From Gut to Heart: A Case Report of Infectious Endocarditis Stemming From Cholecystitis-Induced Enterococcus faecium Bacteremia.

Systemic infections are not always going to present as we expect. The study of bacteremia and febrile syndrome represents one of the most important diagnostic challenges nowadays. This case demonstrates the importance of a multidisciplinary approach and finding a common point that explains all the patient's symptoms, no matter how disconnected they may seem. Here, we present the case of a patient where multiple treatments were performed to manage recurrent infective endocarditis due to Enterococcus faecium but the cause of this persistence was never found despite surgical management. With only a few cases reported in literature involving this pathogen, it is of great importance to emphasize how searching for a natural reservoir, such as the gallbladder, for this pathogen helped solve the diagnostic mystery that this patient represented. Here, we present how the culture of biological materials, such as the aortic valve replacement, as well as blood cultures, made it possible to identify the etiological agent associated with the pathology and, in turn, find the cause of recurrent bacteremia.

Response predictors to cardiac resynchronization therapy in chronic heart failure: a 10-year-cardiovascular center experience.

BACKGROUND: Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life. OBJECTIVES: Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT). METHODS: We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF). RESULTS: Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population. CONCLUSIONS: LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.

ANTECEDENTES: La terapia de resincronización cardíaca (TRC) se ha establecido como una terapia efectiva para la insuficiencia cardíaca con fracción de eyección reducida. Ensayos clínicos aleatorizados han demostrado su impacto en la mortalidad y hospitalizaciones por insuficiencia cardíaca, así como la mejora de los síntomas y la calidad de vida. OBJETIVOS: Determinar las variables clínicas, electrocardiográficas y ecocardiográficas que puedan predecir la respuesta a la terapia de resincronización cardíaca (TRC). MÉTODO: Estudio unicéntrico, observacional, analítico, retrospectivo, que incluyó 102 pacientes con diagnóstico de IC sometidos a TRC y terapia dirigida por guías, de enero de 2010 a abril de 2020, en un centro de tercer nivel. La respuesta a TRC fue definida como mejoría de la clase funcional de la New York Heart Association en al menos 1 categoría, asociado con una recuperación ≥ 5% en la fracción de expulsión del ventrículo izquierdo (FEVI). RESULTADOS: Incluimos a 102 pacientes, 61 (59.8%) fueron hombres. El promedio de edad al diagnóstico de IC fue 54 ± 18.7 años. La cardiopatía isquémica fue la etiología en 37 (36.3%) pacientes. 51 (50%) pacientes, fueron clasificados como respondedores. Los respondedores presentaron QRS amplio, menor FEVI y menor fracción de acortamiento del ventrículo derecho al inicio del estudio. Después de la TRC, los respondedores tuvieron una mayor reducción en la duración del QRS, mejoría en la FEVI, strain longitudinal global y parámetros de disincronía ecocardiográfica. El análisis de regresión multivariado mostró que el bloqueo de rama izquierdo (BRI), el volumen telediastólico del ventrículo izquierdo (VTDVI) la excursión sistólica del plano anular tricuspídeo (TAPSE) y la diferencia basal del período expulsivo fueron predictores de respuesta positiva a TRC. CONCLUSIONES: BRI, TAPSE, VTDVI y la diferencia basal de períodos preexpulsivos son variables independientes que predicen respuesta adecuada a TRC.

Response predictors to cardiac resynchronization therapy in chronic heart failure: a 10-year-cardiovascular center experience / Predictores de respuesta a la terapia de resincronización cardíaca en insuficiencia cardíaca crónica: 10 años de experiencia en un centro cardiovascular

Abstract Background: Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life. Objectives: Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT). Methods: We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF). Results: Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population. Conclusions: LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.

Resumen Antecedentes: La terapia de resincronización cardíaca (TRC) se ha establecido como una terapia efectiva para la insuficiencia cardíaca con fracción de eyección reducida. Ensayos clínicos aleatorizados han demostrado su impacto en la mortalidad y hospitalizaciones por insuficiencia cardíaca, así como la mejora de los síntomas y la calidad de vida. Objetivos: Determinar las variables clínicas, electrocardiográficas y ecocardiográficas que puedan predecir la respuesta a la terapia de resincronización cardíaca (TRC). Método: Estudio unicéntrico, observacional, analítico, retrospectivo, que incluyó 102 pacientes con diagnóstico de IC sometidos a TRC y terapia dirigida por guías, de enero de 2010 a abril de 2020, en un centro de tercer nivel. La respuesta a TRC fue definida como mejoría de la clase funcional de la New York Heart Association en al menos 1 categoría, asociado con una recuperación ≥ 5% en la fracción de expulsión del ventrículo izquierdo (FEVI). Resultados: Incluimos a 102 pacientes, 61 (59.8%) fueron hombres. El promedio de edad al diagnóstico de IC fue 54 ± 18.7 años. La cardiopatía isquémica fue la etiología en 37 (36.3%) pacientes. 51 (50%) pacientes, fueron clasificados como respondedores. Los respondedores presentaron QRS amplio, menor FEVI y menor fracción de acortamiento del ventrículo derecho al inicio del estudio. Después de la TRC, los respondedores tuvieron una mayor reducción en la duración del QRS, mejoría en la FEVI, strain longitudinal global y parámetros de disincronía ecocardiográfica. El análisis de regresión multivariado mostró que el bloqueo de rama izquierdo (BRI), el volumen telediastólico del ventrículo izquierdo (VTDVI) la excursión sistólica del plano anular tricuspídeo (TAPSE) y la diferencia basal del período expulsivo fueron predictores de respuesta positiva a TRC. Conclusiones: BRI, TAPSE, VTDVI y la diferencia basal de períodos preexpulsivos son variables independientes que predicen respuesta adecuada a TRC.

The emergence of dengue as a virological challenge: from phantom disease to "pet" endemic, 1986-1987. / A emergência da dengue como desafio virológico: de doença-fantasma à endemia "de estimação", 1986-1987.

This article analyzes how dengue presented a virological challenge during the 1980s in order to explore the role of virological studies in understanding this disease and constructing expertise in arboviral diseases. Although outbreaks were reported throughout the twentieth century, dengue was barely known in the Americas until the epidemic of dengue fever in Cuba in 1981. When the disease reached the Brazilian city of Nova Iguaçu (RJ) in 1986, it became the focus of attention for a team of virologists led by Hermann Schatzmayr, who mobilized efforts after the creation of the Flavivirus Laboratory at the Oswaldo Cruz Institute.

O artigo analisa como a dengue se apresentou como desafio virológico na década de 1980. O objetivo é entender o papel dos estudos virológicos na compreensão da doença e a construção de uma expertise em arboviroses. Embora surtos da doença já tivessem sido relatados ao longo do século XX, a dengue era pouco conhecida nas Américas até a epidemia de dengue hemorrágica em Cuba, em 1981. Quando em 1986 a doença atingiu a cidade de Nova Iguaçu (RJ), a equipe de virologistas liderada por Hermann Schatzmayr tomaria a doença como objeto, mobilizando esforços a partir da criação do Laboratório de Flavivírus do Instituto Oswaldo Cruz.

A emergência da dengue como desafio virológico: de doença-fantasma à endemia "de estimação", 1986-1987 / The emergence of dengue as a virological challenge: from phantom disease to "pet" endemic, 1986-1987

Resumo O artigo analisa como a dengue se apresentou como desafio virológico na década de 1980. O objetivo é entender o papel dos estudos virológicos na compreensão da doença e a construção de uma expertise em arboviroses. Embora surtos da doença já tivessem sido relatados ao longo do século XX, a dengue era pouco conhecida nas Américas até a epidemia de dengue hemorrágica em Cuba, em 1981. Quando em 1986 a doença atingiu a cidade de Nova Iguaçu (RJ), a equipe de virologistas liderada por Hermann Schatzmayr tomaria a doença como objeto, mobilizando esforços a partir da criação do Laboratório de Flavivírus do Instituto Oswaldo Cruz.

Abstract This article analyzes how dengue presented a virological challenge during the 1980s in order to explore the role of virological studies in understanding this disease and constructing expertise in arboviral diseases. Although outbreaks were reported throughout the twentieth century, dengue was barely known in the Americas until the epidemic of dengue fever in Cuba in 1981. When the disease reached the Brazilian city of Nova Iguaçu (RJ) in 1986, it became the focus of attention for a team of virologists led by Hermann Schatzmayr, who mobilized efforts after the creation of the Flavivirus Laboratory at the Oswaldo Cruz Institute.

Pharmaceutical strategies for the treatment of bacterial biofilms in chronic wounds.

Biofilms are sessile communities of microorganisms, mainly bacteria, that grow on biotic and abiotic surfaces. These microorganisms are embedded within an extracellular polymeric substance that provides enhanced protection from antimicrobials. Chronic wounds provide an ideal habitat for biofilm formation. Bacteria can easily attach to wound debris and can infect the wound due to an impaired host immune response. This review highlights the mechanism of biofilm formation and the role of biofilms in the pathophysiology of chronic wounds. Our major focus is on various formulation strategies and delivery systems that are employed to eradicate or disperse biofilms, thereby effectively managing acute and chronic wounds. We also discuss clinical research that has studied or is studying the treatment of biofilm-infected chronic wounds.

O coelho é a saúva: a proposta brasileira e o uso do vírus do mixoma (MYXV) contra a praga de coelhos na Austrália, 1896-1952 / Rabbits and leaf-cutting ants: the Brazilian plan to use the myxoma virus (MYXV) against rabbit plagues in Australia, 1896-1952

Resumo O artigo analisa a singularidade dos processos históricos, científicos e políticos que vão da descoberta da doença que passou a ser conhecida como mixomatose infecciosa, causada pelo vírus do mixoma (MYXV), à sua aplicação no controle de uma praga de coelhos na Austrália. A narrativa segue especialmente as pesquisas de Henrique de Beaurepaire Aragão, pesquisador do Instituto Oswaldo Cruz, e posteriormente os esforços da cientista Jean Macnamara para promover pesquisas e implementar o MYXV na Austrália. Foram consultadas notas de pesquisa de cientistas, documentos oficiais que registraram o desenvolvimento dos experimentos, bem como periódicos. Nesse processo, foi considerado o desenvolvimento histórico do campo de estudos da virologia e controle biológico.

Abstract This article analyzes the singularity of historical, scientific, and political processes from the discovery of the disease caused by the myxoma virus (MYXV) that came to be known as infectious myxomatosis to the application of this virus against a plague of rabbits in Australia. This narrative focuses on research by Henrique de Beaurepaire Aragão, a researcher at the Oswaldo Cruz Institute, and later efforts by the scientist Jean Macnamara to promote studies and implement MYXV in Australia. The scientists' research notes were consulted, along with official documents recording the experiments and periodicals. In this process, the historical development of virology and biological controls as a field of study was also considered.

Response to Edaphoclimatic Conditions and Crop Management of the Bacterial Microbiome of Musa acuminata Rhizosphere Profiled by 16S rRNA Gene Amplicon Sequencing.

Bacterial rhizospheric microbiomes of Musa acuminata cultivated in farms close to the west and east Mexican coasts and with different climate, soils, and crop management practices were characterized by 16S rRNA gene amplicon sequencing. Results showed that rhizospheric microbiome composition changed along with seasonal weather but were mostly indifferent to soil type.

[Rabbits and leaf-cutting ants: the Brazilian plan to use the myxoma virus (MYXV) against rabbit plagues in Australia, 1896-1952]. / O coelho é a saúva: a proposta brasileira e o uso do vírus do mixoma (MYXV) contra a praga de coelhos na Austrália, 1896-1952.

This article analyzes the singularity of historical, scientific, and political processes from the discovery of the disease caused by the myxoma virus (MYXV) that came to be known as infectious myxomatosis to the application of this virus against a plague of rabbits in Australia. This narrative focuses on research by Henrique de Beaurepaire Aragão, a researcher at the Oswaldo Cruz Institute, and later efforts by the scientist Jean Macnamara to promote studies and implement MYXV in Australia. The scientists' research notes were consulted, along with official documents recording the experiments and periodicals. In this process, the historical development of virology and biological controls as a field of study was also considered.

O artigo analisa a singularidade dos processos históricos, científicos e políticos que vão da descoberta da doença que passou a ser conhecida como mixomatose infecciosa, causada pelo vírus do mixoma (MYXV), à sua aplicação no controle de uma praga de coelhos na Austrália. A narrativa segue especialmente as pesquisas de Henrique de Beaurepaire Aragão, pesquisador do Instituto Oswaldo Cruz, e posteriormente os esforços da cientista Jean Macnamara para promover pesquisas e implementar o MYXV na Austrália. Foram consultadas notas de pesquisa de cientistas, documentos oficiais que registraram o desenvolvimento dos experimentos, bem como periódicos. Nesse processo, foi considerado o desenvolvimento histórico do campo de estudos da virologia e controle biológico.

Vacuna hexavalente en el Perú. Hacia la cobertura segura y sostenida de la vacunación en la infancia. Consenso de expertos / Hexavalent vaccine in Peru. Towards safe and sustained coverage of childhood immunization. Expert consensus

Objetivo. La inmunización es una de las intervenciones más importantes para prevenir la morbimortalidad en la población mundial. No obstante, aún persisten brechas para alcanzar coberturas ideales de vacunación. Además, las múltiples dosis y vacunas dificultan alcanzar las metas mínimas establecidas. Por ello, se desarrollan vacunas combinadas y fraccionadas para reducir el número de inyecciones, errores programáticos, reactogenicidad y mejorar la adherencia. En tres días distintos, durante 9 horas, se reunieron 6 médicos pediatras expertos en vacunas en el Perú siguiendo el método RAND/UCLA, con el objeto de elaborar un consenso de opinión y actualización de la vacuna combinada hexavalente [DTaP+Haemophilus influenzae tipo b (Hib)+Hepatitis B (HVB)+antipolio inactivada (IPV)] y su eventual uso en el Programa ampliado de inmunizaciones (PAI). Las recomendaciones del consenso son: reemplazar las vacunas, antipolio oral (OPV) por IPV, pertussis de células enteras por vacunas acelulares y DTP de los 4 años por dTap entre los 4 y 6 años; usar la vacuna hexavalente para la serie primaria (2, 4 y 6 meses); usar 4 dosis de vacuna contra Hib (2, 4, 6 y 18 meses); incorporar la vacuna hexavalente en el PAI; no usar la IPV fraccionada (fIPV) y administrar solo 4 dosis de IPV.

Objetive. Immunization is one of the most important interventions to prevent morbidity and mortality in the world population. However, gaps persist to achieve ideal vaccination coverage. In addition, the multiple vaccines and necessary doses make it difficult to reach the minimum established goals. On this scenario, combined and fractionated vaccines are being developed with the aim of reducing the injections number, programmatic errors, reactogenicity and improving adherence. On three different days, for 9 hours, 6 pediatricians experts in vaccines in Peru met following the RAND/UCLA method in order to develop a consensus opinion and update of the combined hexavalent vaccine [DTaP+Haemophilus influenzae type b (Hib)+Hepatitis B (HVB)+Inactivated Polio Vaccine (IPV)] and its eventual use in the Extended Immunization Program (EPI). The consensus recommendation are: replace the vaccines, Oral Polio Vaccine (OPV) by IPV, pertussis of whole cells by acellular vaccines and DTP of 4 years old by dTap between 4 and 6 years old; use the hexavalent vaccine for the primary series (2, 4 and 6 months); use 4 doses of Hib vaccine (2, 4, 6 and 18 months); incorporate the hexavalent vaccine in the EPI; do not use fractionated IPV (fIPV) and only administer 4 doses of IPV.

Resting time before slaughter restores homeostasis, increases rigor mortis time and fillet quality of surubim Pseudoplatystoma spp.

This study assesses the respiratory dynamics related to stress parameters and resting time before slaughter, in the quality of surubim (Pseudopatystoma spp.) fillets. A completely randomized design was conducted using five treatments: resting time before slaughter of 0, 2, 4, 8 and 24 hours, with 15 fish sampled per treatment. Time 0 corresponded to the treatment without resting time, where the fish were slaughtered immediately after arriving at the processing plant. The resting time did not affect the electrolyte balance, hemoglobin, plasma, hepatic glycogen, myofibrillar fragmentation index (MFI) and water holding capacity (WHC) of surubins. However, with increased resting time, there was a significant decrease in muscle glycogen and an increase in blood pH and blood bicarbonate levels. Additionally, respiratory parameters showed an increase in pO2 and, consequently, in O2 saturation and a decrease in pCO2.The hematocrit and MCV values of the surubins after 24 hours of resting decreased significantly. In the first hours of resting, the highest values of erythrocytes and CHCM were observed. The lowest level of stress was observed for fish having 24 hours of resting. Fish having longer resting periods (8 and 24 hours) presented fillets with a higher pH (P <0.05) and the rigor mortis establishment time was shorter for the first 2 hours and 24 hours of resting time. There was a linear decrease in fillet lightness and an increase in the intensity of red (CIE a*) color up to 24 hours when resting was increased. In CIE b*, a linear decrease (P <0.05) of the yellow intensity of the fillets was observed as the surubim resting time increased. A resting time of 4 to 8 hours before slaughter is effective in reestablishing homeostasis after transporting surubim, providing fillets with higher quality and a greater length of the pre-rigor mortis period.

Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplastic patients.

INTRODUCTION: Surgical lengthening and angular correction of the limbs are an option for treating the orthopedic clinical manifestations in patients with achondroplasia. This study assesses a staged limb lengthening protocol, performing simultaneous bilateral lengthening of the femur and tibia (stage I [S1]), and humeral lengthening (stage II [S2]). MATERIALS AND METHODS: Twenty-one achondroplastic patients were included in this study, and 106 segments (34 femurs, 34 tibias and 38 humeri) were lengthened. Achondroplasia patients with a growth curve below the mean of the standard growth curves for achondroplasia were included in S1. The remaining patients were included directly in S2. Variables analyzed included anthropometric measurements, lengthening outcomes, difficulties, and functionality. RESULTS: Of the all patients included in the protocol, 15 patients completed S1 and S2, 4 only completed S2, and 2 only completed S1. Height and limb-trunk ratio before S1 were 107.65 ± 7.14 cm and 1.89 ± 0.10 and after S1 were 126.50 ± 9.19 cm and 1.64 ± 0.09, respectively. Limbs were lengthened 14.43 ± 1.41 cm (femurs and tibias) for S1 and 9.95 ± 0.60 cm for S2 (humeri), with a stage healing index of 18.23 ± 3.54 in S1 and 28.92 ± 4.42 in S2. Correction of lower angular deviations, functional improvement, and a controlled complications rate were achieved in all patients. CONCLUSIONS: The limb lengthening protocol proposed in this study is a suitable treatment for achondroplasia patients to achieve the agreed-upon objectives (limb-trunk ratio, improved functionality, and lower limb alignment). The reproducibility of the procedure and patient safety were upheld.

Incidence of osteonecrosis of the jaw by the use of osteoclast inhibitors in patients with bone metastases: a retrospective cohort study.

BACKGROUND: The use of osteoclast inhibitors in metastatic bone disease, increase bone mineral density and reduce the risk of fracture, patients with osteonecrosis have been reported after the chronic use of these inhibitors. In our country, the use of osteoclast inhibitors is in the context of osteoporosis and bone metastases, so it is important to describe the incidence of this complication in Mexican population. OBJECTIVE: To describe the incidence of osteonecrosis of the jaws at the Centro Médico Nacional 20 de Noviembre, during the period from January 1st, 2010 to June 1st, 2016. METHODS: This is a retrospective cohort study developed at the Centro Medico Nacional 20 Noviembre, ISSSTE, Mexico. We included all patients who received bisphosphonates or denosumab in the context of metastatic bone disease due to solid tumors and who had osteonecrosis of the jaw. RESULTS: A 802 patients who used bisphosphonates or denosumab in metastatic bone disease (699 bisphosphonates and 103 denosumab). Of these, 28 (3.5%) patients presented osteonecrosis. The median use of zoledronic acid for the presence of osteonecrosis was 25 months (15-49 months) and for Denosumab it was 16 months (11-35 months), without finding significant differences between the use of drugs p = 0.511 and the risk of osteonecrosis. CONCLUSIONS: Drug-induced osteonecrosis has a low incidence in Mexican population, denosumab does not show a greater number of cases of osteonecrosis compared to bisphosphonates; no association was found between functional status, number of metastatic bone sites, nor use of antigenic or tyrosine kinase inhibitors as factor associated with osteonecrosis of the jaws.

ANTECEDENTES: El uso de inhibidores de osteoclastos en la enfermedad metastasica ósea tiene como objetivo aumentar la densidad mineral ósea y reducir el riesgo de fractura. Se han reportado pacientes con osteonecrosis de los maxilares tras el uso crónico de estos inhibidores. En nuestro país, los inhibidores de osteoclastos se usan en el contexto de osteoporosis y de metástasis óseas, por lo que es importante describir la incidencia de esta complicación en población mexicana. OBJETIVO: Describir la incidencia de osteonecrosis de los maxilares en el Centro Médico Nacional 20 de Noviembre, durante el periodo del 1 de enero del 2010 al 1 de junio de 2016. MÉTODO: Estudio de cohorte retrospectiva desarrollado en el Centro Médico Nacional 20 de Noviembre, del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, en Ciudad de México. Se incluyeron todos los pacientes que recibieron bisfosfonatos o denosumab con enfermedad metastasica ósea por tumores sólidos, y que presentaron osteonecrosis de mandíbula. RESULTADOS: Se analizaron 802 pacientes que recibieron bisfosfonatos o denosumab en enfermedad metastasica ósea (699 bifosfonatos y 103 denosumab). De ellos, 28 (3.5%) presentaron osteonecrosis. La mediana de uso de ácido zoledrónico para la presencia de osteonecrosis fue de 25 meses (15-49 meses), y para denosumab fue de 16 meses (11-35 meses), sin encontrar diferencias significativas entre ellos (p = 0.511) y el riesgo de osteonecrosis. CONCLUSIONES: La osteonecrosis inducida por medicamentos tiene una baja incidencia en población mexicana. El denosumab no muestra un mayor número de casos de osteonecrosis en comparación con los bisfosfonatos. No se encontró asociación entre el estado funcional, el número de sitios óseos metastásicos ni el uso de antiangiogénicos o de inhibidores de la tirosina cinasa como factor asociado a osteonecrosis de los maxilares.

Imbalance of the redox system and quality of tilapia fillets subjected to pre-slaughter stress.

The objective of this study was to evaluate the effect of oxidative stress on the instrumental and sensory quality of Nile tilapia fillets. The experiment was conducted in a 2x2 factorial arrangement, evaluating densities (60 and 300 kg m-3) and depuration times (1 and 24 hours) in a total of four treatments. The serum levels of cortisol and gene expression levels of catalase (CAT), glutathione peroxidase (GPx) and 70 kDa heat shock protein (HSP70) as well as the pH, color, tenderness, water-holding capacity and sensory analysis of the fillets were evaluated. High density (300 kg m-3) resulted in higher mean cortisol levels, lower expression of CAT and GPx enzymes as well as higher expression of HSP70. Fish under this treatment also exhibited fillets with greater tenderness, higher lightness, lower redness and lower sensory acceptance. The longer depuration time (24 hours) resulted in lower expression of the CAT and GPx enzymes and fillets with higher lightness. The water-holding capacity was not affected by the different treatments. Therefore, low density and longer depuration times are recommended for decreased stress and improved quality of fillets.

QRS-fragmentation: Case report and review of the literature / Fragmentación del QRS: reporte de caso y revisión de la literatura

Abstract Fragmentation of QRS complex (QRSf) is an easily evaluable, non-invasive electrocardiographic parameter that represents depolarisation anomalies and has been associated with several adverse outcomes, such as sudden death, fibrosis, arrhythmic burden, and a worse prognosis in different conditions, including coronary artery disease (CAD). The case is presented of a 69-year old male referred due to symptoms of chronic stable angina. His electrocardiogram showed sinus rhythm, absence of Q waves, but the presence of QRSf in the inferior leads and V4-V6. A Tc-99 myocardial perfusion SPECT scan revealed a fixed perfusion defect in the inferolateral region, corresponding to the finding of QRSf. QRSf is an easily valuable electrocardiographic marker with relative sensitivity, but poor specificity. Its routine clinical application could contribute to an increase in the suspicion of coronary artery disease. Conclusion: The presence of fragmented QRS represents distortion of signal conduction and depolarisation, which is related to myocardial scar or myocardial fibrosis. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen La fragmentación del QRS (fQRS) es un parámetro electrocardiográfico fácilmente evaluable que representa anomalías de despolarización y que se ha asociado a varios resultados adversos como muerte súbita, fibrosis, carga arrítmica y peor pronóstico en diferentes afecciones, incluyendo la enfermedad arterial coronaria (EAC). Se presenta el caso de un hombre de 69 años referido para estudio por síntomas compatibles con angina de esfuerzo. El electrocardiograma mostró ritmo sinusal, sin ondas Q, pero con fQRS en la cara inferior y en V4-V6. Un SPECT cardiaco con Tecnecio-99 demostró fijo inferior e inferolateral, correspondiente al territorio electrocardiográfico de fQRS. La fQRS es un marcador electrocardiográfico fácilmente valorable, relativamente sensible, aunque poco específico, el cual puede contribuir en la práctica clínica a aumentar la probabilidad de sospecha de una enfermedad arterial coronaria. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

QRS-fragmentation: Case report and review of the literature.

Fragmentation of QRS complex (QRSf) is an easily evaluable, non-invasive electrocardiographic parameter that represents depolarisation anomalies and has been associated with several adverse outcomes, such as sudden death, fibrosis, arrhythmic burden, and a worse prognosis in different conditions, including coronary artery disease (CAD). The case is presented of a 69-year old male referred due to symptoms of chronic stable angina. His electrocardiogram showed sinus rhythm, absence of Q waves, but the presence of QRSf in the inferior leads and V4-V6. A Tc-99 myocardial perfusion SPECT scan revealed a fixed perfusion defect in the inferolateral region, corresponding to the finding of QRSf. QRSf is an easily valuable electrocardiographic marker with relative sensitivity, but poor specificity. Its routine clinical application could contribute to an increase in the suspicion of coronary artery disease. CONCLUSION: The presence of fragmented QRS represents distortion of signal conduction and depolarisation, which is related to myocardial scar or myocardial fibrosis.

National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II) / Registro Nacional de Programas de Rehabilitación Cardiaca en México II (RENAPREC II)

Abstract: Objective: The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation. Methods: All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units. Results: In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n = 24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%). Conclusions: CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses.

Resumen: Objetivo: El propósito de este trabajo es comparar el estado actual de los programas de rehabilitación cardiaca (PRC) en México con el RENAPREC-2009, dirigido a la asistencia, docencia, investigación y barreras. Métodos: Se convocó a participar a todos los autores de RENAPREC-2009 y a otros líderes en rehabilitación cardiaca de México. Los centros fueron distribuidos en 2 grupos: los que participaron en el 2015 y las nuevas unidades de PRC. Resultados: En 2009 había 14 centros operativos, de los cuales 2 cerraron y 2 no respondieron. En 2015 se registraron 24 centros en total, representando un aumento neto del 71%. La distribución geográfica fue centrípeta. La cobertura fue de 0.02 centros/100,000 habitantes y de solamente un 4.4% de los pacientes elegibles (10.4 pacientes/100,000 habitantes). La relación cardiólogo clínico-rehabilitador cardiaco es de 94:1 y la de intervencionista-rehabilitador cardiaco es de 16:1. Las actividades realizadas y los costos de los PRC varían de forma importante de centro a centro. En promedio, el 12% de los pacientes en fase ii abandonaron el programa. Las principales barreras para el desarrollo de PRC fueron: económicas (83%), falta de personal capacitado (67%), falta de equipo (46%), áreas inadecuadas (42%) y un insuficiente número de centros operativos (38%). Conclusiones: Los PRC en nuestro país continúan en crecimiento. Se observan fortalezas como el nivel de docencia y el enfoque multidisciplinario, así como deficiencias en la homogeneidad de las actividades y la falta de referencia de la población elegible.

Effect of physical training on the recovery of acute exercise, among patients with cardiovascular disease / Efecto del entrenamiento físico en la recuperación del ejercicio agudo, en pacientes con enfermedad cardiovascular

Abstract: Introduction: Physical training programs (PTP) have shown several beneficial effects for patients with cardiovascular disease (CVD), particularly by increasing survival and quality of life. Physiological response during the effort and recovery phases of an exercise testing, is one of the strongest prognostic markers among patients with CVD. A reasonable mechanism that explains those training effects on survival is through the adaptations seen on heart rate recovery (HRR) and oxygen uptake kinetics at the post-exertional phase (RVO2). Objective: Compare the HRR and RVO2 values before and after a PTP in patients with CVD. Methods: We studied a cohort of patients included in a cardiac rehabilitation program, whom performed a cardiopulmonary exercise testing (CPX). Then, risk stratification and an individualized exercise training program were performed. The exercise training program included 20 sessions of aerobic exercise, 30 min a day, five times a week, at moderate intensity. Finally, a second CPX was performed. Results: A total of 215 patients were included. Peak oxygen uptake values rose 2.2 ± 5.2 ml/kg/min (p < 0.001), HRR increased 1.6 ± 10 bpm (p < 0.05) and RVO2 improved −21 ± 98 s (p < 0.001). A post-hoc analysis show that the percentage of maximum heart rate remained statistically associated with HRR increment. Furthermore, diabetes and sedentarism were strongly related to RVO2 improvement. No correlation between HRR and RVO2 was found (R2 = 0.002). Conclusion: Physical exercise was associated with a beneficial effect on HRR and RVO2. Nevertheless, both variables were statistically unrelated.

Resumen: Introducción: Los programas de entrenamiento físico han demostrado efectos benéficos en pacientes con enfermedad cardiovascular, particularmente debido al aumento de la supervivencia y calidad de vida. La respuesta fisiológica durante la prueba de esfuerzo cardiopulmonar tanto en las fases de ejercicio como de recuperación son de los principales marcadores pronósticos debido a la adaptación en la recuperación de la frecuencia cardiaca (RFC) y la cinética de recuperación de oxígeno en la fase de postesfuerzo (RVO2). Objetivo: Comparar los valores de RFC y RVO2 antes y después de un programa de entrenamiento físico. Métodos: Se estudió una cohorte de pacientes incluidos en un programa de rehabilitación cardiaca, que hayan realizado una prueba de esfuerzo cardiopulmonar. El programa de entrenamiento consistió en 20 sesiones de ejercicio aeróbico de 30 min diarios, 5 veces a la semana de intensidad moderada. Por último, se realizó una segunda prueba de esfuerzo cardiopulmonar. Resultados: Se incluyeron 215 pacientes. El consumo pico de oxígeno aumentó en 2.2 ± 5.2 ml/kg/min (p < 0.001), la RFC se incrementó 1.6 ± 10 lpm (p < 0.05) y mejoró la RVO2 −21 ± 98 seg (p < 0.001). En el análisis post-hoc se observó que el porcentaje de la frecuencia cardiaca máxima se mantuvo asociado con el incremento de la RFC. Por otra parte, la diabetes y el sedentarismo estuvieron fuertemente asociados con la mejora de la RVO2. No se observó correlación entre RFC y RVO2 (R2 = 0.002). Conclusiones: El ejercicio físico se asoció con un efecto benéfico sobre la RFC y la RVO2. Sin embargo, ambas variables no se relacionaron estadísticamente.