Síndrome Hughes-Stovin: Caso clínico / Hughes-Stovin syndrome: Report of one case

We report a 25yearold mole admitted to a critical care unit for fever, lung opacities and acute respiratory failure. A chest angio-CAT sean showed multiple pulmonary artery aneurysms. A deep venous thrombosis of both lower limbs was also documented. A Hughes-Stovin syndrome was postulated. An inferior vena cava filter was placed. The patient received antimicrobial therapy subsiding fever and respiratory failure. Subsequently, he was treated with intravenous and oral steroids and one dose of cyclophosphamide. The patient was discharged in good conditions fifteen days after admission.

Hipertensión pulmonar en paciente VIH positiva / Pulmonary arterial hypertension in a HIV positive patient

Se presenta el caso clínico de una paciente de 30 años, con diagnóstico de VIH + desde el año 2000, en terapia antirretroviral desde el año 2004. Desde el año 2007 con disnea de esfuerzo progresiva, que en el último año se hace severa, asociada a astenia, fatigabilidad y edema vespertino de extremidades inferiores. El ecocardiograma detecta un aumento de la presión de arteria pulmonar, lo que se confirma a través de un cateterismo cardíaco derecho. Se descarta tromboembolismo pulmonar y se concluye como una HAP secundaria a VIH. La hipertensión arterial pulmonar (HAP) es una enfermedad de baja frecuencia y se puede asociar a infección por virus de la inmunodeficiencia humana (VIH), presentando una prevalencia 6 a 12 veces mayor en relación a individuos sin infección por VIH. La HAP es independiente del recuento de linfocitos T CD4 y en su patogenia participan proteínas virales, como la glicoproteína 120 y las proteínas Nef y Tat, que estimulan una cascada inflamatoria sistémica, induciendo angiogénesis en los vasos pulmonares. El estudio hemodinámico a través de cateterismo derecho es el método de elección para la confirmación diagnóstica.

We report the case of a patient 30 years, diagnosed with human immunodeficiency virus (HIV) since 2000, on antiretroviral therapy since 2004. Since 2007 with progressive dyspnea, which in the past year becomes severe, associated with asthenia, fatigue and edema of lower limbs evening. Echocardiography detects an increase in pulmonary artery pressure, which is confirmed by a right heart catheterization. Pulmonary embolism is ruled out and concludes as a pulmonary arterial hypertension (PAH) secondary to HIV. Pulmonary arterial hypertension is a disease of low frequency and can be associated with infection by HIV, with prevalence 6 to 12 times greater relative to individuals without HIV infection. PAH is independent of CD4 T lymphocyte count and viral proteins involved pathogenesis, such as glycoprotein 120 and Nef and Tat proteins, which stimulate a systemic inflammatory cascade, inducing angiogenesis in the pulmonary vessels. The hemodynamic study through right heart catheteri-zation is the method of choice for diagnostic confirmation.

Enfermedades afectivas y actividad solar: Seguimiento a 16 años / Association between hospital admissions due to affective disorders and solar activity: Analysis of 16 years

Background: Exposure to solar activity may be associated with incidence of depressive and manic disorders. Aim: To assess the link between solar activity and appearance of affective disorders. Material and Methods: We examined 1862 clinical records of a psychiatric clinic located in Santiago, Chile. Patients with major depression and manic disorders were included in the study, only when they were admitted at the clinic for the first time. Solar activity was calculated using the Wolf number, which is given by the formula R= K(10g+f), where “g” stands for the groups of sunspots and “f ” is the total number of sunspots. We examined the correlation between annual incidence of hospital admissions and average Wolf numbers for the period 1990-2005, which corresponds to approximately one and half solar cycles of 16 years. Results: A total of 450 medical records corresponding to 299 patients (199 women) with depressive symptoms and 151 patients (73 women) with mania, were analyzed. There was a higher number of admissions for depression during the years with lower solar activity. Admissions due to mania tended to increase in the years with high solar activity. There was a negative correlation between the number of hospital admissions due to depression and solar activity (Spearman r =-0.812, p < 0.01). The association between the latter parameter and admissions due to mania did not reach statistical significance. Conclusions: There is a significant negative association between the rate of hospital admissions due to depressive disorders and solar activity.

Un sistema computarizado para la detección de fragmentaciones en la despolarización. primera parte / Development of a computer system to detect late-potentials fragmentation. first-part

Se desarrolló un sistema computarizado que permite amplificar la señal del ECG, digitalizarla, promediarla, filtrarla digitalmente, analizar la primera derivada y analizarla a través de la Transformación de Fourier. Tal sistema es capaz de detectar potenciales retrasados que se originan en áreas del miocardio alterando morfológicamente que condicionan altraciones en la velocidad de conducción. Para validar el sistema, se realizaron 28 estudios que correspondieron a 15 sujetos normales (Grupo 1), 10 en pacientes con infarto del miocardio tanto antiguo como reciente (Grupo 2) y 3 en pacientes con infarto del miocardio y taquicardia ventricular sostenida, documentada en la unidad coronaria o en electrocardiografía ambulatoria. De las 31 variables obtenidas del análisis en tiempo, primera derivada y análisis en frecuencia, el voltaje RMS de los 40 mseg terminales del QRS filtrado a 25 HZ, los cruces por la línea de base de la derivada de la deriación Y y el voltaje RMS de la transformada de Fourier de los 40 mseg terminales de 3.9 a 304.7 Hz, permitieron diferenciar a los pacientes del Grupo 3 de aquellos del Grupo 1 (p<0.0001). Por otra parte, el valor RMS de la derivada de la derivación Y, la amplitud pico-pico de la derivada de la derivación Z y el valor RMS de la derivada de esta derivación permiteiron diferenciar al Grupo 3 del Grupo 2 (p<0.002). Se concluye que el análisis de la primera derivada, el análisis en frecuencia y el análisis en tiempos son, en ese orden, útiles en la identificación de potenciales retrasados en la porción terminal del QRS.