Discrepancies in the evaluation of the safety of the human papillomavirus vaccine

Despite being more than ten years since its introduction, global acceptance to the human papillomavirus (HPV) vaccine is still low. The immunogenetic background of the host, and HPV antigen recognition, are important in natural HPV infection, and should be taken into account in the understanding of adverse autoimmune reactions by the HPV vaccine in certain groups. There is no doubt of the benefit of vaccines in the reduction of the incidence of infectious diseases, and in the case of HPV, the prevention of persistent infection that would lead to cervical cancer. Side-effects, however, should be closely monitored and reported without any bias, to ensure that the benefits of vaccines outweigh the risks of adverse reactions. In this article we bring the attention on certain adverse effects of the vaccine against HPV that have not been well studied as they are not well defined. We also compare the different approaches on HPV vaccine policies regarding its adverse reactions in countries like Japan and Colombia, vs. the recommendations issued by the WHO.

Exclusión del ventrículo venoso. Evolución y retos. A propósito de los primeros cien casos del procedimiento de Fontan en el Instituto Nacional de Cardiología [quot ]Ignacio Chávez[quot ] / Exclusion of venous ventricle. Evolution and challenges

The history and evolution of the cardiovascular surgery and pediatric cardiology is fascinating. For centuries many erroneous galenic concepts about cardiovascular anatomy and physiology were sustained by physicians. At the end of the XIX century and during the XX century, the progress in science allowed for a more appropriate understanding of the anatomophysiology of the cardiovascular system, promoting the concept of dispensability of half of the heart. This concept of right ventricle dispensability has subsisted, teaching us lessons that have led to a bear understanding of the hemodinamic behavior of many cardiac congenital malformations. The cavopulmonar total bypass or Fontan procedure with its modifications is an example of this knowledge. In the present article we make a brief historical review of the concept of right ventricle dispensability, and a brief analysis of the learned lessons provided by many authors and our own experience, without forgetting that we still have a long way to fully understand the pulmonary vasculature behavior and the univentricular physiology.

Tratamiento quirúrgico de lafibrilación auricular crónica asociada a valvulopatía mitral / Surgical treatment of atrial fibrillation associated with mitral valve disease

The modified Cox maze procedure is the gold standard for ablation of atrial fibrillation in patients undergoing mitral valve surgery, and new approaches to atrial fibrillation ablation must be compared with it. Therefore, we sought to determine the time-related prevalence of atrial fibrillation and its risk factors after combined Cox maze and mitral valve surgery. In some patients undergoing mitral valve surgery and a Cox maze procedure, atrial fibrillation recurs over time, mandating close, long-term follow-up of heart rhythm. Earlier operation should be considered to improve results in selected patients.

Anomalía de Ebstein / Ebstein anomaly

We evaluated the results for primary repair of Ebstein anomaly in 61 patients, both adults and children. The records were reviewed of patients undergoing repair of Ebstein anomaly at the Congenital Heart Surgery Service of the National Institute of Cardiology [quot ]Ignacio Chávez[quot ] from January 1993 to August 2003. Functional, demographic, and echocardiographic parameters were studied both preoperatively and postoperatively, along with functional status and adverse events. The repair technique involved vertical plication of the atrialized ventricle and valve leaflet reimplantation after clockwise rotation or replacement of tricuspid valve. Ebstein repair has good functional outcomes in patients despite residual tricuspid regurgitation, likely because of reduction in right ventricular volume loading and relative annular and ventricular plasticity. Intraoperative radiofrequency ablation represents an important adjunctive treatment for intractable arrhythmias, which may now represent relative indications for operative intervention.