Motor development in premature infants: Study protocol for an interdisciplinary hospital-home intervention.

BACKGROUND: Deviations occur in the neuropsychomotor development of premature infants; early interventions minimize delay motor. This study aimed to determine the effect of an interdisciplinary hospital-home intervention addressing motor development adaptation in premature infants in Colombia in comparison with traditional interventions. METHODS: This study was based on a parallel design, with two groups, namely, experimental and control. The experimental group, hospital-home intervention (HHI) performed in two settings (i.e., hospital neonatal care units and homes), and the control group, traditional intervention, (TI) performed in institutions for premature infants. The sample will be composed of 130 randomly-allocated infants, 65 in the experimental group (HHI) and 65 in the control group (TI) of moderate to late preterm infants (gestational age between 34 and 37 weeks), weighing more than or equal to 1.800 g, who are hemodynamically stable and reside in the cities of Tunja and Bogotá-Colombia recruited between 2021 and 2022. For the pre- and post-intervention assessments, the TIMPSI and the CapDMP are the instruments used to assess motor development and the degree of parents' or caregivers' knowledge about motor development. The HHI is composed of 10 intervention strategies based on stimulation of motor development, performed twice a day for 10 min for two months, in combination with calls to a mobile device, using software (Baby Motor Skills) and an instant messaging system (WhatsApp). RESULTS: This hospital-home intervention program proposes an approach focused on the motor development of premature infants, based on sensory and motor stimulation strategies, in addition to follow-up performed at home with the use of a mobile application that improves the motor development of premature infants. Register Clinical Trial: NCT04563364. CONCLUSION: The HHI provides the opportunity to determine whether the individualized four-week from admission to follow up at home with parent training will improve the motor skills of premature infants.

Estenosis aórtica grave con bajo gradiente y fracción de eyección normal: una cuestión de mala clasificación / Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue

Introducción y objetivos. La estenosis aórtica grave con gradientes bajos y fracción de eyección normal es una entidad discutida. Las discrepancias sobre su pronóstico indican que podría tratarse de una incorrecta clasificación de su gravedad. La planimetría del área aórtica mediante ecografía transesofágica tridimensional podría esclarecer estas dudas. Los objetivos de este trabajo son valorar la concordancia de la medida del área valvular aórtica obtenida mediante ecuación de continuidad en ecocardiografía transtorácica y la obtenida por planimetría mediante ecocardiografía transesofágica tridimensional en pacientes con estenosis aórtica grave y bajo gradiente paradójico. Métodos. Estudio transversal descriptivo de pacientes consecutivos remitidos por estenosis aórtica grave, a los que se practicó ecocardiografía transtorácica y transesofágica tridimensional. Se consideró estenosis aórtica con bajo gradiente paradójico la presencia de un área efectiva < 1 cm2, gradiente ventricular medio < 40 mmHg y fracción de eyección >= 50%. Se estudió la concordancia entre las dos técnicas. Resultados. Estudiamos a 212 pacientes consecutivos con estenosis aórtica grave. De ellos, 63 casos (29,7%) satisfacían los criterios de bajo gradiente paradójico y en 61 se obtuvieron imágenes adecuadas para la comparación de los métodos. La planimetría tridimensional confirmó un área valvular < 1 cm2 en 52 pacientes (85,2%). El coeficiente de correlación intraclase entre las técnicas fue 0,505 (intervalo de confianza del 95%, 0,290-0,671; p < 0,001). Conclusiones. La estenosis aórtica grave con bajo gradiente paradójico es una entidad real que se confirma en el 85% de los pacientes evaluados mediante ecocardiografía transesofágica tridimensional (AU)

Introduction and objectives. Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. Methods. Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm2, mean ventricular gradient<40mmHg, and ejection fraction >=50%. Concordance between the two techniques was evaluated. Results. Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm2. The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). Conclusions. Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography (AU)

Eco-Doppler de ejercicio en pacientes con miocardiopatía hipertrófica. Factores determinantes de la limitación funcional / Exercise eco-doppler in hypertrophic cardiomyopathy patients. Determinant factors of exercise intolerance

Introducción y objetivos. En pacientes con miocardiopatía hipertrófica, los datos ecocardiográficos en reposo han mostrado una pobre correlación con la capacidad de ejercicio. Investigamos si la ecografía Doppler de esfuerzo podría explicar mejor la limitación funcional. Métodos. Estudiamos a 87 pacientes consecutivos, remitidos para test cardiopulmonar y ecografía de esfuerzo. Se realizó estudio basal y en el pico de ejercicio para evaluar el gradiente máximo, la regurgitación mitral y las velocidades diastólicas mitral y del Doppler tisular del anillo. Resultados. Desarrollaron obstrucción con el ejercicio 43 pacientes. Estos alcanzaron un menor consumo de oxígeno (21,3 ± 5,7 frente a 24,6 ± 6,1ml/kg/min; p = 0,012), presentaban mayor volumen auricular izquierdo (42,1 ± 14,5 frente a 31,1 ± 11,6ml/m2; p < 0,001) y desarrollaron más regurgitación mitral y mayor relación E/E’ con el ejercicio. Los datos de ejercicio mejoraron el poder predictivo de la capacidad funcional (R2 ajustada = 0,49 frente a R2 ajustada = 0,38 en reposo). La edad, el volumen auricular izquierdo, la relación E/E’ con el ejercicio y la obstrucción fueron los factores independientes asociados con la capacidad funcional. En los pacientes sin obstrucción, los volúmenes de las cavidades izquierdas fueron los factores determinantes. Conclusiones. En pacientes con miocardiopatía hipertrófica, la obstrucción con el esfuerzo y el volumen auricular izquierdo son los principales determinantes de la limitación funcional. Los parámetros diastólicos de esfuerzo mejoran la predicción de la capacidad funcional, aunque su poder predictivo no supera el 50%. En pacientes sin obstrucción, los volúmenes de las cavidades izquierdas son los factores determinantes (AU)

Introduction and objectives. At-rest echocardiography is a poor predictor of exercise capacity in patients with hypertrophic cardiomyopathy. We aimed to test the performance of treadmill exercise Doppler echocardiography in the prediction of functional limitations in these patients. Methods. Eighty-seven consecutive patients with hypertrophic cardiomyopathy underwent treadmill exercise echocardiography with direct measurement of oxygen consumption. Both at rest and at peak exercise, the mitral inflow, mitral regurgitation, left ventricular outflow tract obstruction and mitral annulus velocities were assessed. Results. Forty-three patients developed left ventricular outflow tract obstruction during exercise, which significantly decreased oxygen consumption (21.3 [5.7] mL/kg/min vs 24.6 [6.1] mL/kg/min; P=.012), and had greater left atrial volume (42.1 [14.5] mL/m2 vs 31.1 [11.6] mL/m2; P<.001) and a higher degree of mitral regurgitation and E/E’ ratio during exercise. Exercise variables improved the predictive value of functional capacity (adjusted R2 rose from 0.38 to 0.49). Independent predictors of oxygen consumption were age, left atrial volume, E/E’ ratio and the presence of left ventricular outflow tract obstruction. In a subset of patients without left ventricular outflow obstruction, only left ventricular and atrial volume indexes were independent predictors of exercise capacity. Conclusions. In patients with hypertrophic cardiomyopathy, left ventricular outflow tract obstruction and left atrial volume are the main predictors of exercise capacity. Exercise echocardiography is a better predictor of functional performance than at-rest echocardiography, although its predictive power is under 50%. In nonobstructed patients, left atrial and ventricular volumes were the independent factors (AU)

Exercise eco-Doppler in hypertrophic cardiomyopathy patients. Determinant factors of exercise intolerance.

INTRODUCTION AND OBJECTIVES: At-rest echocardiography is a poor predictor of exercise capacity in patients with hypertrophic cardiomyopathy. We aimed to test the performance of treadmill exercise Doppler echocardiography in the prediction of functional limitations in these patients. METHODS: Eighty-seven consecutive patients with hypertrophic cardiomyopathy underwent treadmill exercise echocardiography with direct measurement of oxygen consumption. Both at rest and at peak exercise, the mitral inflow, mitral regurgitation, left ventricular outflow tract obstruction and mitral annulus velocities were assessed. RESULTS: Forty-three patients developed left ventricular outflow tract obstruction during exercise, which significantly decreased oxygen consumption (21.3 [5.7] mL/kg/min vs 24.6 [6.1] mL/kg/min; P=.012), and had greater left atrial volume (42.1 [14.5] mL/m(2) vs 31.1 [11.6] mL/m(2); P<.001) and a higher degree of mitral regurgitation and E/E' ratio during exercise. Exercise variables improved the predictive value of functional capacity (adjusted R(2) rose from 0.38 to 0.49). Independent predictors of oxygen consumption were age, left atrial volume, E/E' ratio and the presence of left ventricular outflow tract obstruction. In a subset of patients without left ventricular outflow obstruction, only left ventricular and atrial volume indexes were independent predictors of exercise capacity. CONCLUSIONS: In patients with hypertrophic cardiomyopathy, left ventricular outflow tract obstruction and left atrial volume are the main predictors of exercise capacity. Exercise echocardiography is a better predictor of functional performance than at-rest echocardiography, although its predictive power is under 50%. In nonobstructed patients, left atrial and ventricular volumes were the independent factors.

Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue?

INTRODUCTION AND OBJECTIVES: Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. METHODS: Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm(2), mean ventricular gradient<40 mmHg, and ejection fraction ≥ 50%. Concordance between the two techniques was evaluated. RESULTS: Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm(2). The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). CONCLUSIONS: Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography.

Does pacemaker implantation provide long-term benefits in severe obstructive hypertrophic cardiomyopathy?

INTRODUCTION AND OBJECTIVES: About 25% of patients with obstructive hypertrophic cardiomyopathy (HCM) remain symptomatic despite optimal medical treatment. Some may benefit from pacemaker implantation. The aim of this study was to determine the effect of pacemaker implantation on the left ventricular outflow tract (LVOT) gradient, the maximum thickness of the left ventricle, and functional capacity. METHODS: In total, 72 patients with obstructive HCM and incapacitating symptoms underwent pacemaker implantation. Clinical examination, echocardiography (in 61 patients) and treadmill testing (in 34 patients) were performed before and after implantation. RESULTS: Subjective functional capacity, as assessed using the New York Heart Association (NYHA) classification, improved in 43.1% of patients, but treadmill testing showed no change. There were significant reductions in subaortic gradient, from a median of 87.0 mmHg (interquartile range [IQR] 61.5-115.2 mmHg) to 30.0 mmHg (IQR 18.0-54.5 mmHg; P< .001), and maximum left ventricular thickness, from 22.1+/-4.5 mm to 19.8+/-3.6 mm (P=.001). Univariate analysis identified two factors associated with clinical improvement: female sex (odds ratio [OR]=3.43; P=.020) and functional class III/IV (OR=4.17; P=.009). On multivariate analysis, only functional class III/IV remained a significant predictor (OR=3.12; P=.048). CONCLUSIONS: In patients with obstructive HCM and incapacitating symptoms, pacemaker implantation reduced the LVOT gradient and the maximum left ventricular thickness, but only 43.1% of patients experienced clinical improvement. The only factor predictive of improvement was advanced NYHA functional class.

¿Existe un efecto beneficioso a largo plazo con el tratamiento con marcapasos de la miocardiopatía hipertrófica obstructiva severa? / Does pacemaker implantation provide long-term benefits in severe obstructive hypertrophic cardiomyopathy?

Introducción y objetivos. Alrededor de un 25% de los pacientes con MCH obstructiva permanecen sintomáticos a pesar de una correcta medicación. Algunos pueden beneficiarse del implante de un marcapasos. El objetivo fue valorar el efecto del marcapasos en la modificación del gradiente en el tracto de salida del ventrículo izquierdo (TSVI), grosor máximo del ventrículo izquierdo (VI) y en la capacidad funcional. Métodos. A 72 pacientes con MCH obstructiva y síntomas incapacitantes se les implantó un marcapasos. Se realizó un examen clínico, una ecocardiografía (61 pacientes) y una ergometría (34 pacientes) antes y después de la implantación del marcapasos. Resultados. La capacidad funcional subjetiva, estimada según la clasificación de la NYHA, mejoró en el 43,1% de los pacientes, aunque no lo hizo la estimada mediante ergometría. Se observó una reducción significativa del gradiente subaórtico (mediana, 87 [intervalo intercuartílico, 61,5-115,2] frente a 30 [18-54,5] mmHg; p < 0,001) y del grosor máximo del VI (22,1 ± 4,5 frente a 19,8 ± 3,6 mm; p = 0,001). En el análisis univariable, el sexo femenino (OR = 3,43; p = 0,020) y la clase funcional III/IV (OR = 4,17; p = 0,009) se asociaron a una mejoría clínica. En el análisis multivariable, sólo la clase funcional III/IV mantuvo la significación (OR = 3,12; p = 0,048). Conclusiones. La implantación de marcapasos en pacientes con MCH obstructiva con síntomas incapacitantes disminuye el gradiente obstructivo del TSVI y el grosor máximo del VI, pero sólo el 43,1% consigue una mejoría clínica subjetiva, siendo una clase funcional más avanzada el único factor predictor de mejoría (AU)

Introduction and objectives. About 25% of patients with obstructive hypertrophic cardiomyopathy (HCM) remain symptomatic despite optimal medical treatment. Some may benefit from pacemaker implantation. The aim of this study was to determine the effect of pacemaker implantation on the left ventricular outflow tract (LVOT) gradient, the maximum thickness of the left ventricle, and functional capacity. Methods. In total, 72 patients with obstructive HCM and incapacitating symptoms underwent pacemaker implantation. Clinical examination, echocardiography (in 61 patients) and treadmill testing (in 34 patients) were performed before and after implantation. Results. Subjective functional capacity, as assessed using the New York Heart Association (NYHA) classification, improved in 43.1% of patients, but treadmill testing showed no change. There were significant reductions in subaortic gradient, from a median of 87.0 mmHg (interquartile range [IQR] 61.5-115.2 mmHg) to 30.0 mmHg (IQR 18.0-54.5 mmHg; P < .001), and maximum left ventricular thickness, from 22.1±4.5 mm to 19.8±3.6 mm (P=.001). Univariate analysis identified two factors associated with clinical improvement: female sex (odds ratio [OR]=3.43; P=.020) and functional class III/IV (OR=4.17; P=.009). On multivariate analysis, only functional class III/IV remained a significant predictor (OR=3.12; P=.048). Conclusions. In patients with obstructive HCM and incapacitating symptoms, pacemaker implantation reduced the LVOT gradient and the maximum left ventricular thickness, but only 43.1% of patients experienced clinical improvement. The only factor predictive of improvement was advanced NYHA functional class (AU)

Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients.

AIMS: To study the long-term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with haemoglobin levels and anaemia status. METHODS AND RESULTS: During a 2-year period, we studied 628 consecutive patients (aged 71 years [interquartile range, IQR: 61-77], 68% male) hospitalized with AHF. Demographic, clinical, echocardiographic, and laboratory characteristics were registered at discharge and patients were closely followed-up for 38.1 months [16.5-49.1]. Median RDW was 14.4% [13.5-15.5] and was higher among decedents (15.0% [13.8-16.1] vs. 14.2 [13.3-15.3], P < 0.001). After adjustment for other prognostic factors in a multivariable Cox proportional-hazards model, RDW remained a significant predictor (P = 0.004, HR 1.072, 95% CI 1.023-1.124); whereas, haemoglobin or anaemia status did not add prognostic information. RDW levels above the median were associated with a significantly lower survival rate on long-term follow-up (log rank <0.001). These levels were predictive of death in anaemic patients (n = 263, P = 0.029) and especially in non-anaemic patients (n = 365) (P < 0.001, HR 1.287, 95% CI 1.147-1.445), even after adjustment in the multivariable model. CONCLUSION: Higher RDW levels at discharge were associated with a worse long-term outcome, regardless of haemoglobin levels and anaemia status.

Impact of chronic kidney disease on major bleeding complications and mortality in patients with indication for oral anticoagulation undergoing coronary stenting.

BACKGROUND: Patients with indications for oral anticoagulation (OAC) undergoing percutaneous coronary artery stenting (PCI-S) represent a high-risk population for major bleeding complications. Chronic kidney disease (CKD) is also associated with poor outcome after PCI-S. Limited data are available regarding the impact of CKD on the frequency of major bleeding and mortality in this population. METHODS: We investigated the influence of CKD on major bleeding and all-cause mortality in patients with indication for OAC who undergo PCI-S. Patients were grouped according to calculated creatinine clearance (CrCl): CrCl > 60 mL/min, (n = 98) and CrCl < or = 60 mL/min, (n = 68). Major bleeding and major adverse vascular events (all-cause mortality, myocardial infarction, repeat revascularization, stent thrombosis, or stroke) were collected during follow-up. RESULTS: We analyzed 166 consecutive patients with indication(s) for OAC (77% men; mean age, 71 years; range, 66 to 76 years) after undergoing PCI-S. CKD was associated with higher risk for major bleeding (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.50 to 7.93; p = 0.004) and all-cause mortality (HR, 3.50; 95% CI, 1.53 to 7.99; p = 0.003). In multivariate analyses, age > 75 years (HR, 2.75; 95% CI, 1.15 to 6.56; p = 0.023), CKD (HR, 2.59; 95% CI, 1.00 to 6.95; p = 0.049), anemia (HR, 2.36; 95% CI, 1.00 to 5.54; p = 0.049), and triple antithrombotic therapy (HR, 3.29; 95% CI, 1.23 to 8.84; p = 0.018) were independent predictors for major bleeding, whereas age > 75 years (HR, 2.38; 95% CI, 1.03 to 5.59; p = 0.046) and CKD (HR, 2.44; 95% CI, 1.03 to 5.82; p = 0.044) were predictors for all-cause mortality. CONCLUSION: In this high-risk population, CKD is independently associated with increased major bleeding and all-cause mortality following PCI-S.

Comparison of late mortality in hospitalized patients >70 years of age with systolic heart failure receiving beta blockers versus those not receiving beta blockers.

Beta blockers are underprescribed to elderly patients with systolic heart failure (HF). We studied whether the prescription of a beta blocker is associated with a survival benefit in a nonselected population of patients >70 years of age hospitalized with acute HF and systolic dysfunction. We studied 272 consecutive patients >70 years (median 77.0, interquartile range 73.4 to 81.1) hospitalized with acute HF (left ventricular ejection fraction 34 +/- 8%) during a 2-year period. At discharge, beta-blocker therapy was prescribed in 139 patients (51.1%). A propensity score for the likelihood of receiving beta-blocker therapy was developed and showed a good performance (c-statistic = 0.825 and Hosmer-Lemeshow p = 0.820). After discharge, 120 patients (44.1%) died during the follow-up (median 31 months, interquartile range 12 to 46). Cox regression analysis showed a lower risk of death associated with beta-blocker prescription (p <0.001, hazard ratio [HR] 0.450, 95% confidence interval [CI] 0.310 to 0.655), which persisted after risk adjusting for the propensity score (HR 0.521, 95% CI 0.325 to 0.836, p = 0.007). In a propensity-matched cohort of 130 patients, there was a significantly lower mortality in patients receiving beta blockers (log rank 0.009, HR 0.415, 95% CI 0.234 to 0.734, p = 0.003). Risk reduction associated with beta blockade was observed with both high doses (HR 0.472, 95% CI 0.300 to 0.742, p = 0.001) and low doses (HR 0.425, 95% CI 0.254 to 0.711, p = 0.001). In conclusion, beta-blocker prescription at discharge in a nonselected population >70 years of age hospitalized with systolic HF is associated with a significantly lower risk of death even at low doses. This benefit remains consistent after adjustment for potential confounders.

Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting.

BACKGROUND: The optimal antithrombotic therapy strategy for atrial fibrillation (AF) patients who undergo percutaneous coronary intervention with stent implantation (PCI-S) is unknown. We assessed the safety of antithrombotic therapy strategies in AF patients with indication for oral anticoagulation (OAC) undergoing PCI-S. METHODS: We studied consecutive AF patients with indication for OAC who underwent PCI-S. We compared patients that received triple antithrombotic therapy (TT) [aspirin, clopidogrel, and coumadin] against other regimes (non-TT) after PCI-S. The primary end point was defined as the occurrence of major bleeding complications that were termed as early major bleeding (EMB) [< or = 48 h] or late major bleeding (LMB) [> 48 h]. Clinical follow-up was performed, and complications were recorded. RESULTS: We studied 104 patients (mean age +/- SD, 72 +/- 8 years; 70% men); TT was used in 51 patients (49%). TT was associated with a higher incidence of LMB (21.6% vs non-TT, 3.8%; p = 0.006) but not of EMB (5.8% vs non-TT, 11.3%; p = 0.33). In multivariate analyses, glycoprotein (GP) IIb/IIIa inhibitor use (hazard ratio [HR], 13.5; 95% confidence interval [CI], 1.7 to 108.3; p = 0.014) and PCI-S of three vessels or left main artery disease (HR, 7.9; 95% CI, 1.6 to 39.2; p = 0.01) were independent predictors for EMB. TT use (HR, 7.1; 95% CI, 1.5 to 32.4; p = 0.012), the occurrence of EMB (HR, 6.7; 95% CI, 1.8 to 25.3; p = 0.005), and baseline anemia (HR, 3.8; 95% CI, 1.2 to 12.5; p = 0.027) were independent predictors for LMB. No differences in major cardiovascular events were observed in patients treated with TT vs non-TT (25.5% vs 21.0%; p = 0.53). CONCLUSION: A high rate of major bleeding is observed in AF patients with indication for OAC undergoing PCI-S who receive TT. GP IIb/IIIa inhibitor use and multivessel/left main artery disease during PCI-S were independent predictors for EMB, while TT use, occurrence of EMB, and baseline anemia were independent predictors for LMB.

Modulation-frequency-controlled change from sub- to superluminal regime in highly doped erbium fibers.

We report a change from sub- to superluminal propagation upon increasing the modulation frequency of an amplitude-modulated 1,550 nm signal when propagating through highly doped erbium fibers pumped at 980 nm. We show that the interplay between the pump absorption and the pump-power broadening of the spectral hole induced by coherent population oscillations may drastically affect the fractional advancement or delay of the signal for the considered fibers.

Intervenciones psicoterapéuticas en los pacientes con enfermedad médico-quirúrgica / Psychotherapeutic Interventions for Medical-Surgical Patients

En los últimos años, con el desarrollo de la medicina psicosomática, un número mayor de psiquiatras han entrado en contacto con pacientes que padecen diversas enfermedades médicas y quirúrgicas. Las intervenciones psicoterapéuticas que beneficiarían a estos pacientes no se han estandarizado y son tan diversas como las respuestas emocionales y conductuales a la enfermedad. Este artículo pretende, basándose en revisiones de los textos básicos de la especialidad y de artículos relevantes al tema, proporcionar conceptos básicos acerca de las reacciones emocionales de los pacientes y sus diversas formas de adaptación, así como describir someramente los diferentes tipos de psicoterapias más utilizadas por los profesionales de la salud, que deban ejercer esta función.

More psychiatrists are in contact with medical and surgical patients with the recent development of Psychosomatic Medicine. Patients’ emotional and behavioral reactions to medical illness are diverse. So are the different psychotherapeutic interventions used effectively on this patient population; however many have not been standardized. This article summarizes relevant findings in textbooks and peer-reviewed journal articles concerning basic concepts on the emotional reactions to physical illness, different types of adjustment mechanisms, and provides a brief description of the types of psychotherapy more frequently used by health professionals for the treatment of medical patients.

Trazodone en trastornos del sueño en un nivel de atención primaria / Trazodone on sleep disorders in a primary health care level

Objetivo: Evaluar a nivel ambulatorio la eficacia del trazodone en pacientes que presentan problemas de sueño, provocados por alteraciones depresivas leves a moderadas. Métodos: Se reclutaron 46 pacientes ambulatorios entre l8 y 70 años de edad que asistieron a un Centro de Atención Primaria y que además cumplían criterios de inclusión. Según la severidad del cuadro se inició 50 y 100 mg por día de trazodone y se evaluaron cada semana hasta completar cuatro semanas de tratamiento. Resultados: Después de la primera semana los pacientes que tenían alteraciones leves o moderadas de sueño presentaron mejorías estadísticamente significativas. Casi todos calificaron la calidad del sueño como restauradora. Esta mejoría se sostuvo hasta el final del estudio. La medicación fue bien tolerada y no hubo cambios significativos en presión arterial (PA) y frecuencia cardíaca (FC). El medicamento respondió a las expectativas terapéuticas en 96% de los casos. Conclusiones: El trazodone a dosis de 50 y l00 mg por día se puede considerar una alternativa eficaz para el tratamiento de trastornos del sueño en pacientes ambulatorios que consultan a centros de atención primaria con alteraciones depresivas leves o moderadas concomitantes...

Objective: To evaluate level tolerance and activity of trazodone in outpatients having sleep troubles with simultaneous mild or moderate depressive symptoms. Methods: 46 ambulatory patients between 18 and 80 y.o. from a Centre of Primary Attention were involved in the study. They had sleep problems as well as mild or moderate depression. In accordance with symptoms severity they were given 50 or 100 mg of trazodone daily. Patients were assessed weekly until accomplishing four weeks of treatment. Results: After first week of therapy moderate or light sleep alterations were improved with statistic significance. Almost all of the patients described sleep quality as a repairing one. These improvements, as well as those of previous parameters, were kept until concluding the study. Trazodone was well tolerated with no significant changes of clinical parameters such as blood pressure and myocardial frequency. In 96% of cases trazodone satisfied therapeutic expectancies. Conclusions: Trazodone doses of either 50 or 100 mg daily may be seen as an efficient alternative for treatment of sleep problems in ambulatory patients with simultaneous mild or moderate depression symptomatology...