs using a previously published instrument, which was adapted and authorized by the author. Results: We received 278 surveys. Fifty two percent of respondents were physicians, 34% nurses and 11% physical therapists. Their age ranged between 30 and 39 years in 43% and was over 50 years in 9%. Eighty four percent evaluated pain routinely, but only 26% use a validated scale. Sedation was routinely evaluated with a validated scale and 73% referred to have a protocol. Neuromuscular block is seldom used, and little monitoring occurs (43%). Delirium is routinely evaluated by 48% of respondents, usually using the CAM-ICU scale. Conclusions: There is a heterogeneous adherence to the ASBD recommended practices. The main gaps are in the assessment of pain, monitoring of neuromuscular blockade and diagnosis of delirium through validated instruments.

Medio de enseñanza para el desarrollo de habilidades motrices básicas en niños de sexto año de vida / Meio de ensino para o desenvolvimento das habilidades motoras básicas das crianças no sexto ano de vida / Teaching aid for the development of basic motor skills in children in their sixth year of life

Resumen La educación es el proceso que tiene por finalidad formar de manera integral al ser humano; esto significa desarrollar al máximo las potencialidades motrices, cognitivas, personales y sociales de los individuos para poder ejercer a plenitud todas las facultades en todos los ámbitos de la vida. El objetivo consistió en desarrollar las habilidades motrices básicas en el niño de sexto año de vida o edad preescolar mediante la creación de un medio de enseñanza, a partir de una experiencia constatada con niños del sexto año de vida que asisten a Círculos Infantiles de la Isla de la Juventud, así como la formación de hábitos, habilidades motrices básicas y su tratamiento en el proceso pedagógico de la Educación Física. Se utilizaron los métodos de investigación del nivel teórico como el análisis documental, histórico y lógico, análisis y síntesis e hipotético deductivo; del nivel empírico, la encuesta a educadoras, la observación, la entrevista a las educadoras y el método estadístico. La muestra estuvo constituida por 50 niños, del sexto año de vida de los Círculos Infantiles "Alegres Mineritos" (poblado La Demajagua), "Edad de Oro" y "Mambisito" (Nueva Gerona). Se conformó una muestra de 44 niños que representa el 88 % de dicha población. El aporte está dado en la elaboración de un medio de enseñanza que posibilite un control más objetivo y que contribuya al desarrollo de las habilidades motrices básicas (caminar, correr, saltar y lanzar); sustenta además a las demás habilidades motrices que dan cumplimiento al desarrollo físico, psíquico e intelectual del niño; proporciona una escala valorativa que pueda ser utilizada de manera sencilla y económica por las educadoras. El medio Multipro para el desarrollo de habilidades motrices básicas en niños del sexto año de vida ha demostrado que no solo contribuye al mejoramiento del desarrollo de las habilidades motrices básicas, sino que, contribuye al desarrollo de la creatividad mediante la solución de situaciones reales.

Resumo A educação é o processo que visa formar o ser humano de forma integral; isto significa desenvolver ao máximo as potencialidades motoras, cognitivas, pessoais e sociais dos indivíduos, a fim de poder exercer plenamente todas as faculdades em todas as áreas da vida. O objectivo era desenvolver capacidades motoras básicas nas crianças no sexto ano de vida ou em idade pré-escolar, criando um ambiente de ensino, baseado numa experiência com crianças no sexto ano de vida que frequentam Círculos Infantis na Ilha da Juventude, bem como a formação de hábitos, capacidades motoras básicas e o seu tratamento no processo pedagógico da Educação Física. Foram utilizados métodos de investigação a nível teórico: análise documental, histórica e lógica, análise e síntese e hipotética dedução. A partir do nível empírico: inquérito aos educadores, observação, entrevista aos educadores e o método estatístico. A amostra foi composta por 50 crianças no sexto ano de vida dos Círculos Infantis "Alegres Mineritos" (a localidade de La Demajagua), "Edad de Oro" e "Mambisito" (Nueva Gerona). A contribuição é dada no desenvolvimento de um meio de ensino que permite um controlo mais objectivo que contribua para o desenvolvimento das capacidades motoras básicas (caminhar, correr, saltar e lançar); apoiar as outras habilidades motoras que dão realização ao desenvolvimento físico, psicológico e intelectual da criança; fornece uma escala de valores que pode ser utilizada de uma forma simples e económica pelos educadores. O meio Multipro para o desenvolvimento das habilidades motoras básicas nas crianças no sexto ano de vida demonstrou que não só contribui para a melhoria do desenvolvimento das habilidades motoras básicas, mas também para o desenvolvimento da criatividade através da solução de situações reais.

Abstract Education is the process that aims to form the human being in an integral way; this means developing to the maximum the motor, cognitive, personal and social potentialities of individuals in order to be able to fully exercise all the faculties in all areas of life. The aim was to develop basic motor skills in children in the sixth year of life or pre-school age by creating a teaching environment, based on an experience with children in the sixth year of life who attend The Day care centers in La Isla de la Juventud, as well as the formation of habits, basic motor skills and their treatment in the pedagogical process of Physical Education. Research methods were used at the theoretical level: documentary, historical and logical analysis, analysis and synthesis and hypothetical deductive. From the empirical level: survey of educators, observation, interview of educators and the statistical method. The sample was made up of 50 children in the sixth year of life of the "Alegres Mineritos" Day care centers (La Demajagua town), "Edad de Oro" and "Mambisito" (Nueva Gerona). The contribution is given in the development of a teaching aid that allows a more objective control that contributes to the development of basic motor skills (walking, running, jumping and throwing); supporting the other motor skills that give fulfillment to the physical, psychological and intellectual development of the child; it provides a scale of values that can be used in a simple and economic way by the educators. The Multipro teaching aid for the development of basic motor skills in children in the sixth year of life has demonstrated that it not only contributes to the improvement of the development of basic motor skills, but also to the development of creativity through the solution of real situations.

The branched-chain amino acid transaminase 1 -23c/g polymorphism confers protection against acute coronary syndrome

ABSTRACT Background: Previous studies have shown an association between polymorphisms of the BAT1-NF-κB inhibitor-like-1 (NFKBIL1)-LTA genomic region and susceptibility to myocardial infarction and acute coronary syndrome (ACS). Objective: The objective of the study was to study the role of three polymorphisms in the BAT1, NFKBIL1, and LTA genes on the susceptibility or protection against ACS; we included a group of cases-controls from Central Mexico. Methods: The BAT1 rs2239527C/G, NFKBIL1 rs2071592T/A, and LTA rs1800683G/A polymorphisms were genotyped using a 5' TaqMan assay in a group of 625 patients with ACS and 617 healthy controls. Results: Under a recessive model, the BAT1 -23C/G (rs2239527) polymorphism showed an association with protection against ACS (odds ratio = 0.56, and p-corrected = 0.019). In contrast, the genotype and allele frequencies of the NFKBIL1 rs2071592T/A and LTA rs1800683G/A polymorphisms were similar between ACS patients and controls and no association was identified. Conclusion: Our data suggest an association between the BAT1 -23C/G polymorphism and protection against ACS in Mexican patients.

Juegos para motivar la enseñanza atletismo en edades tempranas desde la clase de Educación Física / Games to motivate teaching athletics at early ages from Physical Education class

RESUMEN El presente trabajo investigativo tiene su punto de partida en la problemática existente para la implementación del atletismo en edades tempranas, dificultad que coexiste con la masificación y práctica de este deporte en las clases de Educación Física en las escuelas. Para la investigación se tomó una muestra de alumnos 5to. y 6to. grado comprendidos entre los 10 y 12 años de edad, de dos escuelas primarias, centrando su atención al proceso de enseñanza aprendizaje del atletismo como objeto de la investigación. El objetivo consiste en implementar un conjunto de juegos alternativos para motivar la enseñanza del atletismo desde las edades más tempranas, a través de las clases de Educación Física, contribuyendo a la formación de las habilidades básicas para que el alumno pueda ir asimilando las distintas técnicas de manera lúdica. Se utilizaron diferentes métodos de investigación; tanto del nivel teórico como del empírico: análisis-síntesis, inductivo-deductivo, sistémico-estructural, análisis de documentos, observación y la entrevista. Su aplicación permite a los profesores tener una herramienta útil que puede ser utilizada para su preparación, así como las posibilidades de generalización de la misma en otros deportes motivo clase.

ABSTRACT The present research, has its starting point in the existent problem for the development of Athletics in early ages, difficulty that coexists with the spreading and practice of this sport in the lessons of Physical Education in schools. For this research there has been taken a sample of students of 5th and 6th grades, between the 10 and 12 years old, from two primary schools, centering their attention to the Process of teaching-learning of athletics like object of the research. This work has been focused as objective to implement a group of alternative games to motivate the teaching of athletics from the earliest ages, through the lessons of Physical Education, contributing to the formation of the basic skills so that the student can go assimilating the different techniques in a leisure time. Different research methods were used; so much of the theoretical level, as of the empiric one, such as: analysis-synthesis, inductive-deductive, systemic-structural, analysis of documents, observation and the interview. Their application allows the professors to have a useful tool that can be used for its preparation, as well as the possibilities of generalization of the same one in other sports to motivate the lessons.

Impact of hypotension and global hypoperfusion in postoperative delirium: a pilot study in older adults undergoing open colon surgery / Impacto da hipotensão e hipoperfusão global sobre o delírio pós-operatório: um estudo piloto com idosos submetidos à cirurgia aberta do cólon

Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.

Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.

Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI): neuropsychological evolution profile after one-year follow up / Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI): evolução do perfil neuropsicológico depois de um ano de seguimento

ABSTRACT The Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI) study is a longitudinal prospective cohort of 50 participants at a single institution in Buenos Aires, Argentina. Longitudinal assessments on a neuropsychological test battery were performed on 15 controls, 24 mild cognitive impairment (MCI) patients and 12 Alzheimer's disease (AD) dementia patients. In our study population, there was a high prevalence of positive AD biomarkers in the AD group, 92.3% (12/13); and a low prevalence in the normal controls, 20%; almost half (48%) of the patients diagnosed with MCI had positive amyloid detection. After a one year, the significant differences found at baseline on neuropsychological testing were similar at the follow-up assessment even though the AD group had significantly altered its functional performance (FAQ and CDR). The exception was semantic fluency, which showed greater impairment between the AD group and MCI and normal controls respectively. For these tests, the addition of AD biomarkers as a variable did not significantly alter the variations previously found for the established clinical group's model. Finally, the one-year conversion rate to dementia was 20% in the MCI cohort.

RESUMO El estudio de Argentina-Alzheimer's Disease Neuroimaging Initiative (Arg-ADNI) es una cohorte prospectiva de 50 pacientes seguidos en una misma institución. Fueron evaluados cognitivamente 15 controles normales (CN), 24 sujetos con deterioro cognitivo leve (DCL) y 12 con demencia tipo Alzheimer (DTA) leve. En los DTA, 92,3% tuvieron biomarcadores positivos para Alzheimer y 20% en los CN. Casi la mitad de los DCL presentaron biomarcadores positivos. Después de un año de seguimiento, la diferencias significativas halladas en la visita de inicio en las pruebas cognitivas fueron similares al año aunque los DTA tuvieron empeoramiento funcional medido en el FAQ y CDR. La excepción fue la fluencia semántica, la cual mostró mayor declinación entre DTA y los demás grupos. La incorporación de los biomarcadores como variable no alteró significativamente los hallazgos de grupo. La tasa de conversión a demencia anual fue del 20%.

Prevalence of Salmonella spp., in mesenteric pig's ganglia at Colombian benefit plants / Prevalencia de Salmonella spp., en ganglios mesentéricos de porcinos en plantas de beneficio Colombianas

ABSTRACT Objective. To determine the prevalence of Salmonella spp., in pigs mesenteric ganglion, from different regions of Colombia. Materials and Methods. A stratified sampling by proportional fixation was carried out at benefit plants of each of the 13 participating departments, whose pork production volume is representative at national level. Sampling was performed during five months, for a total of 457 samples analyzed. Salmonella spp., identification was performed by the MDS Molecular System, later isolates were confirmed in Maldi-TOF MS. Antimicrobial susceptibility of the isolates was determined using the B1016-180 panel and statistical analysis was performed in Whonet 2016, some of the multi-resistant isolates were them serotyped by Kauffman-White method. Results. National prevalence was 28.2%, with the presence of S. Typhimurium, S. Agama, S. London, S. Agona, S. Haifa and S. 1,4,12: i: -. Resistance to antibiotics frequently used in human (23.6% Trimethoprim/Sulfamethoxazole, 2.7% Cefotaxime (CTX), 11.8% Ampicillin (AMP) and 1.8% Ciprofloxacin) was found. Conclusion. The prevalence of Salmonella in mesenteric ganglia was 28.2%, being the Huila region the one with the highest prevalence, recovering atypical serotypes such as S. London and S. Haifa.

RESUMEN Objetivo. Determinar la prevalencia de Salmonella spp., en ganglios mesentéricos de porcinos, provenientes de diferentes regiones de Colombia. Materiales y Métodos. Se realizó un muestreo estratificado por fijación proporcional en plantas de beneficio, de cada uno de los 13 departamentos participantes, cuyo volumen de producción de carne de cerdo es representativo a nivel nacional. El muestreo se realizó durante cinco meses, para un total de 457 muestras analizadas. La identificación de Salmonella spp., se realizó mediante el Sistema Molecular MDS, luego los aislamientos fueron confirmados por Maldi-TOF MS. Se determinó la susceptibilidad antimicrobiana de los aislamientos usando el panel B1016-180 y el análisis estadístico se realizó en Whonet 2016, posteriormente algunos de los aisalmientos multi-resistentes fueron serotipificados por el método de Kauffman-White. Resultados. La prevalencia nacional fue 28.2%, con presencia de los serotipos S. Typhimurium, S. Agama, S. London, S. Agona, S. Haifa y S. 1,4,12: i : --. Se encontró resistencia a antibióticos de uso frecuente en humanos (23.6% Trimetoprim/Sulfametoxazol, 2.7% Cefotaxime (CTX), 11.8% Ampicilina (AMP) y 1.8% Ciprofloxacina). Conclusión. La prevalencia de Salmonella en ganglios mesénticos fue del 28.2%, siendo la región del Huila la que más aportó, se recuperaron serotipos atípicos como S. London y S. Haifa.

Miocardiopatía/displasia arritmogénica del ventrículo derecho. Revisión de la literatura además de un reporte de caso / Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Literature review and case report

Resumen: La miocardiopatía/displasia arritmogénica del ventrículo derecho es una enfermedad hereditaria autosómica dominante con una prevalencia estimada de 1:2,500-1:5,000, siendo mayor en el género masculino (3:1). Se caracteriza histológicamente por reemplazo de los cardiomiocitos por tejido fibroadiposo, lo cual predispone a arritmias ventriculares, insuficiencia ventricular derecha y muerte súbita cardiaca. El objetivo principal del tratamiento es reducir el riesgo de muerte súbita y mejorar la calidad de vida de los pacientes. Se presenta el caso de una mujer de 23 años con clínica de palpitaciones, dolor torácico con actividad física, síncope y cefalea iniciada hace 6 años durante un primer embarazo. Por aumento de sintomatología se realizó prueba de esfuerzo, durante la cual presentó taquicardia ventricular monomórfica sostenida colapsante. Se realizó cardiorresonancia, evidenciando dilatación ventricular derecha, aumento en su trabeculación y disminución de su función. Se realizó ablación con mapeo tridimensional; durante la comprobación con infusión de isoproterenol se generó flutter ventricular polimórfico requiriendo cardioversión eléctrica. Se decidió implantar cardiodesfibrilador bicameral y realizar ablación de ganglio estrellado como prevención secundaria. Tras su egreso reconsultó múltiples veces por descargas del dispositivo asociadas a palpitaciones. Se realizó una revisión exhaustiva de la historia clínica encontrando que la paciente tiene características sugestivas de displasia arritmogénica del ventrículo derecho por lo cual se aplican los criterios de Task Force concluyendo que, al cumplir con más de 2 criterios mayores, la paciente presentaba un diagnóstico definitivo de esta enfermedad. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract: Arrhythmogenic right ventricular cardiomyopathy/dysplasia is an inherited autosomal dominant disease, with an estimated prevalence of 1:2,500 to 1:5,000, being higher in males (3:1). It is characterised histologically by the substitution of cardiomyocytes for fibrous-adipose tissue, which predisposes to ventricular arrhythmias, right ventricular failure, and sudden cardiac death. The main aim of treatment is to reduce the risk of sudden death and improve the quality of life of patients. The case is presented of a 23 year old woman whose clinical symptoms started with palpitations, chest pain with physical activity, syncope, and headache, 6 years ago during her first pregnancy. Due to an increase in symptomatology, a stress test was performed, during which she collapsed with a sustained monomorphic ventricular tachycardia. A cardiac magnetic resonance scan showed dilation, an increase in trabeculae, and decreased function of the right ventricle. A 3-dimensional mapping and ablation was performed, and during the isoproterenol infusion test, a polymorphic ventricular flutter was generated that required electrical cardioversion. The decision was made to implant a dual chamber cardioverter defibrillator and perform stellate ganglion ablation as secondary prevention. After her discharge, the patient re-consulted many times due to discharges of the device associated with palpitations. A comprehensive review of the patient's medical records was performed, finding characteristics that may suggest arrhythmogenic right ventricular dysplasia. The Task Force criteria was applied, concluding that, as she met more than 2 major criteria, the patient had a definitive diagnosis of this disease. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Prevalencia y extensión de la calcificación arterial coronaria en población mexicana asintomática cardiovascular: estudio Genética de la Enfermedad Aterosclerosa / Prevalence and extent of coronary artery calcification in an asymptomatic cardiovascular Mexican population: Genetics of Atherosclerotic Disease study

Resumen: Objetivo: La prevalencia de calcificación arterial coronaria (CAC), marcador específico de aterosclerosis, no es conocida en México. Nuestro objetivo fue investigar la prevalencia y extensión de CAC y su asociación con factores de riesgo cardiovascular en población mexicana. Métodos: La CAC fue medida por tomografía computarizada multidetector en individuos asintomáticos que participaron en el estudio Genética de la Enfermedad Aterosclerosa. Los factores de riesgo cardiovascular y los medicamentos fueron registrados. Resultados: La muestra incluyó 1,423 individuos (49.5% hombres), con una edad de 53.7 ± 8.4 años. Los portadores de CAC mostraron prevalencias más altas de dislipidemia, diabetes, hipertensión y otros factores de riesgo. La prevalencia de CAC > 0 unidades Agatston fue de 27%, significativamente más alta en hombres (40%) que en mujeres (13%). Los valores medios del puntaje de CAC aumentaron consistentemente con la edad y fueron más altos en hombres que en mujeres en todos los grupos etarios. La edad y el c-LDL elevado se asociaron de manera independiente con la prevalencia de CAC > 0 en hombres y mujeres, mientras que la presión arterial sistólica en las mujeres, y el incremento de la edad en ambos géneros mostró una asociación independiente con la severidad de CAC. Conclusiones: En población mexicana la prevalencia y la extensión de CAC fueron mucho más altas en hombres que en mujeres y aumentaron consistentemente con la edad. Los predictores independientes de la prevalencia de CAC fueron la edad y el c-LDL.

Abstract: Objective: The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. Methods: CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. Results: The sample included 1,423 individuals (49.5% men), aged 53.7 ± 8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC > 0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC > 0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. Conclusions: In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).

Prevalencia y asociación de la calcificación valvular aórtica con factores de riesgo y aterosclerosis coronaria en población mexicana / Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population

Resumen: Objetivo: La prevalencia de calcificación valvular aórtica (CVA) tiene influencia importante de la etnia y se desconoce en población mexicana. Nuestro objetivo fue investigar la prevalencia de CVA y sus asociaciones con factores de riesgo cardiovascular y calcificación arterial coronaria (CAC). Método: En 1,267 sujetos (53% mujeres) sin enfermedad coronaria conocida y con edad de 35 a 75 años, la CVA y la CAC se evaluaron mediante tomografía computada multidetector, utilizando el método de Agatston. Los factores de riesgo cardiovascular se documentaron en todos los participantes. Las asociaciones de CVA con CAC y factores de riesgo se estimaron usando el análisis de regresión logística múltiple. Resultados: La prevalencia global de CVA y CAC fue del 19.89% y del 26.5%, respectivamente. Ambas condiciones aumentaron con la edad y se encontraron con mayor frecuencia en hombres (25.5 y 37.1%, respectivamente) que en mujeres (14.9 y 13%, respectivamente). La CVA se observó en únicamente el 8.5% de los sujetos sin CAC, mientras que en aquellos con CAC 1-99, 100-399 y > 400 unidades Agatston, las prevalencias fueron del 36.8, 56.8 y 84%, respectivamente. El análisis de regresión logística múltiple ajustado por edad, género, obesidad, inactividad física, hipertensión, dislipidemia y valores altos de insulina, mostró que la presencia de CAC (RM [IC95%]: 3.23 [2.26-4.60]), obesidad (1.94 [1.35-2.79]), género masculino (1.44 [1.01-2.05]) y edad (1.08 [1.03-1.10]), fueron predictores independientes y significativos de la CVA. Conclusiones: La prevalencia de CVA es alta y se asocia significativamente con factores de riesgo aterosclerótico y CAC en población mexicana.

Abstract: Objetive: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. Methods: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. Results: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects wit-hout CAC, while those with CAC 1-99, 100-399, and > 400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. Conclusion: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.

Candidiasis intraabdominal masiva secundaria a cirugías digestivas en pacientes inmunocompetentes. A propósito de 2 casos / Massive intra-abdominal candida infection secondary to digestive surgery in inmunocompetent patients: A report on 2 cases

La perforación asociada a infección intraabdominal difusa por Candida spp. es excepcional. Suele asociarse a pacientes inmunodeprimidos o con enfermedad tumoral avanzada. Presentamos 2 casos de perforación digestiva secundaria a candidiasis invasiva. En el primer caso, una mujer de 68 años con una perforación duodenal secundaria a Candida spp., se realiza laparotomía exploradora y reparación de la perforación duodenal. Sin embargo, la paciente requiere más de 2 intervenciones, observándose Candida spp. macroscópica diseminada por toda la cavidad abdominal. El segundo caso es el de un varón de 60 años que presenta un postoperatorio complicado de una hemicolectomía derecha, que se asocia con pancretitis, y con posterior diseminación fúngica abdominal secundaria a Candida parapsilopsis, con múltiples complicaciones infecciosas. En ambos casos se intentó un tratamiento basado en resección quirúrgica y cambio de anti-fúngicos, sin éxito. El tratamiento antifúngico precoz evita la diseminación hematógena y el shock séptico, disminuyendo la morbimortalidad de estos pacientes.

Candida spp. as cause of diffuse intraabdominal infection is very rare. Often associated with immunocompromised or patients with advanced tumor disease. We are reporting 2 cases of gastrointestinal perforation secondary to invasive candidiasis. The first case, a 68 years old female with a Candida spp. duodenal perforation. An emergency exploratory laparotomy was performed and a duodenal perforation repair was done. However, the patient required 2 more reoperation due to Candida spp. macroscopic intra-abdominal disemination. The second case, is presented in the context of a postoperative period of a right hemicolectomy, pancreatitis associating abdominal spread and subsequent secondary fungal Candida parapsilopsis with multiple infectious complications. In both cases there were unsuccessful surgical resection and antifungal change. The early antifungal treatment prevents hematogenous dissemination and septic shock, reducing the morbidity and mortality of these patients.