MitraClip para el reparo de insuficiencia mitral severa / MitraClip for the repair of severe mitral insufficiency

Resumen Objetivo: Reportar el primer caso de implante de MitraClip realizado en la costa atlántica. Material y métodos: Paciente femenina de 69 años de edad, con diagnóstico de: cardiopatía dilatada de 10 años de evolución con aumento progresivo de deterioro funcional. Ha presentado edema pulmonar recidivante. Resultados: Se realiza procedimiento de implante del dispositivo. Mediante cateterismo transeptal, se procede a introducir el MitraClip con maniobras del sistema de posicionamiento pasando la válvula mitral guiado por el ETE 3 D y se realiza la captura de ambos bordes de la válvula en el sitio de mayor regurgitación A2/P2 sujetando los bordes por él. Se observa persistencia de la insuficiencia moderada por lo que se coloca un segundo MitraClip en forma satisfactoria. Se realizan las medicines Doppler observando una insuficiencia residual mínima. Se corrobora por la angiografía y el ETE su adecuada implantación. Se considera un éxito pudiendo realizar el implante del dispositivo en forma rápida, adecuada y sin complicaciones. Conclusiones: Se reporta el primer caso de implante de MitraClip para el manejo de la IM severa, en la ciudad de Barranquilla, siendo la segunda ciudad de Colombia, después de Cali, donde se implanta este tipo de dispositivos para el reparo de la insuficiencia mitral severa.

Abstract Objective: To report the first case if MitraClip implantation performed in the Atlantic coast. Material and methods: 69 year-old female patient diagnosed with dilated cardiomyopathy with a 10-year course suffering from gradual functional deterioration. She developed relapsing pulmonary edema. Results: Device implantation is performed. By means of a transseptal catheterization MitraClip is inserted with positioning system operations below the mitral valve guided by 3 D TEE and captures both vale leaflets on the place where most A2/P2 regurgitation is located, thus holding the leaflets. Mild insufficiency is still observed, so a second MitraClip is implanted succesfully. Doppler measurements reveal minimal residual insufficiency. Angiography and TEE confirm correct implantation. Procedure is considered a success, being able to conduct device implantation in a fast, proper and uncomplicated way. Conclusions: The first case of MitraClip implant for management of severe MI in Barranquilla is presented, this being the second Colombian city after Cali where this type of device is implanted for the repair of severe mitral insufficiency

Los mapas conceptuales como estrategia que permite mejorar el proceso de enseñanza aprendizaje de la neuroanatomía / Concept maps as a strategy for improving the teaching learning process in neuroanatomy

Los mapas conceptuales son una estrategia de enseñanza aprendizaje que permite organizar los contenidos de una temática determinada facilitando su interpretación, comprensión y análisis. Su construcción en forma grupal incrementa la capacidad de los estudiantes de aprender de modo significativo debido al aumento del interés y la atención para integrar los conceptos más relevantes en forma cooperativa. El objetivo de este trabajo fue evaluar el rendimiento académico de los estudiantes que cursaron la asignatura morfofisiología II en la Universidad Industrial de Santander (UIS) al implementar el uso de los mapas conceptuales como herramienta pedagógica para la enseñanza de la anatomía funcional del sistema nervioso. Se realizó un estudio de tipo prospectivo analítico con mediciones transversales en cuatro momentos en 130 estudiantes de medicina (II semestre 2006) que cursaban la asignatura morfofisiología II a quienes durante los dos primeros cortes se les transmitió la información en forma de cátedra magistral y para el tercer corte se dividieron en grupos de trabajo que utilizaron como método activo de enseñanza los mapas conceptuales. Los resultados de sus exámenes académicos escritos se compararon utilizando la prueba de Bonferroni (p<0.05) cuando los ANOVA indicaron diferencias estadísticamente significativas. Los resultados demostraron que las calificaciones de las evaluaciones del tercer corte fueron significativamente mejores que las de los otros, lo que nos sugiere que la realización de mapas conceptuales en forma cooperativa ofrece ventajas al estudiante entre las que se encuentra la mejoría de su rendimiento académico.

The present study describes the implementation of conceptual maps as a pedagogical strategy that tends to transform the passive students into an active producer.The use of concept maps in groups encourages students to meaningful learning, increasing interest and attention in relevant concepts working in a cooperative way. The objective was to measure the improvement of academic performance of the student when implementing the strategy of conceptual maps as a pedagogical tool of students of morphophysiology II at the Universidad Industrial de Santander (UIS) for teaching the functional anatomy of the nervous system. An analytic prospective with four transversal sections study was conducted in 130 students of medicine (II semesters of 2006) Bucaramanga, Santander at 2006, who attended the course morphophysiology II.For the first and the second section the students received master classes and for the third section the group was divided and the active method of concept maps was applied. The multiple corrected comparisons were made using the Bonferroni test (p< 0.05) when the ANOVA shows significant statistical differences. All student received master classes as a group. For other activities they were divided in 4 groups; A, B, C and D with 36, 40, 25 and 29 students respectively. It is important that at the third period the performance of the group was homogeneous, finding not difference between groups. An ANOVA for all students in comparison of the 4 periods showed significant differences (F3,387: 39,116, p<0,001) where the comparison with Bonferroni demonstrated that performance in the third period was significantly better than in the other periods. Using concept maps as an strategy for actively constructing knowledge by students confirms that the process of learning is active and was reflected in the improvement of their performance.

Prueba computarizada memonum: efecto de intervalos y distractores sobre la memoria de trabajo en mujeres mayores de 50 años / Memonum computer test: effects of intervals and distractors on working memory in women over 50 years of

Mediante la prueba computarizada Memonum se evaluaron los efectos de dos intervalos de exposición de dígitos (1 y 8 segundos), y la presentación de un distractor sobre el desempeño de la memoria de trabajo en 80 mujeres mayores de 50 años. Se evidenció un efecto significativo del intervalo sobre las variables: número de aciertos, aciertos acumulados, y empleo de estrategias adicionales, demostrando un mejor desempeño mnemónico en participantes que presentaron la prueba en el intervalo de 8 segundos y sugiriendo que un tiempo amplio de exposición potencia la capacidad de almacenamiento de la memoria en adultos mayores. La presencia del distractor tuvo un efecto significativo sobre el número de aciertos acumulados,considerándose como un estimulo interferente capaz de afectar la memoria de trabajo en adultos mayores.

By means of the Memonum computerized test the effects of two exhibition intervals of digits (1 and 8 seconds), and the presentation of a distracter were evaluated on the working memory performance in 80 women older than 50 years. Significant effect of the exhibition interval on the number of successes, total successes and use of additional strategies it was revealed, demonstrating better mnemonic performance of participants that presented the test in the interval of 8 seconds and suggesting that a wide time of contact with the information power the memory’s storage capacity in older adults. The distracter presence had a significant effect on total successes variable, considered as interfere stimulus able to affect the working memory in older adults.

Aportes fisiológicos a la validez de criterio y constructo del diagnóstico de ansiedad según entrevista psiquiátrica y el State-Trait Anxiety Inventory (STAI) en una muestra de estudiantes universitarios colombianos / Physiological contributions to the validity of criterion and construct of the diagnosis of anxiety according to the psychiatric structured interview and the state-trait anxiety inventory (STAI) in a sample of Colombian university students

Introducción: Los trastornos de ansiedad son los más prevalentes en la población colombiana, según el último estudio de salud mental realizado en el país. Constituyen cuadros con manifestaciones cognitivas, emocionales y fisiológicas, cuyo diagnóstico se realiza con una gran variedad de herramientas. Método: A fin de contribuir a la validez de criterio y de constructo del diagnóstico de ansiedad en enfermería, según las características definitorias de la North American Nursing Diagnosis Association (NANDA), se aplicó el instrumento STAI Rasgo y Estado (State-Trait Anxiety Inventory), la entrevista psiquiátrica estructurada para los trastornos del eje I del DSM-IVR (SCID-I) y la evaluación de respuestas fisiológicas inducidas en 69 estudiantes universitarios. Resultados: La clasificación diagnóstica de ansiedad con criterios psiquiátricos evidenció respuestas fisiológicas inducidas por la aplicación de los cuestionarios del STAI y de la NANDA, coherentes con estados de activación fisiológica sugestivos de preparación frente a potenciales amenazas. Las respuestas fisiológicas encontradas pueden considerarse un elemento de criterio adicional y complementario al diagnóstico. Conclusión: Al no encontrar que las respuestas fisiológicas discriminaran significativamente los niveles de estado o rasgo de ansiedad por medio de la clasificación del STAI, en las condiciones del presente estudio, estos parámetros no deben ser considerados dentro de su validez de criterio o constructo...

Introduction: Anxiety disorders are the most prevalent disorders in the Colombian population, according to the latest study carried out in the country; these disorders present cognitive, emotional and physiological manifestations which are diagnosed using a variety of tools. Materials and Methods: The present study aims to contribute to the validity of criterion and construct of the diagnosis of anxiety in Nursing, according to the characteristics of NANDA, by the application of the State-Trait Anxiety Inventory, the psychiatric structured interview for disorders of axis I of DSM-IVR (SCID-I) and the evaluation of induced physiological responses in 69 university students. Results and Conclusions: The results led to the conclusion that the diagnostic classification of anxiety with psychiatric criteria demonstrated physiological responses induced by the application of the STAI and NANDA, coherent with states of physiological activation suggestive of preparation for potential threats. The physiological response may be considered an additional and complementary criterion to the diagnosis. We did not find that the physiological response discriminated significantly the levels of state or trait anxiety according to the STAI, in the conditions of the present study. Thus, these parameters should not be considered for the validity of criterion or construct...

Implementación de una prueba automatizada para la evaluación de memoria operacional: Memonum / Use of a Computarized Test of Evaluate Working Memory: Memonum

Introducción: Memonum es un test computarizado que se basa en la tarea de retención de dígitos directos de Wechsler. El estudio evaluó en una población universitaria la influencia de diversos intervalos de presentación de dígitos e interferencia atencional sobre el desempeño mnemónico derivado de la prueba Memonum. Método: La muestra estuvo conformada por 28 estudiantes, entre los 17 y los 25 años de edad, a quienes se les aplicó el Memonum en sus dos presentaciones (blanco-negro sin interferencia atencional y color con interferencia) con intervalos de exposición de 1, 8 y 16 segundos. Al fi nalizar cada intervalo se aplicó un formato de autoinforme para evaluar las estrategias empleadas y el grado de distracción y dificultad generado por la prueba. Resultados: El número de aciertos alcanzado por los participantes en la prueba Memonum fue similar al reportado con la subprueba de Wechsler. Además, el incremento de los intervalos de exposición de los dígitos en la prueba Memonum aumentó el desempeño mnemónico de los individuos. La presentación en color tuvo un efecto de interferencia atencional detectado por los análisis de variabilidad en el dominio del tiempo. Conclusión: La prueba Memonum es una herramienta útil en la evaluación de la memoria operacional por medio visual, pues detecta la perturbación atencional y se plantea como una prueba viable de evaluación y diagnóstico.

Introduction: The Memonum test is a computerized test based on the Wechsler test for retention of direct digits. The present study evaluated the infl uence of different intervals of digits presentation and attention interference on the mnemonic performance derived from the Memonum test, in a university population. Method: Twenty-eight students between the ages of 17 and 25 years were tested. All the subjects were tested with the Memonum in two presentations (Black-White without attention interference, and Color with interference), with exhibition intervals of 1, 8 and 16 seconds. After each interval an auto-test format was applied to evaluate the used strategies, and the level of distraction and difficulty generated by the test. Results: The number of successes obtained by the participants in the Memonum test was similar to that reported with the Wechsler sub-test. In addition, the increase of the exhibition intervals of the digits in the Memonum test, increased the mnemonic performance of the subject. The Color presentation had an interference effect at the attention level detected by the analyses of variability in the time dominion. Conclusion: The Memonum test is a useful tool in the evaluation of working memory as a visual test, that detects disturbances at the attention level, rendering a viable test for evaluation and diagnosis.

Evaluación de la memoria declarativa asociada con contenido emocional en pacientes lobectomizados / Evaluation of declarative memory associated with emotional content in lobotomized patients

La participación del lóbulo temporal en la memoria para eventos emocionales, ha sido evaluada utilizando la Prueba auditivo-visual, cuyo contenido emocional es presentado en narrativas complejas. El presente estudio examinó si el desempeño en el Token Test, afectaba la retención a largo plazo de información alertante emocionalmente en pacientes con lobectomía temporal unilateral. Se evaluaron 48 participantes, a quienes se les aplicó: Trail Making Test, Token Test y una Prueba auditivo-visual. De manera general, la ausencia del efecto depotenciación mnemónico encontrado en pacientes con lobectomía temporal izquierda no estuvo correlacionada con el rendimiento en el Token Test. En conjunto, se muestra la importancia de la integridad del lóbulo temporal izquierdo para la potenciación de la memoria declarativa asociada a contenido emocional.

Several studies have demonstrated that long-term declarative memory is enhanced by emotional arousal contents. Additionally, the role of the temporal lobe in memory associatedto emotional stimuli has been evaluated through the audio-visual Emotional Memory Test, where emotional content is presented by complex narratives. The present study examined ifToken Test’s performance influenced the long-term retention associated to emotional arousal in patients undergoing unilateral temporal lobectomy. A sample of 48 volunteers, were evaluated by Trail Making Test, Token Test and audio-visual Test. Patients didn’t show a mnemonic enhancement effect, particularly, those with left lobectomy. Low Token’s performance did not show any correlation with audio-visual Test’s performances. Results highlightthe importance of left temporal lobe for long-term enhancement of declarative memory associated to emotional events.

Evaluación de las manifestaciones autonómicas asociadas a la aplicación de una prueba auditivovisual de memoria emocional en humanos / Evaluation of autonomic displays associated to the application of an auditory-visual emotional memory test in humans

Con el fin de contribuir a la caracterización fisiológica del estado de alertamiento de personas expuestas a una prueba de memoria emocional auditivo-visual, se estudiaron 63 voluntarios, entre 18 y 48 años de edad, distribuidos aleatoriamente en dos grupos de acuerdo con las versiones narradas de las historias de la prueba (emocional o neutra). Se evaluó el desempeño mnemónico, la atribución del valor emocional y se registraron, en paralelo a las sesiones, la conductancia eléctrica de la piel (SCL) y la frecuencia de pulso (FP). En conjunto, los resultados verificaron el efecto de potenciación mnemónica inducida por la versión emocional asociada a activación simpática e inhibición parasimpática, tanto en adquisición como en evocación. Por lo tanto, se concluye que la percepción de alertamiento es coherente con el cuadro fisiológico inducido.

In order to contribute to the characterization of people’s arousal state when exposed to an audio-visual emotional memory test, 63 volunteers aged from 18 up to 48 years old were distributed randomly in two groups according to the test stories’ narrated versions (Emotional or Neutral). The mnemonic performance, the emotional value, and in parallel to the sessions, the skin’s electrical conductance (SCL) and pulse’s frequency (FP) were evaluated. Altogether, these results verified an enhancer mnemonic effect induced by the emotional version associated to sympathetic activation and parasympathetic inhibition both in acquisition and recovery. It is therefore concluded that the arousal perception is coherent with the induced physiological state.

NT-ProBNP reduction percentage during admission for acutely decompensated heart failure predicts long-term cardiovascular mortality.

BACKGROUND: N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. METHODS AND RESULTS: This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). CONCLUSION: NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.

[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin]. / Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco.

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to find out using the available diagnostic tools. Many patients present both heart and lung diseases that cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in this context has not been well settled so far. The objective was to describe the prediction usefulness of HC in patients suffering from dyspnea of heart origin, and to find out if HC changed after administering treatment. PATIENTS AND METHOD: HC was analyzed in 61 patients whose main symptom was dyspnea in the emergency department, and it was evaluated by means of clinical history, clinical course and performance of lung function tests and echocardiography. RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea of lung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea of heart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI, 8-52) than in patients with dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administering treatment. The sensitivity (52%), specificity (88%), positive predictive value (92%) and negative predictive value (58%) was established for a 30% HC cutoff. The prediction model of heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1). CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance, identifies the majority of patients suffering from current or past heart failure or severe cardiac dysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focus on selected patients.

Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco / Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin

FUNDAMENTO Y OBJETIVO: El origen respiratorio o cardíaco de la disnea no siempre es fácil de establecercon las herramientas diagnósticas disponibles. Muchos pacientes presentan a la vez procesoscardiológicos y pulmonares que la justifica. El papel que puede desempeñar el recuentode hemosiderófagos (RH) en esputo en este contexto no ha sido establecido suficientemente.El objetivo fue determinar la utilidad en la predicción y el diagnóstico del RH en pacientes condisnea de origen cardíaco, y si varía tras el tratamiento.PACIENTES Y MÉTODO: Hemos realizado el RH a 61 pacientes que consultaron por disnea en urgenciasy cuyo origen fue determinado por la historia clínica de urgencias, el curso clínico y la realizaciónde pruebas funcionales respiratorias y ecocardiograma.RESULTADOS: El RH fue superior en los pacientes con disnea de origen cardíaco (n = 35), 37%(intervalo de confianza [IC] del 95%, 26-47) o de origen cardiopulmonar (n = 9), 30% (IC del95%, 8-52) que el de origen respiratorio (n = 17), 15% (IC del 95%, 4-27). La sensibilidad(52%), especificidad (88%), valores predictivos positivo (92%) y negativo (58%) se determinaronpara un punto de corte del RH del 30%. El modelo de predicción de disnea de origen cardíaco,incluido el RH, presentó un área bajo la curva ROC de 0,978 (IC del 95%, 0,95-1).CONCLUSIONES: El RH refleja la gravedad de la alteración de la permeabilidad venocapilar pulmonar,identifica a la mayoría de los pacientes que presentan o han presentado disfunción o insuficienciacardíaca moderada o grave y predice la disnea de origen cardíaco. Su utilidad debecentrarse en casos seleccionados

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to findout using the available diagnostic tools. Many patients present both heart and lung diseasesthat cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in thiscontext has not been well settled so far. The objective was to describe the prediction usefulnessof HC in patients suffering from dyspnea of heart origin, and to find out if HC changed afteradministering treatment.PATIENTS AND METHOD: HC was analized in 61 patients whose main symptom was dyspnea in theemergency department, and it was evaluated by means of clinical history, clinical course andperformance of lung function tests and echocardiography.RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea oflung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea ofheart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI,, 8-52) than in patientswith dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administeringtreatment. The sensitivity (52%), specificity (88%), positive predictive value (92%)and negative predictive value (58%) was established for a 30% HC cutoff. The prediction modelof heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1).CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance,identifies the majority of patients suffering from current or past heart failure or severe cardiacdysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focuson selected patients

[Immediate and long-term outcome after angioplasty with stenting of the left main coronary artery]. / Resultados inmediatos y a largo plazo de la angioplastia con stent del tronco común.

INTRODUCTION AND OBJECTIVES: Coronary artery bypass graft surgery is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. The aim of the present study was to analyze the immediate and long-term results of angioplasty with stenting of the left main coronary artery, and to identify factors predictive of death. PATIENTS AND METHOD: A total of 38 nonconsecutive patients (mean age 69 [8] years) with a severe lesion in the left main coronary artery were treated with angioplasty and stenting between November 1997 and March 2003. The procedure was elective in 27 patients and urgent in the remaining 11. In 23 patients (60.5%) the left main coronary artery was not protected by aortocoronary bypass. All patients underwent clinical follow-up examination at 25 (20) months. RESULTS: Angiographically documented success was obtained in all patients. However, one patient died from acute occlusion one hour after the operation. Four patients (10%) had a non-Q-wave myocardial infarction. In-hospital mortality was 15.8% (6/38 patients). Five of the 11 patients (45.4%) who underwent emergency angioplasty and stenting died in the hospital from acute myocardial infarction complicated by severe (Killip grade III-IV) heart failure. However, only one of 27 patients (3.7%) in the elective surgery group died (P=.007). Major clinical cardiac events during follow-up occurred in 5 patients (13%); 3 died and the other 2 had recurrent angina. All patients who died had an unprotected left main coronary artery. Cumulative survival rates for the elective group were 92 (0.5)% at 6 months, 88 (0.6)% at 1 year and 86 (0.7)% at 3 years, respectively. For the emergency surgery group cumulative survival rate was 54 (0.2)% at 6 months (P<.05). CONCLUSIONS: Elective angioplasty and stenting of the left main coronary artery in selected patients was associated with a high immediate success rate. In patients who underwent elective angioplasty and stenting, the incidence of major cardiac events during follow-up was relatively low. Emergency angioplasty and signs of left ventricular dysfunction were the main predictors of in-hospital mortality.

N-terminal pro-brain natriuretic peptide reflects pulmonary capillary leakage in patients with acute dyspnea.

Natriuretic peptides have proved useful in the diagnosis of heart failure in patients presenting to the emergency department with shortness of breath. Dyspnea and orthopnea in heart failure are clinical expressions of pulmonary capillary congestion and leakage, which may be assessed by the percentage of pulmonary hemosiderin-laden macrophages (HLM) in induced sputum. We found a significant difference in the percentage of HLM present in sputum among patients with acute heart failure, patients with noncardiac dyspnea with ventricular dysfunction, and patients without heart failure (p = 0.008). N-terminal pro-brain natriuretic peptide (N-BNP) concentrations were also different among these 3 patient groups (p = 0.006). N-BNP concentrations were positively associated with the percentage of HLM in patients with acute dyspnea (r = 0.6; p < 0.0001). N-BNP, in addition to being a ventricular dysfunction marker, may reflect the severity of pulmonary capillary congestion and leakage in patients with acute shortness of breath.

N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction.

OBJECTIVE: To evaluate the utility of NT-proBNP in the emergency diagnosis and in-hospital monitoring of patients with acute dyspnoea and ventricular dysfunction. BACKGROUND: Misdiagnosis of heart failure (HF) is common in the urgent care setting using clinical diagnostic tests. Reports show that BNP is useful to diagnose HF in patients with acute dyspnoea. METHODS: Prospective study of 100 patients attending the Emergency Department (ED) for acute dyspnoea. Final diagnosis was determined on the basis of ED data sheets, echocardiography and pulmonary function tests. NT-proBNP levels were obtained on admission, at 24 h and at day 7. RESULTS: Patients with ventricular dysfunction were sub-classified into decompensated HF and masked HF, defined as HF with concomitant signs of pulmonary disease. Decompensated and masked HF patients had significantly higher NT-proBNP values than patients with non-cardiac dyspnoea (normal ventricular function) (920+/-140 and 978+/-363 vs. 50+/-15 pmol/L; P<0.001 and P<0.01, respectively). The mean area under the ROC curve for NT-proBNP was 0.957 (95% CI, 0.918 to 0.996, P<0.001). In multiple logistic-regression analysis NT-proBNP>115 pmol/l was the strongest independent predictor of ventricular dysfunction (odds ratio 45.4; 95% CI: 4.5-452.3). At day 7, a significant and similar reduction in NT-proBNP was observed in the two groups of patients with ventricular dysfunction (P<0.001 vs. admission values), but complete clinical resolution was less frequent in masked HF patients (P<0.05 vs. decompensated HF). CONCLUSIONS: NT-proBNP is a new candidate marker for the detection and exclusion of ventricular dysfunction in patients attending the ED for acute dyspnoea. NT-proBNP may also serve to monitor outcome during hospitalization.

Modelos animales de estrés post-traumático / Animal models of post-traumatic stress

El presente artículo describe los fundamentos generales y particulares de diversos modelos animales del trastorno de estrés post-traumático (TEPT). Describe ejemplos de modelos que utilizan el miedo condicionado, el sobresalto potenciado por miedo, la desesperanza aprendida, la sensibilización y la degeneración hipocampal. Adicionalmente, se describen los criterios de Yehuda y colaboradores y en su contexto, los autores esbozan la propuesta del laberinto en cruz elevado con su fenómeno conocido como “One trial Tolerante” como un posible modelo del TEPT.

The current article describes the general and peculiar foundations of several animal models of the Post-traumatic Stress Disorder (PTSD). It describes examples of models that use the conditional fear, the startle potentialized by fear, the learned helplessness, the sensitization and the hipocampal degeneration. Additionally, the criterion of Yehuda and collaborators are described and in their context, the authors sketch the proposal of the elevated plus maze with its phenomenon known as “One trial tolerance” as a possible model of the PTSD.