ABSTRACT
Compromised water quality risks public health, which becomes particularly acute in economically marginalized communities. Although the majority of the clean-water-deprived population resides in Sub-Saharan Africa and Asia, a significant portion (32 million) lives in Meso- and Latin-America. Oaxaca is one of the marginalized southern states of Mexico, which has experienced high morbidity from infectious diseases and also has suffered from a high rate of infant mortality. However, there has been a paucity of reports on the status of water quality of culturally diverse rural Oaxaca. This study follows community-based participatory research methods to address the data gap by reporting on water quality (chemical and microbiological) and by exploring social realities and water use practices within and among communities. Surveys and water quality analyses were conducted on 73 households in three rural communities, which were selected based on the choice of water sources (i.e., river water, groundwater, and spring water). Statistically significant variations among communities were observed including the sanitation infrastructure (p-value 0.001), public perception on water quality (p-value 0.007), and actual microbiological quality of water (p-value 0.001). Results indicate a high prevalence of diarrheal diseases, a desire to improve water quality and reduce the cost of water, and a need for education on water quality and health in all the surveyed communities. The complexities among the three studied communities highlight the need for undertaking appropriate policies and water treatment solutions.
ABSTRACT
Coronary collateral circulation usually develops as a consequence of recurrent ischemia associated with severe stenosis. In exceptional cases, it can develop with moderate coronary lesions if there is severe recurrent vasospasm. In this situation, the presenting clinical features of vasospastic angina (i.e., effort angina with ST-segment depression) can be identical to those of a severe permanent lesion. We present a patient who exhibited effort angina and ST-segment depression on treadmill testing. Angiography showed severe right coronary artery stenosis and the development of coronary collateral circulation from the other main artery. After repeated intracoronary bolus injection of nitroglycerin, only a moderate stenosis was still apparent and the collateral circulation had disappeared.
Subject(s)
Angina Pectoris/complications , Collateral Circulation , Coronary Circulation , Coronary Stenosis/complications , Coronary Vasospasm/etiology , Angina Pectoris/diagnosis , Angina Pectoris/diagnostic imaging , Angina Pectoris/physiopathology , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/drug therapy , Coronary Stenosis/physiopathology , Coronary Vasospasm/diagnosis , Coronary Vasospasm/diagnostic imaging , Electrocardiography , Exercise Test , Humans , Male , Middle Aged , Nitroglycerin/administration & dosage , Vasodilator Agents/administration & dosageABSTRACT
La circulación colateral coronaria aparece como consecuencia de la isquemia miocárdica recurrente, generalmente debida a lesiones coronarias severas y fijas, y de manera excepcional puede desarrollarse en lesiones no significativas provocadas por un vasospasmo coronariosevero. En esta situación, la angina vasospástica puede manifestarse como una angina de esfuerzo con descenso del segmento ST. Presentamos el caso de un paciente con angina de esfuerzo, ergometría clínicamente positiva y descenso horizontal del segmento ST. En la angiografía se observó una estenosis crítica en la arteria coronaria derecha y el desarrollo de circulación colateral heterocoronaria. Tras la administración de nitroglicerina intracoronaria, la lesión finalmente fue moderada con desaparición de la circulación colateral
Coronary collateral circulation usually develops as a consequence of recurrent ischemia associated with severe stenosis. In exceptional cases, it can develop with moderate coronary lesions if there is severe recurrent vasospasm. In this situation, the presenting clinical features of vasospastic angina (i.e., effort angina with ST-segment depression) can be identical to those of a severe permanent lesion. We present a patient who exhibited effort angina and ST-segment depression on treadmill testing. Angiography showed severe right coronary artery stenosis and the development of coronary collateral circulation from the othermain artery. After repeated intracoronary bolus injectionof nitroglycerin, only a moderate stenosis was still apparent and the collateral circulation had disappeared
Subject(s)
Male , Middle Aged , Humans , Coronary Vasospasm/physiopathology , Angina Pectoris/physiopathology , Neovascularization, Pathologic/physiopathology , Myocardial Ischemia/complications , Neovascularization, Pathologic/etiology , Nitroglycerin/pharmacokinetics , Aspirin/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Hyperlipidemias/complicationsABSTRACT
Introducción. La presencia de shock cardiogénico es la principal causa de muerte intrahospitalaria en pacientes con un infarto agudo de miocardio. No se ha demostrado que los tratamientos convencionales mejoren la supervivencia de estos pacientes, y estudios previos de revascularización urgente con angioplastia coronaria parecen ofrecer resultados prometedores. Pacientes y método. Se describen de forma retrospectiva los resultados clínicos y angiográficos de la angioplastia primaria electiva en 48 pacientes con shock cardiogénico secundario a un infarto agudo de miocardio de menos de 12 h de evolución. Se utilizó contrapulsación intraaórtica en el 79 por ciento de los pacientes. Se excluyeron los enfermos con shock cardiogénico secundario a complicaciones mecánicas. Resultados. Se obtuvo éxito angiográfico (estenosis final < 50 por ciento y TIMI 2) en el 85 por ciento de las lesiones causantes, y se implantó al menos un stent en el 76 por ciento de las lesiones. Se realizó angioplastia multivaso en el 25 por ciento de los pacientes y se utilizó abciximab en el 35 por ciento de los casos. El tiempo medio desde el inicio de los síntomas hasta la angioplastia fue de 7,4 ñ 3,1 h. La supervivencia intrahospitalaria fue del 58 por ciento, y a los 6 meses del 54 por ciento. Conclusiones. La revascularización coronaria urgente mediante angioplastia primaria e implante de stent intracoronario en pacientes con shock cardiogénico como complicación de un infarto agudo de miocardio es efectiva, consigue restablecer un flujo TIMI 2 en una alta proporción de pacientes y disminuye la mortalidad respecto a los resultados del tratamiento conservador en series históricas (AU)
