Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Hipertensión arterial nocturna: análisis según su gravedad / Nocturnal Hypertension: Analysis According to its Severity

RESUMEN Introducción: En el diagnóstico y seguimiento de la hipertensión arterial (HTA) la mayoría de las guías de práctica recomiendan el monitoreo ambulatorio de la presión arterial (MAPA). En este sentido, existe cada vez más evidencia que respalda la superioridad de la hipertensión arterial nocturna (HTAN) como predictor de eventos cardiovasculares. Se sabe poco sobre la relación con los eventos cardiovasculares según la gravedad de la HTAN. Además, no está claro a partir de qué valor de presión arterial nocturna comienza a aumentar el riesgo. Objetivos: Conocer si la presencia de HTAN y sus niveles de gravedad se asocian con resultados cardiovasculares adversos durante el seguimiento. Material y métodos: Estudio observacional. Realizamos un análisis de los datos obtenidos en un centro médico de alta complejidad de Buenos Aires, recopilados a partir de estudios de MAPA de 24 horas. Examinamos las características clínicas de los pacientes, los resultados de laboratorio, los estudios de imagen y sus resultados durante el período de seguimiento. Nuestro estudio incluyó personas de 18 años o más a las que se les había diagnosticado hipertensión. Definimos HTAN como aquellos casos con valores de presión arterial ≥ 120/70 mmHg durante el periodo nocturno. Resultados: Fueron incluidos 981 pacientes en el análisis final. De ellos, el 53 % eran hombres; la edad media era de 59,4 años. Presentaban HTAN 63,6 % (n=624). Clasificamos la HTAN en cuatro estratos de gravedad para comparar, según el valor de presión arterial sistólica nocturna: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg y 160-220 mmHg. Se registraron eventos adversos cardiovasculares mayores en 8 (2,2 %), 17 (4,1 %), 8 (5,6 %) y 7 (11,3 %) sujetos, respectivamente, y esta diferencia entre grupos fue estadísticamente significativa (p=0,007). El análisis multivariado de regresión de Cox demostró que la presencia de HTAN fue un predictor independiente de eventos cardiovasculares adversos (HR 3,60; IC 95% 1,12-11,5; p=0,033), incluso al considerar la presencia de hipertensión arterial diurna. Conclusión: En esta cohorte contemporánea, la HTAN y su gravedad se asociaron independientemente con la incidencia de eventos cardiovasculares adversos.

ABSTRACT Background: In the diagnosis and follow-up of arterial hypertension (HTN) most practice guidelines recommend ambulatory blood pressure monitoring (ABPM). In this regard, there is increasing evidence supporting the superiority of nocturnal hy pertension (NHTN) as a predictor of cardiovascular events. Little is known about the relationship with cardiovascular events according to the severity of NHTN. Furthermore, it is unclear from what nighttime pressure value the risk begins to increase. Objectives: The aim of this study was to determine whether the presence of NHTN and its severity levels are associated with adverse cardiovascular outcomes during follow-up. Methods: An observational study was performed analyzing data collected from 24-hour ABPM studies obtained in a high complexity medical center in Buenos Aires. We examined patients' clinical characteristics, laboratory findings, imaging studies and their results during the follow-up period. Our study included ≥18 year-old persons who had been diagnosed with hypertension. We defined NHTN as those cases with blood pressure values ≥120/70 mmHg during the nighttime period. Results: The final analysis included 981 patients. Among these, 53% were men, mean age was 59.4 years and NHTN was present in 63.6% of cases (n=624). Nocturnal HTN was classified into four severity strata for comparison, according to the nighttime systolic blood pressure value: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg and 160-220 mmHg. Major adverse cardiovascular events were recorded in 8 (2.2%), 17 (4.1 %), 8 (5.6%) and 7 (11.3%) subjects, respectively, and this differ ence between groups was statistically significant (p=0.007). Multivariate Cox regression analysis showed that the presence of NHTN was an independent predictor of adverse cardiovascular events (HR 3.60; 95% CI 1.12-11.5; p=0.033), even when considering the presence of daytime hypertension. Conclusion: In this contemporary cohort, NHTN and its severity were independently associated with the incidence of adverse cardiovascular events.

Conocimientos sobre enfermedades cardiovasculares en un establecimiento de primer nivel de atención en Lima, Perú / Knowledge about cardiovascular diseases in a first-level healthcare center in Lima, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimiento sobre enfermedades cardiovasculares en personas en un centro de salud del primer nivel de atención en salud (PNAS). Se realizó un estudio descriptivo y transversal mediante una encuesta a personas que asistieron a un establecimiento de salud del PNAS en Lima, Perú. Un puntaje menor a 6 se consideró como conocimiento inadecuado. Se encuestó a 400 personas, 66,3% mujeres, de 46,8 ± 16,2 años. La nota promedio fue de 4,52 +/- 1,85. El 71% de los encuestados tuvo un nivel de conocimiento inadecuado, independientemente de la edad, género o grado de instrucción. Nuestros hallazgos muestran que el nivel de conocimiento sobre los factores de riesgo y la enfermedad cardiovascular resultó inadecuado en la población en atención primaria. Es necesario lograr una educación específica en factores de riesgo cardiovascular, para reducir el impacto de estas enfermedades.

ABSTRACT This study aimed to determine the level of knowledge about cardiovascular diseases in people in a primary healthcare center (PHCC). A descriptive and cross-sectional study was carried out by surveying people who attended a PHCC in Lima, Peru. A score less than 6 was considered inadequate knowledge. A total of 400 people were surveyed, 66.3% were women and the mean age was 46.8 ± 16.2 years. The average score was 4.52 +/- 1.85. We found that 71% of those surveyed had an inadequate level of knowledge, regardless of age, gender or education level. Our findings show that the level of knowledge about risk factors and cardiovascular disease was inadequate in the primary care population. It is necessary to achieve proper specific education in cardiovascular risk factors in order to reduce the impact of these diseases.

The myriad presentations of peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is an idiopathic, non-ischemic systolic type of heart failure which can present anytime from the last month of pregnancy till the end of 5th month post-partum. The incidence of PPCM in the Indian population is 1:1340 with 60% of the cases occurring post-partum. PPCM has a mortality rate of 11.7% with unpredictable sequelae ranging from worsening heart failure, cardiogenic shock, development of arrythmias to complete recovery and recurrence in subsequent pregnancies. With an idiopathic aetiology with multiple theories, PPCM remains a diagnosis of exclusion, demanding a high index of suspicion and surveillance in pregnant women. The management involves a multidisciplinary approach involving the obstetrician, cardiologist and at times the anaesthesiologist and includes various drugs like beta- blockers, diuretics, digoxin, bromocriptine. In severe cases, maternal circulatory support may also be needed. We present three cases of PPCM diagnosed in the antepartum, intrapartum and immediate post-partum periods respectively. Out of 3 patients, one delivered vaginally and two underwent emergency caesarean sections. All of patients went home post-delivery with good outcomes and were doing well after 4 weeks of delivery.

The prevalence of congenital heart disease in newborn detected by pulse oximeter screening test at 24 hours of birth and its correlation with clinical findings and ECHO

Background: Detecting congenital heart disease (CHD) early is crucial for better outcomes, but most newborns show no symptoms. Newborn screening for CHD can identify such cases preventing serious consequences. This study aims to determine CHD prevalence and evaluate the effectiveness of pulse oximeter screening and clinical examination, correlating them with echocardiography findings.Methods: A cross-sectional study was conducted to screen for CHD in all newborns born in our institution over a period of 3 months. A sample of 660 newborns were screened by pulse oximeter screening and clinical examination after random sampling.Results: Comparison of baseline data like age distribution in mothers, gender and gestational age were comparable between newborns with CHD and those without CHD. A total of 8 CHDs were picked up after screening 660 newborns screened during a period of 3 months. CHDs that were picked up included hypoplastic left heart syndrome, pulmonary atresia, bicuspid aortic valve, transposition of great arteries, coarctation of the aorta, and other complex CHDs. It was found that either clinical examination or pulse oximeter screening has higher sensitivity than pulse oximetry screening or clinical examination alone.Conclusions: For identification of a CHD in newborns after 24 hours of birth the order of preference for screening based on sensitivity is as follows-either pulse oximeter screening or clinical examination >clinical examination >pulse oximeter screening >pulse oximeter screening and clinical examination.

A study of clinical and etiological profile of mitral valve dysfunction

Background: Heart valve diseases are a leading cause of cardiovascular morbidity and mortality globally; putting a significant strain on healthcare resources. In developing countries, rheumatic heart disease (RHD) remains the most common type of heart valve disease. Mitral valve disease is the most frequent of the valvular heart diseases. Mitral valve disease is a distressing and painful condition, and requires immediate attention before they result in death. Methods: This was a prospective observational study done from September 2019 to February 2021, at the Department of General Medicine, Goa Medical College and Hospital, Bambolim, Goa: A tertiary care hospital in Goa. Results: Out of the 50 patients enrolled in the study 44% patients had MS ,18% had MR and 38%had MR+MS. Mean age of the study population was 41 to 50 years of which 54% patients were females. All isolated Mitral Stenosis patients were rheumatic origin. Of the 9 MR patients, predominant form of MR was ischemic (66.66%), followed by rheumatic (22.22%) and MVP (11.11%). 19 patients had MR+MS, predominant form was rheumatic (84.21%). It was also observed that 42% each of total patients had pulmonary hypertension and congestive cardiac failure, 40% had pulmonary edema, while 30% had atrial fibrillations complications. Conclusions: Our study revealed that the most common valve dysfunction observed is mitral stenosis, with a female preponderance and its most common etiology being rheumatic. Further it was also observed that the most common complication is pulmonary hypertension and congestive cardiac failure.

Successful management of complete heart block in pregnancy

This case report presents a comprehensive account of effectively managing complete heart block (CHB) in a pregnant patient with prior cardiac surgery. At 36 weeks of gestation, the team opted for an elective caesarean delivery, necessitating the insertion of a temporary pacemaker. The multidisciplinary collaboration, involving obstetricians, cardiologist, and anaesthetist, played a pivotal role in ensuring a secure delivery. The report delves into the intricacies of addressing acquired CHB during pregnancy, emphasizing the scarcity of established protocols and the need for further research in this domain. Physiological changes in pregnancy, potential complications, and pacing recommendations are discussed. The success of this case underscores the significance of meticulous planning, risk stratification, and multidisciplinary approach in managing bradycardia during high-risk pregnancies. Overall, the report provides valuable insights into navigating the complexities of acquired CHB in pregnancy, advocating for enhanced screening, early recognition, and collaborative efforts among specialists.

Cardiac disease in pregnancy

Cardiac disease is an important cause of maternal morbidity and mortality. It can invariably affect fetus with variable intensity depending upon nature of cardiac disease in mother. Cardiac disease can affect women antenatally, in labor and even in post-partum period. It is a case series of 12 cases who presented to labor room in a particular unit at SSG hospital, Baroda over a period of 1 year starting from 1st May 2022 to 30th April 2023. Mean age at presentation was 24.8. 3 women were having valvular heart disease while 4 were having peri-partum cardiomyopathy (PPCM), 4 were having atrial septal defect (ASD), 1 was having ventricular septal defect (VSD). Associated medical comorbidities and obstetrical factors were evaluated. 2D ECHO findings of all cases were recorded. Risk assessment must be done for the mother and fetus to minimize the effect of cardiac disease in pregnancy. Joint consultation with cardiologist should be done in already known case of cardiac disease.

Transición y transferencia del adolescente con cardiopatía congénita / Transition and transfer of the adolescent with congenital heart disease

En las últimas décadas los avances médicos han permitido la sobrevida de los niños con cardiopatías congénitas hacia la adolescencia y adultez. Un número sustancial de pacientes tienen lesiones persistentes o residuales que requerirán asistencia durante toda la vida. El manejo exitoso durante el proceso de transición en pacientes con cardiopatía congénita (CC) requiere un enfoque integral y colaborativo. Es fundamental desarrollar un programa de transición planificado que incorpore educación y autocontrol. La educación continua y la participación activa de pacientes y familias son esenciales. La formación de especialistas y la creación de unidades de atención de Adolescentes y Adultos con cardiopatía congénita (AACC) garantizarán una mayor supervivencia y calidad de vida en esta creciente población de pacientes en Argentina. La investigación continua y la implementación de mejores prácticas, con el apoyo de políticas sanitarias, son clave para abordar los desafíos y controversias en la gestión de la transición y transferencia (AU)

In recent decades, medical advances have allowed children with congenital heart disease (CHD) to survive into adolescence and adulthood. A substantial number of these patients have persistent or residual lesions that require lifelong care. Successful management during the transition process for patients with CHD requires a comprehensive and collaborative approach. It is critical to develop a planned transition program that incorporates education and self-management. Continuing education and the active participation of patients and families are essential. The training of specialists and the creation of Adolescent and Adult Congenital Heart Disease (AACHD) care units will ensure greater survival and quality of life for this growing patient population in Argentina. Continued research and implementation of best practices, supported by health policies, are key to addressing the challenges and controversies in transition and transfer management (AU)

Pulmonary hypertension in congenital heart disease of children

Background: Pulmonary arterial hypertension is the dreaded complication of congenital heart disease with left-right shunt. The aim of this study was to describe the epidemio-clinical aspects of PAH associated with congenital heart disease.Methods: This was a retrospective descriptive multicentre study over a 2-year period (1 January 2020 to 31 December 2021) conducted in three University Hospitals in Antananarivo. Hospitalized children with congenital left-right shunt heart disease were included.Results: A total of 74 cases were recruited. The sex ratio was 0.7. The mean age of the children was 10.9 (SD=18.2) months. The mean age of onset of heart disease was 8 (SD=13.6) months. Heart disease was dominated by ventricular septal defect (51.3%), patent ductus arteriosus (39.2%), and atrioventricular canal (8.1%). PAH was encountered in 49 cases (66.2%). The majority of children with PAH were under 12 months of age (71.4%) and malnourished (70.2%). According to the type of heart disease, PAH was encountered in all complete CAVs, in 76.3% of CIVs and in 55.2% of PCAs. Eseinmenger's syndrome was present in 4% of cases, and the death rate was 20.3%.Conclusions: Improved management of children with congenital heart disease is needed, both in terms of diagnosis and surgical treatment, to prevent the onset of PAH.

Efficacy of Ayurved based therapy on global longitudinal strain in ischemic heart disease: a retrospective analysis

Background: The current study aimed to investigate the efficacy of the Ischemia Reversal program (IRP) as an Ayurveda based therapy to standard anti-ischemic therapy in patients with ischemic heart disease (IHD). Methods: A retrospective, single centre, observational study was conducted from January 2022 to May 2023. A total of 39 patients diagnosed with ischemic heart disease and global longitudinal strain (GLS) <15, regardless of underlying co-morbidities such as diabetes mellitus, hypertension, obesity, hyperlipidemia, low ejection fraction, history of myocardial infarction were included in this study. The primary endpoint was improvement in GLS from baseline to the 90-day follow-up in various different categories. Secondary endpoints were improvement in EF, abdominal girth, weight and reduction in dependency on allopathic medication from baseline to the 90-day follow-up. Results: The mean age of the study population was 59.23±9.01 years. Weight (day 1: 67.29±13.16 kg and day 90: 61.39±11.11 kg; p=0.00), body mass index (day 1: 25.75±4.03 and day 90: 23.79±3.50; p=0.00), abdominal girth (day 1: 95.31±10.75 cm and day 90: 85.67±17.02 cm p=0.00), EF (day 1: 40.74±10.30% and day 90: 53.91±11.87%; p=0.00), and GLS (day 1: -10.99±2.72 and day 90: -13.17±3.75; p=0.00) improved at the 90 day follow-up. Conclusions: The study showed notable improvements in weight, body mass index, abdominal girth, EF, and GLS after 90 days. These results suggest that IRP is beneficial treatment for IHD, but more extensive research is needed to confirm its effectiveness.

Circulating zinc levels and cardiometabolic risk-related variables in adults / Niveles de zinc circulante y variables relacionadas con el riesgo cardiometabólico en adultos

Introduction. Altered serum zinc levels, lower and higher than values in healthy controls, have been observed in individuals affected by non-communicable chronic diseases. However, to date, studies describing potential determinants of zinc levels in general populations free of chronic diseases appear to be limited. Objective. To evaluate whether nutrient intake, biochemical and clinical measures, lifestyle, and family history of cardio-metabolic diseases are independently associated with zinc levels in apparently healthy individuals. Materials and methods. We evaluated 239 healthy subjects. Serum zinc was measured via flame atomic absorption spectrometry, and the remaining biochemical markers were assessed using enzymatic colorimetric methods. Standard techniques were employed to quantify waist circumference, height, and weight. Body fat was measured via bioimpedance, and blood pressure was measured using digital sphygmomanometers. We applied a survey to record the personal and family history of non-communicable chronic diseases, and nutrient intake was estimated using the 24-hour recall method. Results. Women had lower serum zinc levels than men. In multivariate analyzes, total fat intake (ß = -0.15; standard error = 0.03; p < 0.001), plasma log-triglycerides (ß = -10.18; standard error = 3.9; p = 0.010), and female gender (ß = -6.81; standard error = 3.3; p = 0.043) were significant predictors for serum zinc levels. Zinc intake was not significantly related to serum zinc in univariate and multivariate analyses. Conclusions. Variables related to cardiometabolic risk, such as plasma triglyceride levels and total fat intake, were associated with serum zinc levels in individuals without a diagnosis of chronic or infectious/inflammatory diseases. Further studies are required to confirm our findings and to evaluate possible biological mechanisms for these relationships.Keywords: Zinc; heart disease risk factors; triglycerides; micronutrients.

Introducción. Se han observado niveles séricos alterados de zinc, más altos o más bajos, en personas afectadas por enfermedades crónicas no transmisibles. Sin embargo, la información sobre determinantes de zinc sérico en poblaciones sin enfermedad crónica es muy limitada. Objetivo. Evaluar si la ingestión de nutrientes, las medidas bioquímicas y clínicas, el estilo de vida y los antecedentes familiares de las enfermedades cardiometabólicas están asociados de forma independiente con los niveles de zinc en individuos aparentemente sanos. Materiales y métodos. Se evaluaron 239 sujetos sanos. El zinc sérico se midió por espectrometría de absorción atómica de llama y el resto de los marcadores bioquímicos por métodos enzimáticos-colorimétricos. Se utilizaron técnicas estándar para medir la antropometría. Se aplicó una encuesta para registrar antecedentes personales y familiares, y se estimó el consumo de nutrientes por recordatorio de 24 horas. Resultados. Las mujeres tenían niveles séricos de zinc más bajos que los hombres. En los análisis multivariados, la ingestión total de grasas (ß = -0,15; error estándar = 0,03; p < 0,001), los triglicéridos plasmáticos (ß = -10,18; error estándar = 3,9; p = 0,010), y el sexo femenino (ß = -6,81; error estándar = 3.3; p = 0,043) fueron predictores significativos de los niveles séricos de zinc. La ingestión de zinc no estuvo significativamente relacionada con el zinc sérico en los análisis univariados y multivariados. Conclusiones. Las variables relacionadas con el riesgo cardiometabólico como los niveles de triglicéridos y la ingestión total de grasas se asociaron con los niveles de zinc en individuos sin diagnóstico de enfermedades crónicas o infecciosas-inflamatorias. Se requieren más estudios para confirmar estos hallazgos, así como la evaluación de los posibles mecanismos biológicos de estas relaciones.

Foeto-maternal outcome in pregnancy with and without heart disease: a comparative cross-sectional study in a tertiary care hospital

Background: Pregnant women with underlying heart disease are at increased risk for adverse maternal, obstetric, and neonatal outcomes. One can successfully treat the majority of these incidents if detected early by accurate individual risk assessment and careful follow-up. The aim and objectives of this study were to compare the foeto-maternal outcome in pregnancy with and without heart diseases with period of gestation >32 weeks.Methods: This study was carried out in a tertiary care teaching hospital of Imphal, the capital city of Manipur, using a standard-questionnaires among patients admitted. Data was analysed using SPSS 21.0 with statistical significance set at p<0.05.Results: Study was conducted on 112 pregnant women. The prevalence of heart disease was higher (71.4%) among the primiparous women. Highest occurrence of heart disease (66.1%) was seen in the housewife group. There was increased incidence of pre-term deliveries among pregnant women with heart disease (26.8%). Caesarean section (62.5%) and maternal complications (42.9%) were found to be higher among the pregnant women with heart disease. The incidence of NICU admission of babies was higher among mothers with heart disease (17.9%) compare to 5.4% in mothers without heart disease.Conclusions: Early detection by accurate individual risk assessment and careful follow-up are key to improving outcomes.

Factores de riesgo cardiovascular en pacientes geriátricos atendidos en el centro de salud INNFA / Cardiovascular risk factors in geriatric patients attended at the INNFA health center / Factores de risco cardiovascular em doentes geriátricos atendidos no centro de saúde do INNFA

Los llamados factores de riesgo cardiovascular conductuales, como la dieta inadecuada, sedentarismo, el consumo excesivo de alcohol y el tabaquismo, aumentan la probabilidad de ataque cardíaco y accidente cerebrovascular, incluso cuando coexisten en personas sin padecimientos previos. Objetivo fue identificar los factores de riesgo cardiovascular en pacientes geriátricos del Centro de salud INNFA, en Macas, Ecuador. Metodología: Investigación con enfoque cuantitativo, diseño no experimental, alcance descriptivo, de corte transversal, empleó una muestra de 40 pacientes geriátricos atendidos en el Centro de Salud referido, la técnica para la recolección de datos fue la encuesta y el instrumento un cuestionario de riesgos cardiovasculares. La muestra de estudio se caracterizó por el predominio del sexo femenino y edades entre 60 y 69 años en los pacientes, condiciones socio-económicas que pueden incrementar el riesgo cardiovascular como como nivel educativo básico y la remuneración menor a un salario básico unificado. Conclusión: La mayoría de los pacientes presentaban dos o más factores de riesgo y entre estos predominaron la hipertensión arterial, hipercolesterolemia, sobrepeso, consumo excesivo de bebidas alcohólicas y la diabetes mellitus.

The so-called behavioral cardiovascular risk factors, such as inadequate diet, sedentary lifestyle, excessive alcohol consumption, and smoking, increase the probability of heart attack and stroke, even when they coexist in persons with no previous conditions. The objective was to identify cardiovascular risk factors in geriatric patients at the INNFA health center in Macas, Ecuador. Methodology: Research with a quantitative approach, non-experimental design, descriptive scope, cross-sectional, used a sample of 40 geriatric patients attended at the referred health center, the technique for data collection was the survey and the instrument was a cardiovascular risk questionnaire. The study sample was characterized by the predominance of female sex and age between 60 and 69 years in patients, socio-economic conditions that may increase cardiovascular risk such as basic education level and remuneration lower than a unified basic salary. Conclusion: Most of the patients had two or more risk factors and among these, arterial hypertension, hypercholesterolemia, overweight, excessive consumption of alcoholic beverages and diabetes mellitus predominated.

Os chamados factores de risco cardiovascular comportamentais, como a alimentação inadequada, o sedentarismo, o consumo excessivo de álcool e o tabagismo, aumentam a probabilidade de enfarte do miocárdio e de acidente vascular cerebral, mesmo quando coexistem em pessoas sem patologias prévias. O objetivo foi identificar os factores de risco cardiovascular em pacientes geriátricos do centro de saúde INNFA em Macas, Equador. Metodologia: Investigação com abordagem quantitativa, desenho não experimental, âmbito descritivo, transversal, com uma amostra de 40 pacientes geriátricos atendidos no referido centro de saúde, a técnica de recolha de dados foi um inquérito e o instrumento foi um questionário de risco cardiovascular. A amostra do estudo caracterizou-se pelo predomínio do sexo feminino e idade entre 60 e 69 anos, condições socioeconómicas que podem aumentar o risco cardiovascular como o nível de escolaridade básico e remuneração inferior a um salário base unificado. Conclusão: A maioria dos pacientes apresentava dois ou mais fatores de risco e, dentre estes, predominaram a hipertensão arterial, a hipercolesterolemia, o excesso de peso, o consumo excessivo de bebidas alcoólicas e o diabetes mellitus.

Implante valvular percutáneo valve-in-valve en tricúspide. Primer reporte de caso de paciente pediátrico en Colombia / Percutaneous valve-in-valve valve implantation in tricuspid position. First case report of a pediatric patient in Colombia

Resumen Las anormalidades de la válvula tricúspide tienen una incidencia menor respecto a los defectos del resto de válvulas cardiacas y pueden deberse a causas primarias o secundarias. Recientemente, se ha estudiado su fisiopatología y su importancia en la morbimortalidad por causas cardiacas. En este sentido, la cirugía valvular tricúspide abierta tiene una tasa de morbimortalidad elevada, más aún cuando se trata de una reoperación. Es por esto que estos procedimientos endovasculares transcatéter cobran relevancia y recientemente se han publicado a lo largo del mundo algunos casos de intervenciones por este método, por medio de implante valvular percutáneo valve-in-valve en posición tricúspide. Se presenta el primer caso reportado de este procedimiento en Colombia en una paciente pediátrica, el cual transcurrió sin complicaciones y con el que se logró una mejoría significativa en la función valvular como paso inicial para continuar desarrollando la técnica y realizando este procedimiento en el país.

Abstract Abnormalities in the tricuspid valve have a lower incidence than defects in the rest of the heart valves and may be due to primary or secondary causes. Recently, its pathophysiology and importance in morbidity and mortality due to cardiac causes have been widely studied. Open tricuspid valve surgery has a high rate of morbidity and mortality, and even more so when it comes to reoperation. For this reason, it is important to carry out these procedures endovascularly via a transcatheter catheter and some cases of exacerbations by this method have recently been published throughout the world, by means of percutaneous valve-in-valve implantation in the tricuspid position. We present the first reported case of this procedure in Colombia in a pediatric patient, whose procedure was uneventful and a significant improvement in valve function was impaired, as an initial step to continue developing the technique and performing the procedure in this country.

Odontopediatría en el paciente con enfermedad sistémica / Pediatric dentistry in patients with systematic disease

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)

This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)

Feasibility of fetal echocardiography screening during first trimester in a low-risk population

Background: Prenatal identification of cardiac defect gives families the opportunity to receive counselling regarding the anticipated fetal and neonatal outcomes. Screening and diagnosis of congenital heart disease in the first trimester has increased over the past decade as almost all CHDs are already established by that time. Objective was to assess the feasibility of screening through first trimester echocardiography by a trained observer in low-risk populations.Methods: The study was conducted on a sample of 500 antenatal mothers of gestational age between 11-13 weeks+6 days attending a teaching hospital. Maternal age, weight, height, body mass index, parity, gestational age, obstetric history and past history were recorded. In addition to first trimester ultrasound screening for aneuploidy in foetuses, a simplified echocardiographic examination was performed. After obtaining the appropriate fetal position, Crown-rump length was documented. Nuchal translucency thickness was recorded. After examination with 2-dimensional sonography, the operator obtained the tricuspid flow and ductus venosus flow. Color flow mapping was applied for evaluating the 4-chamber view and three vessel tracheal views. Specific criteria developed for the 4-chamber view, 3 vessel trachea view, tricuspid flow and ductus venosus flow was used to assess feasibility.Results: Good feasibility was observed for all the views, with tricuspid flow showing 96% feasibility, Ductus Venosus showing 95% feasibility, 3VT view showing 90.1% feasibility and 4CV view having 89.7% feasibility. There was no significant association found between maternal BMI, CRL and the feasibility of fetal cardiac screening.Conclusions: Encouraging results of this study indicates the feasibility of fetal cardiac screening in low-risk population.

Epidemiología y resultados del paro cardiorrespiratorio pediátrico en la unidad de recuperación cardiovascular de un hospital público en Argentina / Epidemiology and outcomes of pediatric cardiac arrest in a cardiovascular unit at a public hospital in Argentina

Resumen Antecedentes: Los niños con cardiopatías congénitas experimentan paro cardiorrespiratorio (PCR) con mayor frecuencia que la población pediátrica general. Se desconoce la epidemiología exacta del PCR en nuestro medio, al igual que el riesgo de mortalidad y los factores que influyen en la evolución neurológica. Objetivo: Describir la epidemiología y los resultados asociados con la reanimación cardiopulmonar pediátrica en una unidad de recuperación cardiovascular. El criterio de valoración primario fue la supervivencia al momento del alta hospitalaria; los secundarios fueron el retorno de la circulación espontánea, la supervivencia a las 24 horas y la condición neurológica en el largo plazo. Método: Estudio de cohorte longitudinal, descriptivo, prospectivo, en menores de 18 años que requirieron reanimación cardiopulmonar entre 2016 y 2019. Se analizaron las variables demográficas y las características del paro cardiorrespiratorio y de la reanimación, así como su resultado. Se realizaron análisis de una y múltiples variables para comparar a los pacientes sobrevivientes con los fallecidos. Resultados: De los 1,842 pacientes internados, el 4.1% experimentó PCR. Se analizaron 50 pacientes con expedientes completos. Se logró el retorno de la circulación espontánea en el 78% (39), con una supervivencia alta del 46%. La reanimación > 6 min y el uso de fármacos vasoactivos fueron factores predictivos de mortalidad; se realizó el seguimiento de 16/23 pacientes, 10 de ellos con desarrollo normal para la edad luego de seis meses, seis tenían trastorno generalizado del desarrollo. Conclusiones: El 4.1% de los pacientes presentó un PCR, con una tasa de 3.4 PCR por 1,000 días-paciente. La supervivencia al egreso hospitalario (n = 50) fue del 46%. La reanimación > 6 min y la utilización de fármacos vasoactivos fueron factores predictivos independientes de mortalidad. Luego de seis meses, el 63% tenía desarrollo neurológico normal para la edad.

Abstract Background: Children with congenital heart disease present a higher frequency of cardiorespiratory arrest (CRA) than the general pediatric population. The epidemiology of CRA is not exactly known in our setting, nor are the mortality risk or the neurological evolution factors. Objective: To describe the epidemiology and outcomes associated with pediatric cardiopulmonary resuscitation in a cardiovascular recovery unit. The primary endpoint was the survival to discharge and the secondary endpoints were the return to spontaneous circulation, the survival at 24 hours and the remote neurological condition. Methods: Descriptive, prospective, longitudinal cohort study in children under 18 years of age who required cardiopulmonary resuscitation between 2016 and 2019. Demographic variables, characteristics of cardiopulmonary arrest, resuscitation and outcome were analyzed. An uni- and multivariate analysis was performed comparing survivors and deceased. Results: Out of 1,842 hospitalized patients, 4.1% presented CRA. Fifty patients with complete records were analyzed. Seventy-eight percent (39) returned to spontaneous circulation with a high survival rate of 46%. Resuscitation > 6 min and the use of vasoactive drugs were predictors of mortality; 16/23 patients were followed up, 10 of them with normal development for age at 6 months, six had pervasive developmental disorder. Conclusions: 4.1% of patients presented CRA, with a rate of 3.4 CRA per 1,000 patient-days. Survival at hospital discharge (n = 50) was 46%. Resuscitation > 6 min and the use of vasoactive drugs were independent predictors of mortality. At six months, 63% had normal neurological development for age.