Aneurisma del seno de Valsalva roto a la aurícula derecha resuelto con intervencionismo / Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism

Resumen Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

Abstract We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism.

We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

The rescue of medical education crippled by the COVID-19 pandemic.

BACKGROUND AND OBJECTIVE: The ravages caused by the COVID-19 pandemic have affected medical education by losing the tutorial teaching that we carried out in out Institution. METHOD: The strategies implemented through information and communication technologies are described in this article. RESULTS: With the strategies carried out, it was possible to continue with all the theoretical education virtually at a distance, including the daily hospital rounds, the presentation of clinical cases, the remote analysis of laboratory and cabinet methods, as well as the teaching of the physical examination and the acquisition of diagnostic aid methods. In addition, the number of attendants for the weekly academic general session of the institute increased from 100 in-person attendants to 500 virtual attendants (average), with approximately 5000 reproductions of the recorded sessions. The advantages and disadvantages of these new techniques and the challenges for the future are discussed in this manuscript. CONCLUSIONS: Undoubtedly, the pandemic has caused damage to the teaching of two generations of medical students during 2020 and 2021, and we are still afraid that, in 2022, it will persist. Therefore, in our opinion, the medical education implemented by us is not ideal, but, at least, it constitutes a good palliative for the harm that the pandemic caused to medical education.

ANTECEDENTES Y OBJETIVO: Los estragos causados por la pandemia COVID-19 alcanzaron también la educación médica perdiéndose la enseñanza tutorial que ejercíamos en nuestro Instituto. MÉTODO: Se implementaron estrategias a través de las tecnologías de la información y de la comunicación que se describen en este artículo. RESULTADOS: Con las estrategias llevadas a cabo se pudo continuar con toda la educación teórica de manera virtual a distancia, incluyendo el pase cotidiano de visita a los enfermos, la presentación de casos clínicos, el análisis a distancia de los métodos de laboratorio y gabinete, así como la enseñanza de la exploración física y la adquisición de los métodos de ayuda diagnóstica de los gabinetes. El número de asistentes a la sesión general semanaria del Instituto incremento de 100 asistentes presenciales a 500 virtuales (promedio) con reproducciones de las mismas en un promedio de 5,000. Se discuten las ventajas e inconvenientes de estas nuevas técnicas y cuáles son los desafíos para el futuro. CONCLUSIONES: Sin duda alguna, la pandemia ha causado daño a la enseñanza de dos generaciones de estudiantes de la medicina en los años 2020 y 2021 y aún seguimos temerosos de que en el 2022 persista. A nuestro juicio la educación médica implementada por nosotros no es lo ideal, pero por lo menos constituye un buen paliativo del daño que la pandemia produjo en la educación médica.

Influence of renal dysfunction phenotype on mortality in decompensated heart failure with preserved and mid-range ejection fraction.

BACKGROUND: Natriuretic peptides or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk renal impairment (RI) in patients with heart failure and reduced ejection fraction (HF-REF). However, the situation in HF patients with preserved ejection fraction (HF-PEF) and mid-range ejection fraction (HF-MREF) remains unclear. METHODS: We evaluated patients from the Spanish National Registry of Heart Failure (RICA) that were admitted to Internal Medicine units with acute decompensated HF. Median admission values were used to define elevated NT-proBNP and BUN/creat. RESULTS: A total of 935 patients were evaluated, 743 with HF-PEF and 192 with HF-MREF). In patients with both NT-proBNP and BUN/creat below median admission values, RI was not associated with mortality (HR 1.15; 95% CI 0.7-1.87, p=0.581 in HF-PEF and HR 1.27; 95% CI 0.58-2.81, p=0.548 in HF-MREF). However, in patients with both elevated NT-proBNP and BUN/creat, those with RI had worse survival than those without RI (HR 2.01, 95% CI 1.33-3.06, p<0.001 in HF-PEF and HR 2.79, 95% CI 1.37-5.67, p=0.005 in HF-MREF). In HF-PEF even patients with RI with only 1 of the 2 parameters elevated, had a substantially higher risk of death compared to patients without RI (HR 1.53; 95% CI 1.04 to 2.26; p=0.031). CONCLUSIONS: In this clinical cohort of acute decompensated HF-PEF and HF-MREF patients, the combined use of NT-proBNP and BUN/creat stratifies patients with RI into groups with significantly different prognoses.

Eficacia del oleozón en la alveolitos dentaria, Policlínico Jimmy Hirtzel Bayamo, 2006-2007 / Oleozon effectiveness for dental alveolitos. Jimmy Hirzel policlinic, Bayamo, 2006-2007

Se realizó un estudio experimental tipo ensayo clínico fase III, controlado, aleatorizado en dos ramas, diseño paralelo, abierto, con el objetivo de comparar la eficacia del oleozón y el alvogil en el tratamiento de la alveolitis dental. La muestra estuvo conformada por los primeros 80 pacientes que acudieron a la consulta de urgencia del Policlínico Jimmy Hirtzel con el diagnóstico de alveolitis dental, en edades comprendidas entre 15 y 65 años de edad en el período de Abril del 2006 a Enero del 2007. Los individuos quedaron distribuidos aleatoriamente en dos grupos: Grupo 1 o estudio, que fueron tratados con oleozón y Grupo 2 o control, tratados con alvogil. Cada paciente se evaluó a partir de las 48 horas en días alternos hasta completar 4 visitas. Se midió el efecto terapéutico del oleozón comparado con el alvogil, teniendo en cuenta la intensidad del dolor, la inflamación, tiempo de curación y nivel de cicatrización del alveolo. Entre los principales hallazgos figuran que 82.5 por ciento de los tratados con el oleozón se reportaron sin dolor ya en la segunda consulta y 87.5 por ciento en los tratados con alvogil, en lo referente a la inflamación, estos se comportaron 78.5 por ciento y 85 por ciento; respectivamente, también 97.5 por ciento de los pacientes tratados con oleozón habían cicatrizado en la cuarta sesión de tratamiento y 92.5 por ciento de los que recibieron la terapia con alvogil, por último se registró que en la 4ta consulta 82.5 por ciento de los tratados con oleozón ya estaban curados, así como 77.5 por ciento de los tratados con alvogil.(AU)

It was carried out an experimental study of clinical trial type III, controlled, at random into two branches with the objective to compare the oleozon and alvogyl effectiveness in dental alveolitis treatment. The sample was made of the first 80 patients that came to the Emergency room of Jimmy Hirzel policlinic with dental alveolitis diagnosis, within the ages among, 15 and 65 years old during the period from april 2006 to january 2007. Patients were selected at random and distributed into two groups: group 1 (experimental) treated with oleozon and group 2 (control) treated with alvogyl. Each patient was evaluated from 48 hours on, in alternate days to get to the appointment 4. It was valued the therapeutic effect of aliozon compared with the alvogyl, taking into account the pain intensity, the inflammation, healing time and alveolus cicatrization level. Among the main research findings, it can be said that inthe second appointment the 82.5 per cent of patients treated with oleozon and the 87.5 per cent treated with alvogyl did not report pain; occording to inflammation it was reported 78.5 per cent and 85 per cent respectively, besides in the fourth treatment session the 97.5 per cent of patients treated with oleozon and the 92.5 per cent treated with alvogyl, had been cicatrized, and in the fourth appointment the 82.5 per cent of patients treated with oleozon and the 77.5 per cent treated with alvogyl had been already cured.(EU)