Cardiotoxicidad inducida por tratamientos oncológicos: fundamentos para la implementación de equipos de Cardio-Oncología / Cardiotoxicity of anticancer therapies: towards the implementation of cardio-oncology units

Recently, we have witnessed major improvements in cancer treatment. Early diagnosis and development of new therapies have reduced cancer-related mortality. However, these new therapies, along with greater patient survival, are associated with an increase in untoward effects, particularly in the cardiovascular system. Although cardiotoxicity induced by oncologic treatments affects predominantly the myocardium, it can also involve other structures of the cardiovascular system, becoming one of the main causes of morbidity and mortality in those who survive cancer. The main objective of cardio-oncology is to achieve the maximum benefits of oncologic treatments while minimizing their deleterious cardiovascular effects. It harbors the stratification of patients at risk of cardiotoxicity, the implementation of diagnostic tools (imaging techniques and biomarkers) for early diagnosis, preventive strategies and early treatment options for the complications. Herein, we discuss the basic knowledge for the implementation of cardio-oncology units and their role in the management of cancer patients, the diagnostic tools available to detect cardiotoxicity and the present therapeutic options.

Composición de leche materna en madres de recién nacidos de pretermino menor a 33 semanas / Composition of breast milk in mothers of preterm infants less than 33 weeks

Introducción: La leche materna es recomendada como el alimento más adecuado en el primer año de vida, ya que proporciona los sustratos necesarios para el crecimiento del recién nacido. En los últimos años se ha ampliado el estudio de la composición de la leche materna y su relación sobre el efecto de la nutrición en los recién nacidos de pre termino. Objetivo: investigar la composición de macronutrientes en leche materna de recién nacidos prematuros (<33 semanas). Métodos: análisis de contenido de proteínas, carbohidratos y lípidos en muestras de leche materna de recién nacidos prematuros (menor que 33 semanas) recolectadas longitudinalmente, según protocolo de estudio. Resultados: Se presenta variabilidad en muestras recolectadas en tres semanas consecutivas de edad posnatal, dando contenido de proteína que vario de 1,34g/dl (DS +/- 0.11) a 1,05 g/dl (DS +/- 0.10) con (p menor que 0,05). Hidratos de carbono vario de 6,20 g/dl (DS +/- 0.17) a 6.77 g/dl (DS+/-±0.22) con (p menor que 0,05). Lípidos vario de 4.10 g/dl (DS +/- 0.39) a 4.33 g/dl (DS +/- 0.26) con (p=0,075).Discusión: Estos datos proporcionan una visión más detallada de la ingesta de nutrientes de los recién nacidos prematuros alimentados con leche materna.

Introduction: Breast milk is recommended as the most suitable food in the first year of life, as it provides the substrates required for growth of the newborn. In recent years it has expanded the study of the composition of breast milk and their relationship on the effect of nutrition in preterm infants. Objective: To investigate the macronutrient composition of breast milk in preterm infants (33 weeks). Methods: Analysis of protein, carbohydrates and lipids in breast milk samples from preterm (<33 weeks) collected longitudinally, according study protocol. Results: We present variability in samples collected in three consecutive weeks of postnatal age, giving protein content ranged from 1.34 g / dl (SD +/- 0.11) to 1.05 g / dl (SD +/- 0.10) with (p < 0.05). Carbon hydrates 6.20 g / dl (SD +/- 0.17) to 6.77 g / dl (SD +/- 0.22) with (p <0.05). Fat of 4.10 g / dl (SD +/- 0.39) to 4.33 g / dl (SD +/- 0.26) with (p = 0.075).Discussion: These data provide a more detailed picture of the nutrient intake ofpreterm infants fed breast milk.

Metabolismo energético del corazón y sus proyecciones en el tratamiento de la insuficiencia cardíaca / Heart energy metabolism and its role in the treatment of heart failure

It is unknown why heart failure progresses even when patients are treated with the best therapy available. Evidences suggest that heart failure progression is due to loss of neurohumoral blockade in advanced stages of the disease and to alterations in myocardial metabolism induced, in part, by this neurohumoral activation. Alterations in cardiac energy metabolism, especially those related to substrate utilization and insulin resistance, reduce the efficiency of energy production, causing a heart energy reserve deficit. These events play a basic role in heart failure progression. Therefore, modulation of cardiac metabolism has arisen as a promissory therapy in the treatment of heart failure. This review describes myocardial energy metabolism, evaluates the role of impaired energy metabolism in heart failure progression and describes new therapies for heart failure involving metabolic intervention.

Diagnóstico antenatal de malformaciones renales / Antenatal diagnosis of renal abnormalities

Se presentan 54 casos de malformaciones congénitas renales, diagnosticadas antes del nacimiento por ecografía, en un período de 3 años. La mayor frecuencia, correspondió a hidronefrosis de diversos orígenes. Se esquematizan los diversos tipos de quistes y tumores renales y su diagnóstico