Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico / Myocardial infarction with non-obstructive coronary artery disease. Diagnostic value of intravascular imaging and cardiac resonance

BACKGROUND: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. AIM: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. MATERIAL AND METHODS: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. RESULTS: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. CONCLUSIONS: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

[Myocardial infarction with non-obstructive coronary artery disease. Diagnostic value of intravascular imaging and cardiac resonance]. / Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico.

BACKGROUND: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. AIM: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. MATERIAL AND METHODS: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. RESULTS: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. CONCLUSIONS: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Rapid carbohydrate digestion rate produced lesser short-term satiety in obese preschool children.

OBJECTIVE: To examine whether high carbohydrate meals with different carbohydrate digestion rates have an effect on the short-term satiety in normal and obese preschool children. SUBJECTS AND SETTING: In total, 48 children of both gender, 24 normal and 24 obese, according to body mass index, aged between 3 and 6 y, were selected from children who were attending to a day-care center where they consumed three meals in the day. INTERVENTIONS: Rapid (potato-based meal) and lente (spaghetti-based meal) carbohydrate digestion rate meal were given at lunch, matching energy intake, carbohydrate, protein and fat levels, and then the preschool children's energy intake at the subsequent mealtime was observed. In this last mealtime, the children received varied types of high-acceptability foods in higher quantities than the normal serving. RESULTS: At lunch, a significant higher energy intake, lesser satiation, was observed in both groups, normal-weight and obese children, when they consumed the potato-based meal. In the subsequent mealtime, a significant effect of carbohydrate digestion rate was demonstrated, but only in obese preschool children, being higher in the meal with rapid digestion rate carbohydrates. CONCLUSIONS: Rapid carbohydrate digestion rate meal produced a significative lesser satiation in normal-weight and obese children. However, only in obese children a significant lesser satiety was observed after consumption of the rapid carbohydrate digestion rate meal, indicating a decreased capacity of energy regulation in obese children. The finding of the present work could provide dietary strategies required for decreasing prevalence in overweight and obesity in preschool children.

[Analog gamma camera digitalization computer system]. / Un sistema de digitalización de gamma cámaras analógicas.

OBJECTIVE: Digitalization of analogue gamma cameras systems, using special acquisition boards in microcomputers and appropriate software for acquisition and processing of nuclear medicine images is described in detail. MATERIAL AND METHODS: Microcomputer integrated systems interconnected by means of a Local Area Network (LAN) and connected to several gamma cameras have been implemented using specialized acquisition boards. The PIP software (Portable Image Processing) was installed on each microcomputer to acquire and preprocess the nuclear medicine images. A specialized image processing software has been designed and developed for these purposes. This software allows processing of each nuclear medicine exam, in a semiautomatic procedure, and recording of the results on radiological films. RESULTS: . A stable, flexible and inexpensive system which makes it possible to digitize, visualize, process, and print nuclear medicine images obtained from analogue gamma cameras was implemented in the Nuclear Medicine Division. Such a system yields higher quality images than those obtained with analogue cameras while keeping operating costs considerably lower (filming: 24.6%, fixing 48.2% and developing 26%.) CONCLUSIONS: Analogue gamma camera systems can be digitalized economically. This system makes it possible to obtain optimal clinical quality nuclear medicine images, to increase the acquisition and processing efficiency, and to reduce the steps involved in each exam.

Un sistema de digitalización de gamma cámaras analógicas / Analogue gamma camera digitalization computer system

Objetivo. Se describe un sistema de digitalización de gamma cámaras analógicas, integrado por tarjetas de adquisición montadas en microcomputadores, y software adecuado para la adquisición y procesamiento de las imágenes digitales. Material y métodos. Se implementa un sistema formado por microcomputadores interconectados mediante una Red de Area Local (LAN), y conectados a cada gamma cámara mediante una tarjeta de adquisición especializada. En cada computador, se instala además, el software PIP (Portable Image Processing) para realizar la adquisición y pre-procesamiento de las imágenes adquiridas. Se diseña y desarrolla un software de procesamiento de imágenes, con el cual es posible procesar cada examen obtenido con las gamma cámaras, cuantificar valores y curvas de manera semiautomática, e imprimirlos en placas radiológicas. Resultados. Se obtiene un sistema robusto, flexible y económico, que permite digitalizar, visualizar, procesar, e imprimir las imágenes de medicina nuclear adquiridas mediante las gamma cámaras analógicas existentes en el Servicio de Medicina Nuclear. Mediante este sistema se obtienen imágenes de mejor calidad (con respecto a las obtenidas con las gamma cámaras analógicas), y se obtiene una disminución considerable en el uso de los insumos (Película: 24,6 por ciento, Fijador: 48,2 por ciento, y Revelador: 26,0 por ciento).Conclusiones. Es posible digitalizar sistemas de gamma cámaras analógicas, de manera económica. Obteniéndose así imágenes de calidad clínica óptima, aumentando la eficiencia, y produciendo un ahorro en los insumos (AU)

Prevalence of sexual dysfunction in a cohort of middle-aged women: influences of menopause and hormone replacement therapy.

In order to determine the prevalence of sexual dysfunction (SD) and related risk factors in a cohort of middle-aged women the Laumann's test (DSM-IV) was passed to 534 healthy women between 40 and 64 years old (mean: 52.4+/-5.7) attending the Southern Metropolitan Health Service in Santiago de Chile. Of all the women, 82.8% were peri- or postmenopausal, 23% had received hormone replacement therapy (HRT) and 79.2% were sexually active. Among those who were sexually active a total of 51.3% presented SD. The prevalence of SD increased with age (from 22.2% in the 40-44-year age group to 66% in the 60-64-year age group). HRT users and healthy women presented a lower risk of SD (OR: 0.1 CI: 0.0-0.1 and OR: 0.6 CI: 0.3-0.9, respectively). The risk increased after the menopause (OR: 3.3 CI: 1.6-6.9) and with age older than 49 years (OR: 3.4 CI: 1.8-6.4), hysterectomy (OR: 3.7 CI: 1.3-10.6) and when male partners presented erectile dysfunction (OR: 3.2 CI: 1.2-8.6). In conclusion sexual dysfunction affects more than 51% of middle-aged women who are sexually active and increases with age. Ovarian function and HRT significantly influence sexual activity.

A comparison between an in vitro method to determine carbohydrate digestion rate and the glycemic response in young men.

OBJECTIVE: This study examines the relationship between the results of in vitro determinations of carbohydrate digestion rates and the glycemic index. SUBJECTS: Ten healthy non smoking men, aged between 21 and 24-y-old, were selected to participate in the study. METHODS: Six different meals with similar levels of carbohydrates were assayed at breakfast in ten subjects and blood samples were obtained at 0, 15, 30, 60 and 120 min to determine glucose levels. The Englyst's enzymatic method was used in the in vitro study. The six meals were based in cereals (rice or spaghetti); legumes (lentil soup and beans with spaghetti); and potato (potato stew with meat and vegetables). RESULTS: The meals showed different glycemic indices: rice and spaghetti based meals had lower values (mean value 31.4 and 42, respectively); the intermediate values corresponded to lentil soup and the bean dish (49.3, and 76.8 respectively) and the higher glycemic index was shown by the potato based meal (82). CONCLUSIONS: A significant correlation was observed when the ratio of rapid carbohydrate digestion rate and the lente carbohydrate digestion rate was correlated with the glycemic index of the meals, but not when only the rapid carbohydrate digestion rate was considered. These results demonstrate a useful, simple and inexpensive method to estimate the biological response of high carbohydrate meals.

[Paralytic ileus during treatment of acute promyelocytic leukemia with all-trans retinoic acid].

A 54-year-old man was referred to our hospital because of petechiae and pancytopenia. Bone marrow aspiration showed a normocellular marrow with 92.4% promyelocytes. PML/RAR alpha mRNA was detected by reverse transcription polymerase chain reaction. On the basis of above data, a diagnosis of acute promyelocytic leukemia (APL) was made, and treatment with all-trans retinoic acid (ATRA) at a dose of 60 mg/day was begun. Fourteen days after the start of treatment, the patient developed paralytic ileus, accompanied by hyperleukocytosis, high fever, renal dysfunction and elevation of the serum FDP level. There was no evidence of infection. At this time, retinoic acid syndrome was suspected, and therefore steroid pulse therapy was started, which led to an improvement of the symptoms within four days. This case suggests that ATRA may have an adverse effect on the small intestine, causing paralytic ileus.

Short-term satiety in preschool children: a comparison between high protein meal and a high complex carbohydrate meal.

The aim of this study was to investigate whether a high protein meal has a different effect on short-term satiety in preschool children than a high carbohydrate meal by measuring their intake of a subsequent meal. Subjects were 35 normal preschool children of both genders aged 5 to 6 years. All children were healthy and randomly chosen from those who were attending to a day-care center where they received feeding at three meal times: breakfast, lunch and teatime. Children were weighed with light clothes following standard recommendations. They were normal according to the weight for height index, using the NCHS standards. Two meals with different levels of protein and carbohydrate and equal energy contents were assayed at lunch. The lunches were cooked dishes made from common ingredients. The high carbohydrate meal was consumed in greater amount than the high protein meal (P < 0.01) and a significantly greater energy intake was observed (P < 0.01). Food and energy intakes at teatime were greater with the high carbohydrate meal, but only the energy intake was significant (P < 0.05). When subjects consumed the high protein meal during lunch, they ate a significantly lower amount of protein in the subsequent meal, but the carbohydrate intake was similar. The long-term effects of a high protein diet remain to be investigated before recommending of a high protein for obese children.

Effect of the energy density and volume of high carbohydrate meals on short term satiety in preschool children.

OBJECTIVE: To investigate the effect of energy density and food volume intakes in one meal (lunch-time) on food and energy intakes in the subsequent meal (tea-time). DESIGN: During lunch, two meals with different energy densities (1.26 and 0.69 kcal/g) were offered to preschool children using normal foods and maintaining a similar energy, carbohydrate, and fat intakes. In the subsequent meal a varied type of high acceptability foods were served in higher amounts than those that children usually consume. SETTING: A day care center where the children were fed during lunch-time and tea-time. SUBJECTS: Two hundred and thirty-four normal preschool children, 108 males and 126 females, according to the weight for height index using the NCHS standards. METHODS: Chemical analysis of the meals served using the AOAC methods and determination of food and energy intakes by differential weighing of the foods. RESULTS: The preschool children had a similar energy intake at lunch but a significantly higher food intake when they consumed the meal with the lower energy density (313 vs. 290.7 kcal) (P = 0.001). There were no differences in the food intakes at the subsequent meal times. CONCLUSIONS: The results of this present work demonstrate that under the conditions of the study, there is an inverse relationship between the energy density of the meals consumed at the first meal-time and the energy intakes at the subsequent meal in normal preschool children; and a direct relationship with the short-term satiety. It is possible that differences in satiety reflect, in part, effects from the characteristics of the normal food used in the dietary treatments. These conclusions suggest that future research must be carried out in order to investigate the separate effects of food and the dietary variables commonly used in the studies of food and energy regulations in humans.

Intoxicación por carbamazepina con dos dosis de claritromicina: reporte de un caso / Intoxication by carbamazepin with 2 clarithromycin doses: clinical report

La interacción entre carbamazepina y claritromicina ha sido recientemente reportada en la literatura. Reportamos el caso de un niño de 8 años, portador de epilepsia, quien presentó una intoxicación por carbamazepina luego de que se agregara claritromicina al tratamiento. Después de la segunda dosis del antibiótico el paciente se mostró somnoliento y con ataxia cerebelosa, demostrándose una importante elevación del nivel plasmático de carbamazepina. El paciente recobró su condición normal rápidamente, luego de que se suspendiera el antibiótico con la concomitante disminución del nivel plasmático del anticonvulsivante. Se discuten las características de esta interacción de fármacos haciendo resaltar las características del metabolismo de los niños que hace especialmente importante esta situación clínica

Intermittent distracting rod for correction of high neurologic risk congenital scoliosis.

STUDY DESIGN: Report of three cases of severe congenital scoliosis corrected by a new device. OBJECTIVES: To show a new, safe alternative for treatment to achieve and maintain correction of the most severe spinal deformity. SUMMARY OF BACKGROUND DATA: Because of neurologic risk, severe congenital scoliosis is usually not instrumented. Gradual correction seems to be safer for the spinal cord and to produce more efficient results because of the viscoelastic properties of the spine. METHODS: A new device was used in three patients with congenital scoliosis. This device is placed by a posterior approach and permits correction of the scoliosis by slow, intermittent distraction. The gear of the elongation mechanism is activated by an extender placed subcutaneously. The correction takes place in the conscious patient, under rigorous neurologic control. RESULTS: At the end of the distraction procedure, corrections of the scolioses in the three patients were from 118 degrees to 45 degrees, 104 degrees to 47 degrees, and 137 degrees to 71 degrees, respectively CONCLUSIONS: The new device has proved useful for correcting, efficiently and without neurologic damage, severe scoliosis in three patients, and may be helpful in those curves with high neurologic risk.

Polineuropatía inflamatoria desmielinizante crónica: presentación de 6 casos / Chronic inflammatory demyelinating polyneuropathy: report of 6 cases

Chronic inflammatory demyelinating polyneuropathy is a heterogeneous disease characterized by symmetrical motor and sensitive alterations, absence of tendom reflexes and increased cerebrospinal fluid protein levels. We report 6 patients with the disease (3 males) aged 41 to 70 years old. Four had tha classical presentation and two had an asymmetrical paresis, that predominated in superior limbs. These patients had proximal block with scarce prolongation of distal nerve conduction velocity. In all patients, underlying illnesses were discarded with a full diagnostic work up. Subjects were followed from 2 to 14 months after the diagnosis. In all, treatment with steroids improved muscle strength and sensivity

[Effect of energy density and fat level of milk formulas on subsequent food and energy intake in preschool children]. / Efectos de la densidad energética y del nivel de grasa de las fórmulas lácteas sobre el consumo subsecuente de alimentos y energía en preescolares.

The aim of this study was to examine the effects of two levels of energy intakes and two levels of fat at breakfast, on the food and energy intakes in subsequent meal (lunch). The study was performed in 51 children both genders, with ages ranging from 24 to 48 months, attending a day care center. The children selected had normal nutritional status (weight/height index) according to the NCHS standards. The food intake was determined by differential weighing and energy intake was calculated from proximal analysis. The energy densities of the cow's milk formula used were 0.8 and 1.2 kcal/g, resulting in a total energy offer (breakfast) of 267.5 and 367.5 kcal respectively, the fat levels were 6.3 and 0.9 g/250 g of formula, using the design 2 x 2 factorial. In the study, 720 observations of food intake were conducted in those children consuming higher than 75% of the total food offered at breakfast. In the lunch-time were offered in alternated form two preparations with an 0.97 kcal/g of energy density. The results demonstrated that the children consumed significantly higher energy amounts in the subsequent meal, after being fed the high fat and lower energy-content breakfast. When the total energy intake (breakfast + lunch) was compared these results show that the caloric difference of breakfast was reduced and the degree of reduction was influenced by the fat level. These results show evidence for partial caloric compensation of 67% in the higher-fat level, and only 34% for the children with the lower of fat-level. It is conclude that the energy intake and fat intake at breakfast influences the energy intake at the subsequent meal. These findings are important to the preschool children's feeding with risk of malnutrition.

[Chilean edible sea macroalgae as sources of dietary fiber: effect on apparent digestibility of protein, fiber, and energy and fecal weight of rats]. / Macroalgas marinas comestibles de chile como fuente de fibra dietética: efecto en la digestibilidad aparente de proteínas, fibra y energía y peso de deposiciones en ratas.

The inclusion of algae as a source of fiber in the diet is justified by the present need to increase the intake of this nutrient. The aim of this study was to study on rats, the effect of dietary algae fiber on fecal weight and apparent digestibility of energy, protein and fiber. The type of algae studied were cochayuyo (frond) and ulte (basal part) (Durvillea antarctica), luche verde (Ulva lactuca) and luche rojo (Porphyra columbina). All these algae were boiled and dried at 55 degrees under air flow. Male rats, Wistar strain of 25 days of age, were fed during 29 days with diets containing casein plus the inclusion of 10% (weight) of one of these algae dietary fiber. A group having no fiber intake was used as a Control group. Algae content of dietary fiber ranged between 58.2-75.6 g/100 g (dry weight), soluble fiber portion constituted 37.9-52.4%. In relation to the Control group it was found significant reduction in the apparent digestibility of protein and energy, and a significant reduction in fecal weight. Dietary fiber digestibility ranged between 21.1 and 43.1%. This study shows that algae can be an excellent dietary fiber source, very useful to prevent or treat different fiber-deficiency related diseases.

[Effect of protein and carbohydrate preloads on food and energy intakes in preschool children with different nutritional status]. / Efecto de precargas proteicas y de hidratos de carbono sobre el consumo de alimentos y energia en preescolares con diferente estado nutricional.

Three preloads: high in simple carbohydrates (fruit juice), high in complex carbohydrates (banana) and high in protein (chicken meat), were tested in two groups of preschool children (56), aged 2 to 4 years from both genders. One group had a normal weight for height and the other high weight for height. The preload were given thirty minutes before lunch. The lunches consisted in a legume dish, apple and a milk dessert. Children were stimulated but not forced to eat and the amount of foods consumed was determined by differential weighing. The results showed that overweight children had a lower consumption at lunch that normal children when the high carbohydrate preloads were tested. High simple carbohydrate preload, 338,2 +/- 87.0 vs 350,9 +/- 75.9, high complex carbohydrate preload, 336.2 +/- 109.6 vs 375.4 +/- 89.4. High protein preload had not effect on the lunch consumption in the two groups of children studied. When an analysis by age of children were made, dividing the normal and overweight children in two groups, 24 to 36 months and 36 to 48 months, it was demonstrated that differences in lunch consumption between the normal and overweight children was derived essentailly from the results obtained in children of 24 to 36 months, high simple carbohydrate preload 282.3 +/- 88.9 g vs. 318.5 +/- 80.0 g and in the high complex carbohydrate preload, 262.6 +/- 98.9 g vs 364.5 +/- 116.3 g. When energy intake derived from food consumption was analyzed, the same tendency described for food consumption was demonstrated. The results presented show a different response of overweight children to the high carbohydrate preloads consumed before lunch, specially in children aged 24 to 36 months. This findings are important since they give an experimental information that can be utilized to find metabolic answers in relation to the onset of obesity in the childhood and to establish dietary recommendations in order to alleviate the risk of obesity in children.