Factores de riesgo cardiometabólico y tratamiento antitrombótico en población mexicana con fibrilación auricular e insuficiencia cardiaca con fracción de expulsión reducida / Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction

Resumen Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Abstract Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Results: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Conclusions: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

Clinimetric analysis of heart failure in Mexican patients / Análisis clinimétrico de la insuficiencia cardiaca en pacientes mexicanos

Abstract Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 +- 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 +- 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 +- 5.7 and for EMPHASIS 3.3 +- 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.

Resumen La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 +- 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 +- 5.7 y para EMPHASIS 3.3 +- 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.

Diversity and growth-effects of ectomycorrhizal fungi of a Nothofagus pumilio forest in the Andes of Southern Chile / (Diversidad y efectos de crecimiento de hongos ectomicorrízicos en un bosque de Nothofagus pumilio en los andes del sur de Chile

Chilean temperate rainforests have unique climatic, edaphic and biotic conditions, constituting pre-industrial blueprint ecosystems. Mycorrhizal associations play a central role in the biogeochemical processes of these ecosystems´ functioning. Baseline forest ecology studies are necessary in order to better understand diversity patterns, specifically regarding mycorrhizal symbiosis. Therefore, here we describe the vegetation characteristics and the mycorrhizal relationships of vascular plants in a Nothofagus pumilio forest. We also describe, via morphological methods, the ectomycorrhizal diversity present in this forest. Additionally, we determined whether ectomycorrhizal inoculation confers positive growth effects on N. pumilio seedlings. We found that from 46 vascular plant species identified in this study, 42 (91%) were mycorrhizal and of these 33 (72%) were associated with arbuscular mycorrhizae (AM), two (the dominant trees N. pumilio and N. dombeyi) were forming ectomycorrhizae (EM), five were associated with ericoid mycorrhizae, two with orchid mycorrhizae, and four were nonmycorrhizal. Additionally, 26 EM species were detected of which 15 belong to Cortinarius. Finally, there were clear differences in the growth of N. pumilio seedlings inoculated with the ectomycorrhizal fungus Laccaria laccata compared to noninoculated plants. We suggest that mycorrhizal fungi play a key role in seedling colonization of harsh environments such as the Andean treeline.

Los bosques templados lluviosos de Chile tienen condiciones climáticas, edáficas y bióticas únicas, constituyendo ecosistemas preindustriales modelo. Las asociaciones micorrízicas juegan un rol central en los procesos biogeoquímicos del funcionamiento de estos ecosistemas. Por lo tanto, en este estudio describimos las características de la vegetación y las relaciones micorrízicas de las plantas vasculares de un bosque de Nothofagus pumilio. También describimos, vía métodos morfológicos, la diversidad ectomicorrízica presente en este bosque. Adicionalmente, determinamos si inoculaciones ectomicorrízicas confieren efectos de crecimiento positivos a semilleros de N. pumilio. Encontramos que, de 46 especies de plantas vasculares identificadas en este estudio, 42 (91%) son micorrízicas, y de estas, 33 (72%) están formando micorrizas arbusculares (AM), dos (los árboles dominantes N. pumilio y N. dombeyi) están asociados con ectomicorrizas (EM), cinco están asociadas con micorrizas ericoides, dos con micorrizas orquioides, y cuatro fueron nomicorrizadas. Adicionalmente, 26 especies de EM fueron detectadas, de las cuales 15 pertenecen a Cortinarius. Finalmente, hubo claras diferencias en el crecimiento de los semilleros de N. pumilio inoculados con el hongo ectomicorrízico Laccaria laccata, comparados a plantas no inoculadas. Sugerimos que los hongos micorrízicos juegan un rol clave en la colonización de ambientes severos por juveniles, como en el límite altitudinal andino.

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010 / Inappropriate medication use among Chilean older people

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and Methods: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Prevalencia de trastornos psiquiátricos en adolescentes infractores de ley en Chile / Prevalence of psychiatric disorders among teenage offenders

Background: There has been a significant number of adolescents admitted to National Youth Service of Chile (SENAME) detention centers in recent years, specifically since the promulgation of a law reform on juveniles’ penal responsibility for people aged 14 to 18 years (2006). Aim: To determine the prevalence of psychiatric disorders in adolescent male offenders aged between 14 and 17 years. Material and Methods: The Mini International Neuropsychiatric Interview for Kids and Adolescents (MINI-KID) was applied to 489 adolescents admitted to detention centers, to determine the presence of psychiatric disorders. (Hypo) maniac episodes, eating disorders, pervasive developmental disorders, tic disorders, and psychotic disorders were excluded. Furthermore, for purposes of analysis, 23 cases that used a substance of abuse or had signs of consumption the day of the interview were excluded. Results: Eighty six percent of respondents had at least one psychiatric disorder. The most common were substance use disorders (76%). Among these, marijuana dependence disorder had the higher frequency (51%). Disruptive behavior disorders had also a high prevalence (38%), followed by anxiety disorders (27%), attention deficit and hyperactivity disorder (26%), and affective disorders (21%). Conclusions: There is a high prevalence of psychiatric morbidity among teenage offenders which could undermine rehabilitation.

Acidosis tubular renal distal, a propósito de un caso / Distal renal tubular acidosis, a case report

Describimos las características clínicas y de laboratorio de una escolar con los diagnósticos de acidosis tubular renal distal y raquitismo secundario. Se aprovecha el caso para hacer una revisión de la literatura.

We described the clinical and laboratory findings of a child with distal renal tubular acidosis associated to severe rickets and review the literature.

Calidad microbiológica del agua de un área agrícola-ganadera del centro sur de Chile y su posible implicancia en la salud humana / Microbiological quality of water in livestock area of southern Chile and its possible implications on human health

Introduction: A significant proportion of water for human consumption has an underground origin becoming 80% in Chilean rural areas where profound wells represent the only search of water for human and animal beverage. Aim: To study the microbiological quality of water from agricultural land for livestock production in the province of Valdivia (40°S), Chile and its potential impact on human health. Material and Method: Water samples were collected monthly (2008 - 2009), at the entrance and exit of a water stream running through the field and in well water used for human and animal consumption. The total coliform (Tc) and Escherichia coli were determined by the confirmatory method Quanti-Tray together with other physicochemical assessments in the water and climatic variables. Results: In samples from the stream water and wells, the Most Probable Number of Tc and E. coli exceeded the standard Chilean Norm of Water Quality (NCh 409/1) for human consumption. Conclusion: These results show the need to regulate the environmental impact of farming and cattle production and to monitor the drinking water to meet the minimum standards of health protection.

Introducción: Parte importante del agua para consumo humano corresponde a agua subterránea, alcanzando un 80% en áreas rurales de Chile, donde los pozos profundos son la única fuente de agua de bebida para consumo humano y animal. Objetivo: Estudiar la calidad microbiológica del agua de un predio agrícola-ganadero en la provincia de Valdivia (40° S), Chile, y su posible impacto en la salud humana. Material y Método: Muestras de agua fueron recolectadas mensualmente (2008-2009), a la entrada y salida de un estero que atraviesa el predio y en agua de pozos usadas para consumo humano y animal. Las especies coliformes totales (Ct) y Escherichia coli se determinaron por el método confirmativo Quanti-Tray, se evaluaron variables físico-químicas del agua y climáticas del sitio. Resultados: En las muestras de agua del estero y pozos el número más probable de Ct y E. coli sobrepasaron la norma chilena de calidad del agua (NCh 409/1) para consumo humano. Conclusión: Estos resultados muestran la necesidad de regular el impacto ambiental de la actividad agrícola-ganadera y monitorear el agua de bebida para cumplir con los estándares mínimos de protección de la salud.

Identificación y caracterización del adulto mayor saludable / A novel method for targeting and characterizing healthy older people

Background: There is no established definition of healthy aging in clinical practice, although it is a World Health Organization goal. Aim: To develop a clinical protocol to identify healthy older people living in the community and study their clinical, laboratory and functional characteristics. Material and Methods: Healthy people aged 60 years or older, were invited to participate in the study, by newspapers and radio, if they selfperceived as healthy, lived in the community, were functionally independent and had low disease burden. Potential participants were initially screened by telephone, and those who met the inclusion criteria were included. They had a comprehensive geriatric assessment which included clinical, anthropometric, laboratory and functional assessments. Results: Of 384 people who answered the call, 83 subjects aged 60 to 98 years (57 percent women) met the inclusion criteria of healthy older people. Seventy eight percent did not consume any medication, 100 percent were able to perform physical activities that required at least three metabolic equivalents (Mets). Basic laboratory showed that approximately 90 percent of subjects had normal values, using standard benchmarks established for an adult population. Conclusions: The protocol used in this work was able to identify healthy older people with low disease burden and good functionality. It also validated history and comprehensive geriatric assessment as reliable instruments to identify these subjects.

A proposed functional clinical classification predicts in-hospital and long-term survival in the setting of acute right ventricular infarction / Propuesta de una clasificación funcional y clínica para predecir la sobrevida intrahospitalaria y a largo plazo de enfermos con infarto agudo del ventrículo derecho

BACKGROUND: The objectives of the present investigation were to validate the prognostic role of a proposed Clinical Classification [CC], to evaluate the TIMI risk score [RS] and to establish whether the TIMI-RS should incorporate points for patients with acute right ventricular infarction [TIMI-RS-RVI]. METHODS AND RESULTS: A total of 523 RVI patients were classified on clinical and functional basis as: A, without right ventricular failure [RVF], B with RVF and C with cardiogenic shock. The CC was evaluated prospectively among 98 patients with RVI and retrospectively in 425 RVI patients. The TIMI-RS was evaluated prospectively among 622 patients with STEMI [anterior:277, inferior:247, RVI:98], and retrospectively in 425 RVI patients. The CC established differences among the 3-RVI Classes for in-hospital mortality [prospectively and retrospectively; p<0.01, p<0.001, respectively] that were maintained at 8 years [p < 0.001]. Patients with anterior and inferior STEMI, but not those with RVI revealed an association between outcome and TIMI-RS [p<0.001]. Testing for TIMI-RS-RVI did not result a good prognostic tool [ROC=0.9; excellent discrimination, but with a very poor [quot ]clinical calibration[quot ]]. CONCLUSIONS: The proposed CC allowed prediction of mortality at short- and long-term in the setting of acute RVI. The role of the TIMI-RS should be reevaluated prospectively as a prognostic tool in the scenario of RVI patients.

Physiological-enzymatic characteristics and inoculation of mycelial strains of Descolea antarctica Sing. in Nothofagus seedlings

At present, reforestation has focused on native forests with anthropogenic intervention and eroded soils. There is interest in producing Nothofagus seedlings which can overcome adverse conditions encountered on reforestation sites. It is necessary to find new fungi that can be utilized as mycorrhizal inoculants and that enable the seedlings to increase their tolerance to adverse conditions. Two ectomycorrhizal strains of the fungus Descolea antarctica (D1 and D2) were cultured at different temperatures, pH levels and the activities of amylases, cellulases, and phosphatases were determined. In greenhouse and nursery trials, the growth responses of inoculated Nothofagus obliqua seedlings were evaluated. D1 and D2 exhibited the highest growth rates at 23ºC. Both strains grew at pH levels from 4 to 11. The highest enzymatic activities were registered for amylase (57.2 mg glucose/ml g of mycelium hr) and acid phosphatases (58.1 mg p-nitrophenol/ml g of mycelium hr) at 37ºC, and acid phospatases (1.720 mg p-nitrophenol/ml of mycelium hr) and alkaline phosphatases (1.360 mg p-nitrophenol/ml g of mycelium hr) at pH 4 and pH 11, respectively. We conclude that suitable N. obliqua seedlings for use in reforestation were obtained using D2 as inoculant.

El análisis del poder cardíaco [quot ]pulmonar[quot ] en hipertensión arterial pulmonar primaria y secundaria. Observaciones iniciales, su posible utilidad en la clínica / The possible clinical role of the cardiac pulmonary power in patients with primary pulmonary hypertension. Initial observations

The heart is a muscular mechanical pump with an ability to generate both flow [cardiac output] and pressure in the systemic circulation as well in the pulmonary vascular bed. The product of flow output and systemic arterial pressure is the rate of useful work done, or cardiac power output [CP], therefore for the right ventricle and the pulmonary arterial vascular bed it will be: the product of flow output and mean pulmonary arterial pressure will be the rate of useful work done, or cardiac pulmonary power output [CPP]. Cardiac pulmonary pumping reserve capability can be defined as the maximal cardiac pulmonary power output [CPP] achieved by the right heart during maximal stimulation. Therefore, CPP reserve is the increase in power output as the cardiac performance is increased from the resting to the maximally stimulated state. Recently, several studies have shown that CP is a direct indicator of overall cardiac function, as well is an indicator of exercise capacity and a powerful predictor of prognosis for patients with severe heart failure and ischemic cardiogenic shock. On this basis: 1. we decided to investigate the possible previously mentioned roles of the CP and CPP in patients with different degrees of pulmonary arterial hypertension [n = 137], but mainly in those with primary pulmonary arterial hypertension [PPH]. PPH patients [n = 50], as well as those with Eisenmenger's syndrome [n = 10] were found to have most abnormal resting CPP Indexes [I], [0.431 +/- 0.171, 0.607 +/- 0.124 watts/m2, respectively]. During exercise in PPH patients [n = 14], both CPI and CPPI reserves although they increase, were also found to be significantly diminished [CPI: from 0.546 +/- 170 to 1,116 +/- 0.275 watts/m2, p < 0.05], [CPPI: from 0.373 +/- 0.156 to 0.837 +/- 0.226 watts/m2, p < 0.05]. 2. We also found, significant differences in resting CPPI between PPH responders and no responders patients to hydralazine [0.273 +/- 0.04, 0.507 +/- 0.142 watts/m2, respectively, p < 0.01]. During exercise and under the influence of hydralazine, CPPI [quot ]reserve[quot ] was significantly diminished in those patients considered as not responders [0.507 +/- 0.142 to 0.723 +/- 0.232 watts/m2, p = ns] when compared with responders to the vasodilator therapy [0.273 +/- 0.04 to 0.903 +/- 0.057 watts/m2, p < 0.01]. On the basis of these initial findings on CPPI in PPH patients, we think that the values of this parameter should be investigated as an index for classifying the se...

Consideraciones fisiopatológicas actuales del choque cardiogénico asociado a los síndromes isquémicos coronarios agudos / Recent considerations of cardiogenic shock associated to the acute coronary ischemic syndromes

We review novel physiopathological concept of Cardiogenic Shock associated to acute coronary ischemic syndromes, where the mechanist terms become jumbled not only, but the neuro-hormonal, immuno-inflammatory, and biomolecular alterations. In order to offer a pharmacointensive treatment that obtains the stabilization of the acute coronary Syndrome, for the reduction of myocardial ischemia. Also, we incorporate the incidence of this pathology in the Mexican population.

De la placa vulnerable solitaria, a la coronariopatía de múltiples vasos. De sus fundamentos, a las implicaciones terapéuticas modernas. Una realidad clínica en el espectro de los SICA / From the single vulnerable plaque, to the multiple complex coronary plaques. From their basis, to the modern therapeutic approach. A clinical reality in the spectrum of the acute coronary syndromes

Contemporary clinical and laboratory data have challenged our classical concepts of the pathogenesis of the acute coronary syndromes [ACS]. Indeed, several independent lines of clinical evidence have supported that the critical stenoses cause only a fraction of the ACS. Acute myocardial infarction is believed to be caused by rupture of a vulnerable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and therefore result in multiple unstable lesions. Recent studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some ACS patients. It has also been reported that a ruptured plaque at the culprit lesion is associated with elevated C- reactive protein and other inflammatory markers, which indeed indicate a poor prognosis in patients with ACS. Also, multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Therefore some ACS patients [20-40%] may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. It should be accepted that this ACS population represent a part of the spectrum of the ACS, and in particular in this group of patients treatment should focus not only on the stabilization of the culprit site but also warrants a broader approach to systemic stabilization of the arteries. However, recurrent cardiovascular events in this population still remain unacceptably high, indicating that plaque rupture or vulnerability of multiple plaques is a current challenge in the management of ACS patients.

De la placa vulnerable solitaria, a la coronariopatía de multiples vasos. De sus fundamentos, a las implicaciones terapéuticas modernas. Una realidad clínica en el espectro de los SICA / From the single vulnerable plaque, to the multiple complex coronary plaques. From their basis, to the modern therapeutic approach. A clinical reality in the spectrum of the acute coronary syndromes

Contemporary clinical and laboratory data have challenged our classical concepts of the pathogenesis of the acute coronary syndromes [ACS]. Indeed, several independent lines of clinical evidence have supported that the critical stenoses cause only a fraction of the ACS. Acute myocardial infarction is believed to be caused by rupture of a vulnerable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and therefore result in multiple unstable lesions. Recent studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some ACS patients. It has also been reported that a ruptured plaque at the culprit lesion is associated with elevated C- reactive protein and other inflammatory markers, which indeed indicate a poor prognosis in patients with ACS. Also, multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Therefore some ACS patients [20-40%] may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. It should be accepted that this ACS population represent a part of the spectrum of the ACS, and in particular in this group of patients treatment should focus not only on the stabilization of the culprit site but also warrants a broader approach to systemic stabilization of the arteries. However, recurrent cardiovascular events in this population still remain unacceptably high, indicating that plaque rupture or vulnerability of multiple plaques is a current challenge in the management of ACS patients.

El poder cardíaco un instrumento del pasado, posiblemente una herramienta moderna en la valoración: clínica, terapéutica y pronóstica del choque cardiogénico por síndrome isquémico coronario agudo / The cardiac power output an old tool, possibly a modern tool for assessing cardiac pumping capability, as well as for a short-term prognosis in cardiogenic shock due to acute myocardial infarction

Hemodynamic monitoring has been used extensively during the last decades for risk stratification and guiding treatment of patients with cardiovascular destabilization, especially in the scenario of acute heart failure and cardiac shock. Every cardiac pump has its own maximum performance, which denotes its pumping capability. The heart is a muscular mechanical pump with an ability to generate both flow (cardiac output) and pressure. The product of flow output and systemic arterial pressure is the rate of useful work done, [quot ]or the cardiac power[quot ] (CP). Cardiac pumping capability can be defined as the cardiac power output achieved by the heart during maximal stimulation, and cardiac reserve is the increase in power output as the cardiac performance is increased from the resting to the maximally stimulated state (CPR). Resting CP for a hemodynamically stable average sized adult is approximately 1 W. However, during stress or exercise, CPR can be recruited to increase the heart's pumping ability up to 6 W. In acute heart failure, the patient becomes hemodynamically unstable, and most of the cardiac pumping potential is recruited in order to sustain life. Hence, cardiac power measurements in patients with acute heart failure or with cardiogenic shock at rest represent most of the recruitable reserve available during the acute event, and their measurement reflects the severity of the patient's condition. It has been found that a cutoff value for CP of 0.53 W accurately predict in-hospital mortality for cardiogenic shock patients. Others investigators observed cutoff for increased mortality of CP < 1 W, data that were obtained at doses of maximal pharmacologic support yielding the individual maximal CP. In our experience, the cutoff value for CP that accurately predicts in-hospital mortality for cardiogenic shock patients is 0.7 W, but its impact on short-term prognosis is clearer if the patient achieves a CP equal or higher than 1 W after an optimal myocardial revascularization with interventional cardiac procedures. According to the data collected from the literature, CP deserves a place in the evaluation of the patient with cardiogenic shock due to an acute myocardial infarction, but a more profound analysis of this parameter an further evaluation are required in order to better understand its prognostic meaning in this acute cardiac syndrome.

Cerrena unicolor (Bull.) Murr.(Basidiomycota) aislado de micangio de Tremex fuscicornis Fabr. (Hymenoptero Siricidae) asociado a decaimiento y pudrición del Alamo (Populus sp.) en Chile / Cerrena unicolor(Bull.)Murr.(Basidiomycota) isolated from mycangia of Tremex fuscicornis Fabr. (Hymenoptera Siricidae) associated to poplar decline (Populus sp.) in Chile)

Entre septiembre a diciembre del 2004 el Instituto Forestal y el Servicio Agrícola y Ganadero, en investigaciones conjuntas de estrategias de control biológico para Tremex fuscicornis Fabr. (Hym. Siricidae), se profundizó en el conocimiento de la asociación simbiótica que presenta esta avispa xilófaga con un hongo. T. fuscicornis, es una avispa taladradora del álamo que presenta en sus glándulas micangiales el micelio y esporas de un hongo asociado, el cual inyectado al árbol en el momento de la oviposición, causa su posterior decaimiento y biodegradación. Desde hembras adultas se obtuvieron los micangios que contenían micelio y artrosporas del hongo, estos fueron macerados y posteriormente sembrados en agar papa dextrosa, desarrollándose colonias fúngicas que formaron artrosporas. El micelio de estas colonias fue inoculado en varios tipos de sustratos vegetales esterillizados, en especial en trozas de álamo, donde se desarrollaron basidiocarpos, los que taxonómicamente correspondieron a Cerrena unicolor (Bull.) Murr., primer reporte para Chile de este basidiomicete.

Since september to december 2004,Instituto Forestal and Servicio Agrícola y Ganadero, while investigating together the strategies for the biological control of Tremex fuscicornis Fabr. (Hym.Siricidae), acquired thorough knowledge about the symbiotic association existing between this xylophagus wasp with a fungus. T. fuscicornis is a horntail wasp attacking poplar trees and which has in its mycangial glands the mycelium and spores of an associated fungus that once injected in the tree at the oviposition stage, causes its further decayand rottenness. Mycangia containing mycelium and arthrospores of this fungi were obtained from adult females. They were macerated and then cultivated inpotato dextrose agar (PDA) what resulted in fungal colonies that further formed arthrospores. The myceliumof these colonies was inoculated into different kinds of sterilized vegetal substrates, mainly in pieces of poplartrees, where basidiocarpes were developed, taxonomically corresponding to Cerrena unicolor (Bull.) Murr., thisbeing the first report on this basidiomycete in Chile.

Choque cardiogénico: Las variables de mortalidad / Mortality in cardiogenic shock

Objetivo: El choque cardiogénico (CHC) es la causa más frecuente de mortalidad después de un infarto agudo del miocardio (IAM). El objetivo de este trabajo fue conocer cuáles son las principales variables de mortalidad del CHC. Métodos: Se estudiaron en período consecutivo de 12 años a 155 enfermos del Servicio de Urgencias del Instituto Nacional de Cardiología "Ignacio Chávez ". Resultados: En los enfermos mayores de 60 años con antecedentes de diabetes mellitus y con cardiopatía isquémica la mortalidad fue mayor (p<0.001). Al analizar los procedimientos terapéuticos, el grupo de tratamiento exclusivamente médico (n=79) tuvo mortalidad de 97.4% y el de revascularización temprana (n=76) de 59.2% con diferencia significativa (p<0.001). Conclusiones: Se concluye que el CHC tiene mortalidad elevada (78.7%) en el grupo global; que la edad, la presencia de diabetes y el antecedente de cardiopatía isquémica empeoran su pronóstico, y que la revascularización temprana como método terapéutico disminuye su mortalidad.

Objective: Cardiogenic shock (CS) is one of principal causes of mortality after an acute myocardial infarction (MI). The objective of this study was to determine the principal causes that contribute to an increase in mortality in CS. Methods: We studied 155 consecutive patients with CS admitted to the Coronary Care Unit of the Instituto Nacional de Cardiología Ignacio Chávez from 1990 2002. Results: Patients older than 60 years with MI and diabetes mellitus presented a higher cardiovascular mortality (p<0.001). Percutaneous coronary intervention (PCI) procedures decreased the cardiovascular mortality in CS as compared to those patients not submmitted to PCI (59% vs. 98%, p<0.001). Conclusions: Mortality due to CS is still very high (80%). Previous MI and diabetes favor short term mortality and the use of PCI suggests a clinical favourable trend in the reduction of mortality due to CS. PCI appears to be the most appropriate reperfusion procedure for treating CS.

Biodegradación de paja de trigo por cepas fúngicas seleccionadas / Biodegradation of wheat straw by selected fungal strains

Desde suelos derivados de cenizas volcánicas se evaluó la capacidad degradativa de 2 cepas fúngicas seleccionadas: Trichoderma pseudokoningii y Westerdikella multíspora y una cepa control (Trametes versicolor) sobre paja de trigo previamente sometida a pasteurización y con adición de NH4NO3. Como controles fueron incluidos paja de trigo y paja de trigo más NH4NO3, ambas sin inóculo fúngico. Todos los tratamientos fueron realizados en triplicados y mantenidos durante 60 días en un invernadero. Al inicio y al final de las incubaciones se determinó los contenidos de celulosa, lignina, extraíbles totales, N, P, C totales, cenizas y pH. Los tratamientos controles no presentaron variación en los contenidos de celulosa. Las pajas tratadas con las cepas fúngicas presentaron una disminución no significativa del contenido de celulosa pero un aumento significativo del contenido del lignina. El contenido de extraíbles totales sólo en la paja tratada con T. pseudokoningii aumentó significativamente, la cual además presentó una disminución significativa del contenido del C. Por su parte, solo en las pajas tratadas con W. multispora se determinó un aumento significativo del N. Para el contenido de P total no se determinaron aumentos significativos. En todos los tratamientos el pH disminuyó y las cenzas presentaron un aumento significativo en aquellos que incluyeron solo las cepas seleccionadas.

Disminución de hemorragias totales con dosis reducidas de enoxaparina en angina inestable de alto riesgo / Estudio ENHNFAI. (ENoxaparina vs Heparina No Fraccionada en Angina inestable). Informe preliminar. Decrease of total hemorrhage with reduced doses of enoxaparin in high risk unstable angina. ENHNFAI study. (Enoxaparin vs non-fractionated heparin in unstable angina). Preliminary report

In this prospective, randomized and controlled study, we compare complications in 2 groups of patients: group 1, enoxaparin 0.8 mg/kg, subcutaneous every 12 hours during 5 days, and group 2, intravenous unfractionated heparin during 5 days, by infusion treated to activate partial tromboplastin time 1.5-2 the upper limit of normal. Blood samples were obtained at 4, 12, 24 hours and at day 5 of treatment, to measure anti-Xa levels, and also, evaluated end points at 30 days, between groups. Univariate and multivariate logistic regression analyses were performed with clinical and angiographic variables between groups, with p < 0.05. RESULTS: 203 consecutive patients, average age of 60.5 +/- 11.2 years, and 80 men, were included. There were no differences in clinical and angiographic characteristics. All patients with enoxaparin had therapeutic levels of anti-Xa, of 0.5 to 0.67 U/mL. There was increasing risk of total bleeding in group 2 (18.7) than in group 1 (5.6), with RR = 1.72 (95 CI 1.29, 2.29), p = .003. Also, there was 33.3 of MACE in group 2, and only 17.8 in group 1, with RR = 1.88 (CI 95 1.29, 2.29), p = .011. CONCLUSIONS: 1) Low doses of enoxaparine achieve therapeutic levels, since the first 4 hours of treatment. 2) A significant reduction of total bleeding occurred with the low doses of enoxaparin, with the same efficacy to reduce MACE during follow-up.

La influencia del pericardio en la patofisiología de la disfunción ventricular en el infarto agudo del ventrículo derecho: estudio experimental / The role of the pericardium in the pathophysiology of ventricular dysfunction in experimental acute right ventricular infarction

Para obtener mayor información de la función del pericardio en el Infarto Agudo del Ventrículo Derecho (IAVD) se estudiaron las curvas de función ventricular (CFV) y la relación de las presiones diastólicas finales ventriculares (R-Pd2V, VD: VI) en un modelo canino. Estos se dividieron en: Grupo A (N = 12): Basal (B), IAVD, Postpericardiectomía (PP). La CFV derecha (D) B se comportó como parábola y su punto de flexión (PF) estuvo en 13 ñ 2 mmHg de Pd2V. En el IAVD la CFVD se ubicó abajo y a la derecha de la CFVD B (p < 0.05) y el PF se desplazó a 18 ñ 2 mmHg p < 0.05), PP la CFVD se desplazó arriba y a la izquierda de la CFVD IAVD (p = NS). La R- Pd2V VD: VI B fue: 0.75, en IAVD: 0.91 y PP: 0.84 (p = NS). Grupo B (N = 12): Basal (B), Postpericardiectomía (PP) e IAVD. La CFVD PP se desplazó arriba y a la izquierda de la CFVD B (p < 0.05) y el PF fue = 10 ñ 2 mmHg. En IAVD la CFVD se ubicó abajo y a la derecha de la CFVD PP (p < 0.05) y la R-Pd2V, VD:VI fue de 0.45 PP, y con el IAVD se igualaron (0.95) significativamente (p < 0.05). Conclusiones: En la génesis del gasto cardiaco (GC) bajo del IAVD se demostró el papel restrictivo parcial del pericardio, ya que la igualdad de la R-Pd2V se debe también a isquemia. El PF de la CFVD con IAVD (18 + 2 mmHg) es la cifra límite para la infusión de volumen en el IAVD experimental. A reserva de validarse en el hombre este dato puede ser útil para el manejo de la precarga en el humano con IAVD e hipotensión sistémica o GC bajo.