Vein Patch Angioplasty with Internal Mammary Artery Grafting of the Left Anterior Descending Coronary Artery.

Objective: To describe the treatment outcomes of patients who underwent coronary artery bypass grafting (CABG) with vein patch angioplasty with internal mammary artery (IMA) grafting of the diffusely diseased left anterior descending (LAD) coronary artery. Methods: This is a retrospective observational study of 26 patients who have undergone vein patch angioplasty of the LAD coronary artery with IMA grafting in three centers by a single surgeon from January 2012 to August 2017. The demographic profile, intraoperative data, and postoperative outcome (including in-hospital mortality and morbidity, perioperative myocardial infarction, and NYHA functional classification) were recorded. Continuous variables were expressed as means with standard deviation and categorical variables summarized as frequencies and percentages. Student's t-test was used to compare the preoperative versus postoperative mean NYHA functional class. Results: There were 22 (85%) males and 4 (15%) females with a mean age of 62 years (range: 34 to 82). Twenty-five patients (96%) had a three-vessel disease, and one (4%) had a two-vessel disease. Nine patients (35%) had a preoperative myocardial infarction. The mean cardiopulmonary bypass and aortic-cross clamp times were 156 and 118 minutes, respectively. The mean number of vessels grafted was 4.12. Multiple arterial grafting was used in seven patients (27%). There were two in-hospital mortalities (7.7%) and three morbidities (11.5%), including reoperation for bleeding, acute kidney injury, and leg wound infection. Six patients (23%) developed postoperative atrial fibrillation. No patient developed perioperative myocardial infarction. The mean ICU stay was three days, and the mean hospital stay was 10.27 days. The mean NYHA functional class improved from 2.85 preoperatively to 1.5 postoperatively (p<0.00001). Among patients with improvement, postoperative NYHA improved by two functional classes in 38% and by one functional class in 62%. Conclusion: Vein patch angioplasty is a valuable technique for diffuse coronary stenosis of the LAD artery with acceptable early results.

"HIV resignifications" life history of a gay men after a diagnosis / "Resignificaciones del VIH" historia de vida de un hombre gay después de un diagnostico

Goals: Recover the reinterpretations of "living with HIV" through the life story of a 38-year-old gay man with 7 years of diagnosis.  Materials & Methods: Phenomenological study based on the life story of a gay man residing in the Metropolitan Area of Mexico. Through a semi-structured interview, experiences surrounding HIV are recovered. The phenomenological question guiding the study is "What has the experience with HIV been like?"  Results: His most "significant" illness is HIV. Feeling that it "should not be a burden" is a caregiver's perspective, with self-demand and self-exigency leading him not to openly discuss his diagnosis with his family, prompting him to seek other support networks. Viewing HIV as a judgment that "should befall" people who are "more promiscuous or have more partners" is an idea that clashes with personal experiences, as well as ways of relating in both personal and professional contexts. Aging, living with HIV, and having a partner are current situations that relate to past experiences, assuming that living with HIV will lead to greater wear and tear.  Conclusion: The reinterpretation of HIV is a dynamic process that individuals experience throughout their lives, mediated by socio-historical and individual contexts. Combating stigma is a collective and relational process between healthcare professionals and the population served. 

Objetivos: Recupera las resignificaciones de "vivir con VIH" a través de la historia de un hombre gay de 38 con 7 años de diagnóstico.  Materiales y Métodos: Estudio fenomenológico a partir de la historia de vida de un hombre gay residente del Área Metropolitana de México, a partir de una entrevista semi estructurada, se recuperan las vivencias entorno al VIH. Teniendo como interrogante fenomenológica "¿Como ha sido la experiencia con el VIH?".  Resultados: Su enfermedad más "significativa" es el VIH, sentir que "no debe ser una carga" es una visión de cuidador, con un auto demanda y autoexigencia que lo ha llevado a no hablar abiertamente su diagnóstico con su familia llevándolo a buscar otras redes de apoyo. Ver el VIH como un juicio que le "debería de dar" a personas que son "más promiscuas o tienen más parejas"; es una idea que se confronta con la vivencia personal, así como las formas de relacionarse en pareja y laboralmente. Envejecer, vivir con VIH y tener una pareja; son situaciones actuales que se relación con las vivencias anteriores. Suponiendo que por vivir con VIH el desgaste será mayor.  Conclusiones: La resignificación del VIH es un proceso dinámico que la persona experimenta a lo largo de su vida, dicho proceso estará mediado por contextos socio históricos e individuales. Combatir el estigma es un proceso colectivo y relacional entre los profesionales de salud y la población atendida. 

Chest wall and nasal chondromesenchymal hamartoma in a toddler: treated during a global pandemic.

We report an extremely rare case of a synchronous left chest wall and left maxillary sinus chondromesenchymal hamartoma in a toddler female. Although the lesions appeared malignant on imaging, they were benign by biopsy. The enlarging left anterior chest wall mass was surgically resected to prevent cardiovascular compression. The significant chest wall defect was reconstructed using the bird-cage technique with overlying pectoralis major muscle flap and native skin. The lesions at the left posterior rib and left maxillary sinus were closely observed. This case is the first reported synchronous chest wall and maxillary sinus chondromesenchymal hamartoma.

Leuprolide acetate induces structural and functional recovery of injured spinal cord in rats.

Gonadotropin-releasing hormone (GnRH) and its synthetic analog leuprolide acetate, a GnRH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5(th) week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1(st) week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.

Creencias, actitudes y normas subjetivas como predictores de la intención derealizar comportamientos preventivos en hijos de personas que padecen diabetes mellitus tipo 2 / Crenças, atitudes e normas subjetivas como preditores da intenção de realizar comportamentos preventivos em filhos de indivíduos com Diabetes Mellitus tipo 2 / Beliefs, attitudes and subjective norms as predictors of preventive behavioral intentions in offspring of people with Type 2 Diabetes Mellitus

Analizar los conocimientos, las actitudes y las normas subjetivas como predictores de la intención de realizar comportamientos preventivos en hijos de personas con diabetes mellitus tipo 2, en dos ciudades del estado de Hidalgo, México. Métodos: Se trata de um estudio cuantitativo, no experimental, de naturaleza analítica y transversal. A través de uma muestra probabilística de dos etapas, 246 hijos (entre 15 y 59 años de edad) de pacientes apuntados en un programa de diabetes en el servicio de seguridad social fueron encuestados de manera personal. Resultados: Se observó que la reducción del riesgo de contraer diabetes afecta la intención de desarrollar comportamientos preventivos mediada por la actitud hacia la prevención (p=0,000) que es el predictor más importante de tal intención (p=0,000). Las normas subjetivas también tienen un impacto significativo en la intención del comportamiento preventivo (p=0,000), aunque la actitud hacia la prevención no es afectada por las creencias sobre la obtención (p=0,095) y la gravedad de la enfermedad (p=0,056). Conclusión: La aplicación del modelo permitió identificar aspectos relevantes para apoyar la promoción de la salud orientada a influir en los procesos de cambio de comportamiento social en uma población con el riesgo de contraer diabetes mellitus tipo 2 en México...

Analisar os conhecimentos, atitudes e normas subjetivas como preditores da intenção de realizar comportamentos preventivos em filhos de indivíduos com diabetes mellitus tipo 2 em duas cidades do estado de Hidalgo, México. Métodos: Trata-se de um estudo quantitativo, não experimental, de natureza analítica e transversal. Através de um tipo de amostragem probabilística de duas etapas, 246 filhos (entre 15 e 59 anos) de pacientes inscritos em um programa de diabetes no serviço de segurança social foram entrevistados de maneira pessoal. Resultados: Observou-se que a redução do risco de contrair diabetes afeta a intenção de desenvolver comportamentos preventivos mediados pela atitude para a prevenção (p=0,000), que é o preditor mais importante da intenção (p=0,000). As normas subjetivas também têm um impacto significativo na intenção do comportamento preventivo (p=0,000), embora a atitude de prevenção não seja afetada por teorias sobre a obtenção (p=0,095) e gravidade da doença (p=0,056). Conclusão: A aplicação do modelo permitiu identificar aspectos relevantes para apoiar a promoção da saúde, orientada a influir nos processos de mudança do comportamento social em uma população com o risco de contrair Diabetes Mellitus tipo 2 no México...

To analyze beliefs, attitudes and subjective norms as predictors of preventive behavioral intention in offspring of parents with type 2 diabetes mellitus in two cities in the state of Hidaldo, Mexico. Methods: This is a quantitative, nonexperimental, explanatory and cross-sectional study. Through a two-stage probabilistic sample, 246 subjects (between 15 and 59 years old) whose parents were enrolled in a diabetes program in the social security service were interviewed in a personal manner. Results: It was observed that the reduction in the risk of developing diabetes affects the intent of developing preventive behaviors mediated by attitude toward prevention (p=0.000), which is the most important predictor of that intention (p=0.000). Subjective norms also have a significant impact on the preventive behavioral intention (p=0.000), although the preventive attitude is not affected by beliefs regarding the development (p=0.095) and severity of the disease (p=0.056). Conclusion: The application of the model allowed the identification of relevant aspects to support health promotion, oriented to influence the processes of change in social behavior, in a population at risk of developing type 2 diabetes mellitus in Mexico...

Evidence-based clinical practice guidelines on some important aspects of the care of critically ill surgical patients Part II: Surgical intensive care units, implementation of guidelines

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)