Validación del cuestionario de calidad de vida ConQol, en niños chilenos portadores de cardiopatías congénitas / Validation of quality of life questionnaire ConQol for Chilean children with congenital heart diseases

Background: ConQoL questionnaire assesses health related quality of life among children with congenital heart diseases. It has a version for children aged 8 to 11 years and anotherfor children aged 12 to 16years. Aim: To validate ConQol questionnaire for Chilean children with a congenital heart disease. Material and Methods: Using a multicentric cross sectional design, 334 children from four hospitals (54% males), were surveyed. Among them 45% were aged 8 to 11 years and 55%, 12 to 16 years. The study involved three stages: cross cultural adjustment of the original questionnaire, pre-test study, and estimation of its psychometric properties. Content, construct and criterion validity and internal consistency with Cronbach's alpha, were assessed. Results: The version for children aged 8 to 11 years and comprised by three domains (symptoms, activity and relationships), obtained and α ≥ 0.60. In the questionnaire for children aged 12 to 16years, there is one more domain called coping, which obtained an α of 0.53, that was different to the other three domains that obtained an α > 0.70. The correlation between Health Quality of Life and Perception of Health Quality of Life was statistically significant for both groups. The association between Health Quality ofLife and health capability was only significant among children aged 12 to 16years (p < 0.01). Conclusions: The adapted ConQol questionnaire matched properly with the original one. The adapted questionnaire is valid and reliable to assess Health Quality ofLife among Chilean children with congenital heart diseases.

Mutational analyses of open reading frames within the vraSR operon and their roles in the cell wall stress response of Staphylococcus aureus.

The exposure of Staphylococcus aureus to a broad range of cell wall-damaging agents triggers the induction of a cell wall stress stimulon (CWSS) controlled by the VraSR two-component system. The vraSR genes form part of the four-cistron autoregulatory operon orf1-yvqF-vraS-vraR. The markerless inactivation of each of the genes within this operon revealed that orf1 played no observable role in CWSS induction and had no influence on resistance phenotypes for any of the cell envelope stress-inducing agents tested. The remaining three genes were all essential for the induction of the CWSS, and mutants showed various degrees of increased susceptibility to cell wall-active antibiotics. Therefore, the role of YvqF in S. aureus appears to be opposite that in other Gram-positive bacteria, where YvqF homologs have all been shown to inhibit signal transduction. This role, as an activator rather than repressor of signal transduction, corresponds well with resistance phenotypes of ΔYvqF mutants, which were similar to those of ΔVraR mutants in which CWSS induction also was completely abolished. Resistance profiles of ΔVraS mutants differed phenotypically from those of ΔYvqF and ΔVraR mutants on many non-ß-lactam antibiotics. ΔVraS mutants still became more susceptible than wild-type strains at low antibiotic concentrations, but they retained larger subpopulations that were able to grow on higher antibiotic concentrations than ΔYvqF and ΔVraR mutants. Subpopulations of ΔVraS mutants could grow on even higher glycopeptide concentrations than wild-type strains. The expression of a highly sensitive CWSS-luciferase reporter gene fusion was up to 2.6-fold higher in a ΔVraS than a ΔVraR mutant, which could be linked to differences in their respective antibiotic resistance phenotypes. Bacterial two-hybrid analysis indicated that the integral membrane protein YvqF interacted directly with VraS but not VraR, suggesting that it plays an essential role in sensing the as-yet unknown trigger of CWSS induction.

Rol de la evaluación preparticipativa en adolescentes, en el diagnóstico de enfermedades cardiovasculares y prevención de muerte súbita / Screenig for cardiovascular diseases among teenagers that will engage in sport activities

Promotion of physical activity must be apriority in all modern societies, but there are some persons with medical conditions that can develop serious symptoms associated with sports, that can even be fatal, such as sudden death (SD). Adolescents are the age groups with the higher level of participation in recreation or competitive sports. International studies have demonstrated that approximately 1:250.000 adolescents die during the practice of sports. Of these, 50 percent had a prodrome 24 hours before the event and 75 percent had an underlying cardiovascular disease. Therefore, adolescents should be screened for cardiovascular diseases prior to their engagement in sports. This review gives a scientific approach to this issue, usually oversized by mass media. It also analyzes and reports international governmental strategies and practical tools for the clinician that must perform this type of screening.

Variability of SCCmec in the Zurich area.

A periodic survey of methicillin-resistant Staphylococcus aureus (MRSA) in Zurich in 2004 and 2006 revealed a consistently low prevalence of MRSA. SCCmec and ccr typing showed fluctuations in the proportions of SCCmec types and in the carriage of mobile virulence determinants. Together with the presence of variant SCCmecs these findings suggest a high clonal diversity and level of SCCmec recombination. The prevalence of a local "drug clone", associated with low-level methicillin resistance and rapid growth, significantly decreased. This clone had spread among intraveneous drug users, steadily increasing from 1994 to 2001 and was dominant in 2001. Apparently, changes in the management of the Zurich drug scene have restricted the spread of this clone.

Utilidad del cierre del foramen oval permeable en pacientes con AVE criptogénico / Closure of patent foramen ovale in patients with cryptogenic stroke

Antecedentes: El foramen oval permeable (FOP) es un hallazgo frecuente en pacientes con accidente vascular encefálico criptogénico (AVEC), y se discute la utilidad de su cierre percutáneo (CP). Objetivo: Evaluar el riesgo de recurrencia de eventos neurológicos en pacientes con AVEC y FOP, y compararlos entre aquellos tratados médicamente y los sometidos a CP. Métodos: Entre los 106 pacientes admitidos por AVEC y FOP, en el período 2003 a 2006, determinamos la aparición de nuevos eventos neurológicos isquémicos (NEN), y estudiamos sus factores determinantes y comparamos los que se sometieron a CP versus lo que continuaron con tratamiento médico, según criterio del tratante. Se consignaron las características clínicas y de la antomía del FOP en el ecocardiograma Los NEN se confirmaron por examen neurológico y/o neuro-imágenes. Para el análisis de los datos se utilizó chi-cuadrado y regresión logística.Resultados: Entre los 106 pacientes evaluados, 87 siguieron tratamiento médico y 19 CP. Los pacientes sometidos a CP presentaban mayor asociación de FOP con aneurisma del septum interauricular (ASI) (57,9% versus 35,6%, p=0,05). El seguimiento fue de 27 +/-13 meses. En este período se demostró un 12,6% de nuevo evento neurológico entre los tratados médicamente, mientras que ninguno lo presentó entre los sometidos al CP (NS). El único predictor independiente para NEN fue el ASI asociado con FOP; OR: 8,45 (1,56-60,46). Conclusiones: De acuerdo a nuestros resultados, los pacientes con AVEC y FOP tienen alto riesgo de recurrencia cuando el FOP se asocia a ASI y aparentemente se benefician con CP.

Background: Patent Foramen Ovale (PFO) is a frequent finding in patients with cryptogenic stroke (CS). Theeffect of closing the PFO in this setting is debated. Aim: to evaluate de risk of stroke recurrence in patients with CS and PFO; to compare this risk in patients followed under medical treatment with those undergoing percutaneous closure of PFO. Methods: From 2003 to 2006, 106 patients were admitted with a CS and the presence of PFO was documented by echocardiography. New ischemic strokes and risk factors were compared between those who weresubmitted to percutaneous closure of PFO and those treated in a conventional way. The decision to close thePFO was taken by the physician in charge. Clinical findings and echocardiographic characteristics of thePFO were recorded. New ischemic events were diagnosed by neurologic assessment and/or imaging techniques. Data was analyzed by chi square testing and logistic regression. Results: 87 patients were followed under medical treatment and 19 had closure of the PFO. The latter group had a greater incidence of atrial septal aneurysm (57.9% vs. 35.6%, p=0.05). The mean follow up was 27 +/- 13 months.New ischemic stroke occurred in 12.6% in the medically treated group while none was observed in the PFO closure group (NS). The sole independent predictor of new stroke was the presence of atrial septal aneurysm (OR: 8.45, 95% C.I. 1.56 - 60.46) Conclusion: Patients with CS and PFO are at considerable risk of developing new strokes, especially those with concomitant atrial septal aneurysm. Closure of PFO was apparently useful to prevent this risk.

Mosaic staphylococcal cassette chromosome mec containing two recombinase loci and a new mec complex, B2.

A novel staphylococcal cassette chromosome (SCC) mec from a clinical methicillin-resistant Staphylococcus aureus isolate (ST100/CC5) had a mosaic structure, composed of SCC DNA from several different backgrounds. It harbored two complete ccr loci and a new variant of mec complex B, with DeltamecR1 interrupted by the aminoglycoside resistance transposon Tn4001.

[Cardiac tumors in children and adults: A Multicentric retrospective study]. / Comportamiento clínico de los tumores cardíacos desde el feto hasta el adulto: serie multicéntrica de 38 pacientes.

BACKGROUND: Cardiac tumors are very uncommon at all ages. There are important clinical differences between children and adults in the behavior of these tumors. AIM: To compare the behavior of primary and secondary cardiac tumors, from fetal age to adults. PATIENTS AND METHOD: Multicentric retrospective analysis of 38 children and adults with cardiac tumors, evaluated with echocardiography between January 1995 and August 2001. Medical records, echocardiographic and radiological examinations, surgical protocols and pathologic examinations were reviewed. Follow-up was obtained through data on medical records or calling patients by telephone. RESULTS: Tumors were diagnosed in 38 patients (13 children and 25 adults), from a total of 31.800 echocardiograms. In children the diagnosis was made by fetal, transthoracic or transesophageal echocardiography in 23.6% and 8% of cases, respectively. Eighty five percent were primary (10 benign and 1 malignant) and 15%, secondary tumors. Fifty four percent were rhabdomyomas and 75% regressed spontaneously. Seventy seven percent were symptomatic and 31% were treated with surgery. During a follow up of 44+/-35 months, 31% of patients died. In adults, 76% of tumors were diagnosed by transthoracic and 20% by transesophageal echocardiography. Seventy six percent were primary (18 benign and 1 malignant) and 24% secondary tumors. Fifty six percent were myxomas. Ninety two percent were symptomatic and 84% were treated surgically. Twenty percent of patients died in the early postoperative period. No adult patients had a follow-up. CONCLUSIONS: Rhabdomyomas were solely found in children. In adults, myxomas are the predominant cardiac tumors. Primary and metastasic malignant tumors are observed both in children and in adults.

Comportamiento clínico de los tumores cardíacos desde el feto hasta el adulto: serie multicéntrica de 38 pacientes / Cardiac tumors in children and adults: A retrospective study

Background: Cardiac tumors are very uncommon at all ages. There are important clinical differences between children and adults in the behavior of these tumors. Aim: To compare the behavior of primary and secondary cardiac tumors, from fetal age to adults. Patients and Method: Multicentric retrospective analysis of 38 children and adults with cardiac tumors, evaluated with echocardiography between January 1995 and August 2001. Medical records, echocardiographic and radiological examinations, surgical protocols and pathologic examinations were reviewed. Follow-up was obtained through data on medical records or calling patients by telephone. Results: Tumors were diagnosed in 38 patients (13 children and 25 adults), from a total of 31.800 echocardiograms. In children the diagnosis was made by fetal, transthoracic or transesophageal echocardiography in 23.6 percent and 8 percent of cases, respectively. Eighty five percent were primary (10 benign and 1 malignant) and 15 percent, secondary tumors. Fifty four percent were rhabdomyomas and 75 percent regressed spontaneously. Seventy seven percent were symptomatic and 31 percent were treated with surgery. During a follow up of 44±35 months, 31 percent of patients died. In adults, 76 percent of tumors were diagnosed by transthoracic and 20 percent by transesophageal echocardiography. Seventy six percent were primary (18 benign and 1 malignant) and 24 percent secondary tumors. Fifty six percent were myxomas. Ninety two percent were symptomatic and 84 percent were treated surgically. Twenty percent of patients died in the early postoperative period. No adult patients had a follow-up. Conclusions: Rhabdomyomas were solely found in children. In adults, myxomas are the predominat cardiac tumors. Primary and metastasic malignant tumors are observed both in children and in adults.

Reemplazo valvular mitral y aórtico en niños: resultados durante la última década con prótesis de última generación / Mitral and aortic valve replacement in children: last decade results with latest generation prothesis

Antecedentes: El reemplazo valvular mitral (RVM) y aórtico (RVA) es poco frecuente en pacientes pediátricos y las series publicadas reportan elevada morbi-mortalidad. Objetivo: Evaluar los resultados a mediano plazo en niños sometidos a RVM y RVA durante los últimos diez años, con el fin de determinar morbimortalidad y calidad de vida. Método: Análisis retrospectivo de 26 niños consecutivos (mediana de edad 5,6 años) sometidos a RVM y RVA, entre marzo 1992 y junio 2003. Diecisiete presentaban patología mitral y once aórtica. Resultados: Se realizaron 26 operaciones implantando 28 prótesis (26 mecánicas y 2 biológicas). Tres pacientes (12 por ciento) fallecieron durante el primer mes. La mediana de seguimiento fue de 6,2 años. Tres pacientes con RVM fallecieron alejadamente por causa no atribuible al reemplazo valvular con una sobrevida actuarial de 87 por ciento. Tres pacientes requirieron reoperación. Todos realizan actividades adecuadas a su edad, restringiéndose los deportes de contacto. Conclusión: Los resultados a mediano plazo del reemplazo valvular en niños con valvulopatía grave son satisfactorios.

Cirugía paliativa mediante operación de Norwood en distintas formas de corazón univentricular: resultados quirúrgicos inmediatos / Immediate results of palliative surgery for different forms of univentricular heart using the Norwood procedure

Background: Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50 percent), derived from the procedure itself and from their abnormal physiological status. Aim: To report our experience with the Norwood procedure. Patients and methods: Retrospective analysis of all patients subjected to the Norwood procedure between February 2000 and June 2003. Results: Thirteen patients (9 females, age range 5-60 days and median weight of 3.3 kg) were operated. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia. The diagnosis was done in utero in eight patients. All technical variations, according to the disposition and anatomy of the great vessels, are described. Cardiac arrest with profound hypothermia was used in all and regional cerebral perfusion was used in nine. Three patients died in the perioperative period and three died in the follow up (two, four and 10 months after the procedure). Gleen and Fontan procedures were completed in five and one patients, respectively. Conclusions: Our results with the Norwood procedure are similar to other series. There is an important mortality in the immediate operative period and prior to the Glenn procedure (Rev MÚd Chile 2004; 132: 556-63).

Resonancia magnética en el estudio de cardiopatías congénitas: rol en la evaluación de las estructuras vasculares extracardiacas / Magnetic resonance in the study of congenital cardiopathies: role in the evaluation of the extracardiac vascular structures

En la actualidad la resonancia magnética ha adquirido cada vez más importancia en el diagnóstico y seguimiento de las cardiopatías congénitas. Entrega información anatómica y más recientemente información funcional. Se presenta la experiencia acumulada entre enero y agosto del año 2002, en cinco casos pediátricos en que la RM cardiaca fue utilizado como método complementario a la ecocardiografía y angiografía. En todos los casos aportó información anatómica precisa, en especial de la anatomía vascular extracardiaca y fue determinante en la conducta terapéutica. Se discute además las características de método e indicaciones.

Trends in age at AIDS diagnosis in Europe and the United States: evidence of pronounced "ageing' among injecting drug users.

OBJECTIVES: To analyse trends in age at diagnosis for adult AIDS cases reported in Europe and the United States. DESIGN: We used AIDS surveillance data for the seven European countries with the highest cumulative number of AIDS cases reported through June 1994 and for the United States through June 1993. Mean age at AIDS diagnosis over time was calculated by sex, transmission category and country. Linear regression yielded annual increase in age and permitted statistical evaluation of the trends observed. Annual AIDS incidence was calculated for homo-/bisexual men and injecting drug users (IDU) by 5-year age groups over time. RESULTS: We found an overall increase in age at AIDS diagnosis among the main transmission categories in Europe and the United States. The epidemiologic profiles of the two regions were highly similar, despite the lower average age among IDU in Europe compared with the United States (30.6 versus 36.7 years) and lower annual increases in age in the United States. In contrast to homo-/bisexual men, the increase in age at diagnosis is strikingly uniform and pronounced among IDU. Between 1986 and 1993, IDU in all countries exhibited at least a 6-month increase in age at diagnosis per annum. Although annual AIDS incidence remains consistent between various age groups of homo-/bisexual men, IDU aged 30-49 years show continuing increase, whereas their younger counterparts show signs of stabilization or decrease. CONCLUSIONS: Despite different epidemic profiles and prevention policies, the age trends for the European countries examined and the United States were strikingly similar. The meaning of this general increase in age among the main transmission categories and the especially high increase among IDU may provide important insight into epidemic dynamics and intervention assessment.

Safer sex behavior and alcohol consumption. Research Group of the Swiss HIV Prevention Study.

To test the hypothesis that safer sex procedures are less consistently observed by persons under the influence of alcohol, data from the Swiss human immunodeficiency virus (HIV) Prevention Study (HIPS) were evaluated. HIPS is a large prospective cohort study involving 724 HIV-negative and mainly heterosexual subjects who entertain casual sexual contacts. Of the 724 participants, 36% reported that they had had sex while under the influence of alcohol. Of this group, 31% indicated that safer sex procedures were neglected owing to the influence of alcohol. No significant differences with regard to unprotected sexual intercourse were found between subjects who combine sex and alcohol and those who do not. The same was found to be true among subjects with different levels of general alcohol consumption. However, a significant correlation was found between the intensity of alcohol consumption (i.e., the quantity of alcohol intake per sitting) and the incidence of unprotected sexual intercourse. These findings show that the relationship between alcohol consumption and safer sex is complex; they also emphasize the need for preventive efforts to reinforce safer sexual behavior, for example through individual counseling of persons at risk for HIV-infection.

Ablación por radiofrecuencia de haces auriculoventriculares anómalos en niños con taquicardia paroxística supraventricular / Radiofrequency ablation of abnormal atrioventricular bundle in children with paroxysmal supraventricular tachycardia

En 21 pacientes (edad promedio 9,7, márgenes 4 a 16 años) con taquicardias paroxísticas supraventriculares por haces paraespecíficos, se realizaron estudios eslectrofisiológicos y ablación de los haces por radiofrecuencia. Dos pacientes tenían malformaciones congénitas del corazón. La ablación se consiguió en 12/15 haces anómalos izquierdos (80 por ciento) y en 4/6 derechos (67 por ciento), en 10/12 pacientes con preexitación (83//) y 6/9 haces ocultos (67 por ciento) (diferencias no significativas). El buen éxito se obtuvo en 76 por ciento (16/21) del total de pacientes, pero éste aumentó a 84 por ciento (p=0,048 Fisher) después de eliminar los pacientes con malformaciones congénitas. Las complicaciones observadas incluyeron obstrución arterial con síndrome de compartimiento y perforación con taponamiento (un caso de cada una). La ablación por radiofrecuencia es un tratamiento adecuado y definitivo en niños con taquicardia paroxística supraventricular,independientemente de la localización de la vía anómala y la presencia de preexitación, pero puede fracasar en casos de malformaciones cardíacas. Las complicaciones de importancia son poco frecuentes, pero pueden llegar a ser graves, lo que exige una rigurosa selección de los pacientes a estudiar

[How well do condoms protect against HIV infection?]. / Wie sicher schützen Kondome vor einer HIV-Infektion?

A review of the literature shows that condoms offer good protection against HIV infection and other sexually transmitted diseases. A series of in vitro experiments demonstrate that quality condoms made of latex are impermeable to HIV. In addition, more than 30 in vivo studies confirm that condoms are highly effective in preventing the transmission of HIV. Condom breakage or slippage is relatively uncommon (1-5%). Most condom failure probably results from incorrect or inconsistent usage. Failures may be minimized by increasing experience, choice of quality condoms and by strictly following instructions for use.

Síndrome de Di George / Di George syndrome

Se presentan dos casos clínicos de síndrome de Di George cuyo diagnóstico se efectuó a los cuatro meses y a los dieciséis días de vida, respectivamente. Sus manifestaciones clínicas fueron síndrome convulsivo por hipocalcemia, dismorfia facial micrognatia, philtrum corto, hiperterolismo, orejas de implantación baja y malformación cardiovascular (anillo vascular, constituido por arco aórtico a derecha, arteria innominada izquierda y ligamento arterioso en un caso y tetralogía de Fallot extrema, con atresia valvular e hipoplasia del tronco y las arterias pulmonares, en el otro). El primer paciente, un varón, tiene actualmente tres años seis meses y evidencia de hipoparatiroidismo; se le practicó escisión quirúrgica del ligamento arterioso y su estudio de inmunidad celular es normal. El segundo, una niña, tuvo insuficiencia cardíaca precoz. Falleció a los dieciséis días de vida y el estudio anatomopatológico confirmó la tetralogía de Fallot, las alteraciones descritas en válvula y arterias pulmonares, irrigación pulmonar vía arterias bronquiales, ductus arterioso cerrado, ausencia de glándulas paratiroides y timo ectópico de histología normal. En ambos casos se postula forma parcial de síndrome de Di George