Rendimiento y seguridad de las colonoscopías de screening en dos grupos etarios de pacientes de la tercera edad / Yield and safety of screening colonoscopy in two age groups of elderly

Objetivo: Comparar el rendimiento y seguridad de las colonoscopías de screening en el diagnóstico del cáncer colorrectal en dos grupos de pacientes añosos. Materiales y Método: Un análisis retrospectivo de pacientes sometidos a colonoscopías de screening en Clínica INDISA, desde noviembre de 2017 hasta marzo de 2019. Se excluyeron pacientes con síntomas de alarma según criterios de Roma IV, colonoscopías de urgencia y terapéuticas. Se compararon 2 grupos de pacientes: Grupo I entre 70-79 años y Grupo II mayores de 80 años. El objetivo primario fue el rendimiento diagnóstico de la colonoscopía de screening, definida como su capacidad para identificar hallazgos significativos definidos como la presencia de adenomas, displasia de alto grado y cáncer colorrectal. Los resultados secundarios consideraron la morbilidad y mortalidad del procedimiento. Análisis estadístico descriptivo e inferencial. Resultados: Un total de 125 pacientes cumplieron con los criterios de inclusión; Grupo I: 70 pacientes y Grupo II: 55 pacientes. Los hallazgos significativos se presentaron en un 27,1% en el Grupo I y en 30,9% en el Grupo II (p = 0,675). No se observaron diferencias en la calidad de la preparación intestinal o las complicaciones relacionadas con el procedimiento. Discusión y Conclusión: Las colonoscopías de screening en el diagnóstico de cáncer colorrectal son bien toleradas en pacientes mayores de 80 años, con un rendimiento equivalente en comparación al grupo más joven. Dado el aumento de la esperanza de vida, se recomienda realizar colonoscopías en octogenarios, especialmente en aquellos con buen estado de salud.

Aim: To compare diagnostic yield of significant findings rate and safety of screening colonoscopies in two groups of elderly patients. Materials and Method: A retrospective analysis was performed on patients who underwent screening colonoscopies at INDISA Clinic, from November 2017 to March 2019. Exclusion criteria were those with "alarm" symptoms according to Rome IV criteria, emergencies and therapeutic colonoscopies were excluded. Comparison groups were patients between 70-79 years old (Grupo I), and those over 80 years old (Grupo II). The primary outcome was the diagnostic yield of screening colonoscopy, defined as its capacity to identify adenomas, high-grade dysplasia, and colorectal cancer. Secondary outcomes were morbidity and mortality of the procedure. Statistical analysis was descriptive and inferential. Results: A total of 125 patients met our inclusion criteria; Grupo I: 70 and Grupo II 55 patients. Significant findings were observed in 27.1% in Grupo I and 30.9% in Grupo II (p = 0.675). No differences in bowel prep quality or procedure-related complications were observed between both groups. Discussion and Conclusion: Screening colonoscopies for colorectal cancer are well tolerated in patients over 80 years of age, with equivalent diagnostic rates compared with the younger patient group. Given the increasing life expectancy worldwide, it is recommended to continue checking for colorectal cancer with screening colonoscopies in octogenarians, particularly healthy ones.

Analysis of dynamic networks based on the Ising model for the case of study of co-authorship of scientific articles.

Two computational methods based on the Ising model were implemented for studying temporal dynamic in co-authorship networks: an interpretative for real networks and another for simulation via Monte Carlo. The objective of simulation networks is to evaluate if the Ising model describes in similar way the dynamic of the network and of the magnetic system, so that it can be found a generalized explanation to the behaviours observed in real networks. The scientific papers used for building the real networks were acquired from WoS core collection. The variables for each record took into account bibliographic references. The search equation for each network considered specific topics trying to obtain an advanced temporal evolution in terms of the addition of new nodes; that means 3 steps, a time to reach the interest of the scientific community, a gradual increase until reaching a peak and finally, a decreasing trend by losing of novelty. It is possible to conclude that both methods are consistent with each other, showing that the Ising model can predict behaviours such as the number and size of communities (or domains) according to the temporal distribution of new nodes.

SEOM Clinical Guideline of management of soft-tissue sarcoma (2020).

Soft-tissue sarcomas constitute an uncommon and heterogeneous group of tumors of mesenchymal origin. Diagnosis, treatment, and management should be performed by an expert multidisciplinary team. MRI/CT of the primary tumor and biopsy is mandatory before any treatment. Wide surgical resection with tumor-free tissue margin is the mainstay for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not suitable for re-excision. Perioperative chemotherapy should be discussed for high-risk sarcomas of the extremities and trunk-wall. In the case of oligometastatic disease, patients should be considered for local therapies. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. Other drugs have shown activity in second-line therapy and in specific histological subtypes but options are limited and thus, a clinical trial should always be discussed.

Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence.

Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions.

Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience.

BACKGROUND: Cancer and cancer therapies have been associated with an increased incidence of venous thromboembolic events (VTE). However, the incidence of VTE in patients on immunotherapy has not been well characterized. The aim of this study was to assess the incidence of VTE in cancer patients receiving immunotherapy and ascertain its prognostic utility. MATERIALS AND METHODS: We conducted a single-institution retrospective study, including all cancer patients treated with anti-Programmed cell Death 1 (PD-1), anti-Programmed cell Death Ligand-1 (PD-L1), anti-Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA4), a combination of anti-PD-1/anti-PD-L1 and anti-CTLA4 or a combination including any of these drugs with chemotherapy, antiangiogenic agents or both between June 2013 and April 2019 at La Paz University Hospital, Madrid (Spain). RESULTS: We selected 229 patients. VTE occurred in 16 of 229 patients (7%). VTE occurred more frequently in patients with lung cancer followed by melanoma. Female sex and melanoma were independently associated with an increased risk of VTE. 12 of 16 VTE (75%) were symptomatic. Progressive disease to immunotherapy [HR 31.60 (95% CI 11.44-87.22), p = 0.00], lung cancer [HR 2.55 (95% CI 1.34-4.86), p = 0.00] and melanoma [HR 2.42 (1.20-4.86), p = 0.01] were independently associated with shorter OS. VTE occurrence was not independently associated with shorter OS [HR 1.33 (95% CI 0.63-2.80), p = 0.44]. CONCLUSIONS: The incidence of VTE in cancer patients receiving immunotherapy in our study appeared to be similar to the incidence previously reported in other series of cancer patients treated with systemic therapies. VTE occurrence did not correlate with the prognosis. Further and prospective studies are needed to derive definitive conclusions.

Prognostic value of neutrophil-to-lymphocyte ratio and other inflammatory markers in patients with high-risk soft tissue sarcomas.

BACKGROUND: Soft tissue sarcomas (STS) have a high risk of relapse in spite of the use of (neo)adjuvant chemotherapy. In this context, looking for new prognostic biomarkers is an interesting field of research. Our aim is to analyze the prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and other serum markers in patients with STS who received chemotherapy with curative intent. MATERIALS AND METHODS: This is a retrospective observational study. We included all patients with STS (primary tumor, local recurrence or resected metastatic disease) treated with high-dose ifosfamide and epirubicin with curative intent from January 2007 to December 2018. The pretreatment NLR and other serum markers were calculated, selecting the median as the cut-off value for the survival and multivariate analysis. RESULTS: Seventy-nine patients were included. Median NLR, platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) were 2.83, 174.05 and 3.25, respectively. Median progression-free survival (PFS) was significantly longer in patients with low NLR [not reached (NR) vs 21, 92 months, P < 0.01]. No significant differences were found for PFS regarding PLR or LMR. For overall survival (OS), a significant survival advantage was also found for patients with low NLR (NR vs 65.45 months, P = 0.01), without differences for PLR or LMR. In multivariate analysis, NLR remains an independent prognostic factor for PFS. CONCLUSION: In our cohort, low NLR was significantly associated with a longer PFS and OS, and is consolidated as an independent prognostic factor.

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019).

In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

Gastrointestinal stromal tumors (GISTs): SEAP-SEOM consensus on pathologic and molecular diagnosis.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive tract, with an incidence of 1.1 cases/100,000 inhabitants/year. A group of experts from the Spanish Society of Pathology and the Spanish Society of Oncology met to discuss a brief update on GISTs and agree on aspects relating to the pathological and molecular diagnosis of these tumors. GISTs are generally solitary, well-circumscribed lesions of variable size (<10 mm-35 cm) that may present with intra- or extra-luminal parietal growth or a mixed-type (hourglass) growth pattern. Histologically, they are unencapsulated neoplasms displaying expansive growth and spindle-shaped (70%), epithelioid (20%), or mixed cellularity (10%). Mitotic activity is generally moderate or low and should be evaluated only in areas with high cellularity or higher mitotic frequency. The great majority of GISTs harbour mutually exclusive activating mutations in genes coding for the type III receptor tyrosine kinases KIT and PDGFRA; less commonly, GISTs have also been reported to display mutations elsewhere, including BRAF and NF1 and SDH-complex genes. The method most widely used to detect KIT and PDGFRA mutations is amplification of the exons involved by polymerase chain reaction followed by direct sequencing (Sanger method) of these amplification products. Molecular analyses should always specify the type of analysis performed, the region or mutations evaluated, and the sensitivity of the detection method employed.

Diagnóstico de situación del puerperio reciente y la prestación de anticoncepción en pacientes con screening de drogas positivo en un hospital regional, entre junio 2015 a agosto 2016 / Situation diagnosis of recent puerperio and contraception patients with positive drug screening, in a regional hospital, between june 2015 and august 2016

El consumo de sustancias ilícitas y de alcohol durante el embarazo constituye un problema de salud pública grave, que incide en el aumento de la morbi-mortalidad materno-fetal, el síndrome de abstinencia neonatal e institucionalización de los menores. El puerperio de estas mujeres presenta otros desafíos, siendo uno de ellos el control de su fertilidad posterior dado la menor adherencia al uso de métodos de anticoncepción (MAC) versus la población general. OBJETIVO: Conocer sobre la indicación de métodos anticonceptivos en puérperas con consumo problemático de drogas durante el embarazo, atendidas en el Hospital Dr.Gustavo Fricke, de Viña del Mar. MÉTODO: Se realizó un estudio observacional retrospectivo de los registros médicos de todas las pacientes con test de drogas positivo en orina de la Unidad de Puerperio del Servicio de Ginecología y Obstetricia cuyo parto ocurrió entre Junio del 2015 y Agosto del 2016...

The consumption of illicit substances and alcohol during pregnancy is a serious public health problem, given the increase in maternal-fetal morbidity and mortality, neonatal abstinence syndrome and institutionalization of minors. In turn, the postpartum period of these women presents other challenges, one of which is the control of their subsequent fertility given the lower adherence to the use of contraception methods (MAC) versus the general population. OBJECTIVE: Get to know the indication of contraceptive methods in postpartum women with problematic drug use during pregnancy, treated at the Dr. Gustavo Fricke Hospital, in Viña del Mar. METHOD: A retrospective observational study of the medical records of all patients with a positive urine drug test was performed at the Puerperium Unit of the Gynecology and Obstetrics Service whose delivery occurred between June 2015 and August 2016...

[Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial]. / Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO).

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO) / Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Oncoplastic breast surgery: initial experience at the Centro Clinico de Estereotaxia-CECLINES, Caracas, Venezuela.

BACKGROUND: Breast-conserving surgery (BCS) may sometimes lead to deformities in the remaining breast. Oncoplastic surgery (OPS) aims to improve our aesthetic results even in the case of major volume resections. The purpose of this study is to provide an objective evaluation of our initial experience with OPS, mainly based on the levels of satisfaction reported by both patients and surgeons. PATIENTS AND METHODS: This prospective study was performed at CECLINES in Caracas, Venezuela, between January 2011 and October 2012. It involved 107 consecutive patients in two groups: 52 patients with level II OPS versus 55 patients with 'standard' BCS (SBCS). We evaluated the level of satisfaction and cosmetic outcome at 6 and 12 months post-operation using a score from 1 (bad) to 5 (excellent). The cosmetic score was recorded during the follow-up by the surgeon, by phone calls, and photographs were reviewed by a panel of four observers. RESULTS: The participation rate in the cosmetic outcome/level of satisfaction evaluation was 100% at 6 months and 96.2% at 12 months. The average tumour size was 23 mm [standard deviation (SD): 13.5] for the OPS group versus 17.6 mm (SD: 8.3) for the SBCS group (p = 0.017). The average weight for the surgical specimen was 101 g (range: 30-512 g) in the OPS group versus 60.4 g (range: 20-135 g) in the SBCS group (p = 0.004). The OPS techniques most performed were round block 40.3% (21/52), inverted T mammoplasty 26.8% (14/52) and vertical scar mammoplasty 15.3% (8/52). Of all the patients, 51.9% (27/52) had symmetrisation procedures performed distributed according to the period of the study: 77.2% (17/22) in 2011, 56.6% (17/30) in 2012, and 18.1% (6/33) in 2013. The rate of complications was 5.7% (3/52) in the OPS group and 0% for the SBCS group (p < 0.005). The average cosmetic score at 6 months by patients in the OPS group was 4.4; patient satisfaction scores of 4 (good) and 5 (excellent) were 88.4%. In the SBCS group at 6 months, the mean score reported by patients was 4.2, with scores 4-5 being 83.4% (p = 0.644). The cosmetic score by surgeons in the OPS group at 6 months was 4.5; the surgeon satisfaction scores of 4-5 were 94.2%. In the SBCS group, the surgeons' mean score at 6 months was 4.1, with 84.5% of scores being 4 or 5 (p < 0.005). The final cosmetic score by patients in the OPS group at 12 months was 4.5; patient satisfaction scores of 4-5 were 90.4%. In the SBCS group, the final mean score at 12 months by patients was 4.2, with 77.5% of scores being 4 or 5 (p < 0.005). The final cosmetic score by surgeons in the OPS group at 12 months was 4.5; surgeon satisfaction scores of 4-5 were 92.3%. In the SBCS group, the surgeons' final mean score at 12 months was 4.1, with 84.5% of scores being 4 or 5 (p < 0.005). CONCLUSIONS: OPS provides good satisfaction rates. An SBCS when an OPS is not indicated mostly results in good satisfaction levels and cosmetic scores. Usually, the results remain stable after 6 months. The use of OPS allows the excision of bigger lesions and surgical specimens. Symmetrisation procedures are not always required. With the appropriate patient selection, the rate of complications is low for both OPS and SBCS.

Effects of sampling completeness on the structure of plant-pollinator networks.

Plant-animal interaction networks provide important information on community organization. One of the most critical assumptions of network analysis is that the observed interaction patterns constitute an adequate sample of the set of interactions present in plant-animal communities. In spite of its importance, few studies have evaluated this assumption, and in consequence, there is no consensus on the sensitivity of network metrics to sampling methodological shortcomings. In this study we examined how variation in sampling completeness influences the estimation of six network metrics frequently used in the literature (connectance, nestedness, modularity, robustness to species loss, path length, and centralization). We analyzed data of 186 flowering plants and 336 pollinator species in 10 networks from a forest-fragmented system in central Chile. Using species-based accumulation curves, we estimated the deviation of network metrics in undersampled communities with respect to exhaustively sampled communities and the effect of network size and sampling evenness on network metrics. Our results indicate that: (1) most metrics were affected by sampling completeness but differed in their sensitivity to sampling effort; (2) nestedness, modularity, and robustness to species loss were less influenced by insufficient sampling than connectance, path length, and centralization; (3) robustness was mildly influenced by sampling evenness. These results caution studies that summarize information from databases with high, or unknown, heterogeneity in sampling effort per species and should stimulate researchers to report sampling intensity to standardize its effects in the search for broad patterns in plant-pollinator networks.

Estenosis acueductal en acondroplasia: a propósito de un caso / Aqueductal stenosis in achondroplasia: report of a case

Achondroplasia is the most frequent cause of disproportionate short stature. Characterized by abnormal growth of long bones, it renders a short-limbed individual of normal intelligence. A serious potential complication is spinal compression, which can happen at any level but is particularly common at the craniocervical junction. It can cause important morbility during the first few years of life, including sudden death. We present a 22-month-old patient diagnosed with achondroplasia, who developed aqueductal stenosis with symptomatic spinal cord compression, diagnosed during a routine consultation, requiring decompressive surgery with excellent results.

La acondroplasia es la condición asociada a talla baja desproporcionada más frecuente, caracterizada por un crecimiento óseo anormal, que resulta en talla baja con extremidades cortas e inteligencia normal. Una de las complicaciones más habituales es la compresión medular, que puede ocurrir a cualquier nivel, siendo más frecuente en la unión cráneo cervical, generando alta morbimortalidad en los primeros años de vida, principalmente por muerte súbita. Presentamos una paciente de 1 año 10 meses con diagnóstico precoz de acondroplasia, que presentó en su evolución estenosis acueductal con compresión medular, sintomática, pesquisada en control rutinario, que requirió cirugía descompresiva con buena evolución posterior.

Enfermedades raquimedulares congénitas en Teletón Santiago: factores demográficos, sociales, clínicos y funcionales asociados / Congenital spine pathologies in Teleton Santiago: associated demographic factors, social, clinical and functional

Introduction: In our country there is no information on factors related to independence and participation in children with congenital spine pathology. Objective: To describe the demographic, clinical, social and functional characteristics of patients aged 2 to 18 years with neural tube defects, explore the association between age and neurological level and compare with international literature. Materials and Methods: This is a retrospective descriptive study were we review the clinical protocolized evaluation forms from the Integral Spine Polyclinic of Teletón Santiago Institute, from children seen between March 2008 and March 2009. 255 individuals with chronic spine pathology met the inclusion criteria. The data was processed using SPSS version 17.0. Association tests were applied between variables based on a x2 distribution with p < 0.05. Results: Of the 255 patients studied, 92 percent of the patients had myelomeningocele, 50 percent of them with a thoracic level; 58 percent were women; 49 percent were in the group of 8-13 years; 82.4 percent attended school. Thirty three percent of them were obese; 89 percent used intermittent bladder catheterization and 77 percent achieve regular bowel movements; 60-80 percent were independent in feeding and minor hygiene, but less than 40 percent were independent in dressing, bathing and transfers; 62 percent used a wheelchair, 50 percent did not leave their home alone and 30.6 percent did not have any participation in household tasks. Conclusion: Demographic profile similar to patients with the same disease and age in other countries, high neurological level prevalence, obesity tendency in the group from 2-7 years, poor independence in more complex daily life activities and social participation.

Introducción: En el país se carece de información sobre factores relacionados con independencia, participación en el hogar y comunidad, en niños con patología raquimedular congénita. Objetivo: Describir las características demográficas, clínicas funcionales y sociales de pacientes entre 2 y 18 años con mielodisplasia y explorar asociación con edad y nivel neurológico. Materiales y Método: Estudio descriptivo transversal, mediante revisión de formularios de evaluación clínica protocolizados del Policlínico Integral Raquimedular de Instituto Teletón Chile, de niños atendidos entre marzo 2008 y marzo 2009. Doscientos cincuenta y cinco individuos con patología raquimedular cumplieron con requisitos de inclusión. Los datos se procesaron con SPSS versión 17.0. Se aplicaron pruebas de asociación entre variables basado en distribución X2 con p < 0,05. Resultados: De los 255 pacientes estudiados, 92 por ciento eran portadores de mielomeningocele siendo el 50 por ciento clasificados en nivel torácico; 58 por ciento fueron mujeres; 49 por ciento en el grupo de 8-13 años, el 82,4 por ciento asistía al colegio. El 33 por ciento era obeso; 89 por ciento usaba cateterización intermitente y 77 por ciento tenía ritmo intestinal normal; 60-80 por ciento eran independientes en alimentación e higiene menor, pero menos del 40 por ciento eran independientes en vestuario, baño y transferencias, el 62 por ciento usaba silla de ruedas, el 50 por ciento no salía sólo de su casa y el 30,6 por ciento no tenía tareas en el hogar. Conclusión: Perfil demográfico similar a pacientes con igual patología y edad en otros países; nivel neurológico alto, mayor a lo habitual; la independencia en actividades diarias y participación en el hogar y comunidad, fueron bajas en esta población.

Primer implante de electrodo de estimulación selectiva del haz de His en Colombia. Reporte de dos casos / First implantation of selective his bundle pacing in Colombia. Report of two cases

Se conoce que la estimulación en el ápex del ventrículo derecho produce disincronía ventricular y muchas veces los pacientes desarrollan miocardiopatía dilatada, lo que ha llevado a realizar una estimulación más fisiológica. Con el reciente desarrollo tecnológico de los electrodos para la estimulación selectiva del haz de His (fisiológica), se quiere mostrar la experiencia en el implante de este tipo de electrodos en los dos primeros casos del servicio de electrofisiología de la Clínica Medellín.

Pacing in the right ventricular apex is known to produce ventricular dysynchrony and patients often develop dilated cardiomiopathy. For this reason, a more physiological stimulation has been performed. With the recent technological development of electrodes for selective stimulation of the His bundle, we want to show the experience of this type of implantation in the first two cases made in the electrophysiology laboratory in Medellin

Síndrome de QT prolongado congénito y embarazo: reporte de dos casos / Congenital long QT syndrome and pregnancy: report of two cases

El síndrome de QT prolongado congénito, es una entidad clínica que se caracteriza por la alteración en la repolarización miocárdica dada por una prolongación significativa del intervalo QT con riesgo aumentado de síncope, taquicardia ventricular polimórfica y muerte súbita. Se produce por la alteración en la función de canales iónicos responsables del potencial de acción de las células cardíacas, como consecuencia de múltiples mutaciones, de las cuales las más frecuentes se dan en los canales de sodio y potasio. La relación con el embarazo y principalmente la presencia de eventos en el posparto, está determinada por arritmias ventriculares o episodios de muerte súbita, lo cual debe llevar a una evaluación exhaustiva de QTc prolongado y sus factores desencadenantes o enfermedades concomitantes. Se muestran los casos clínicos de dos pacientes que presentaron muerte súbita en el posparto en las cuales se diagnosticó síndrome de QT largo congénito.

Congenital long QT syndrome is a clinical entity characterized by impairment of myocardial repolarization given by significant prolongation of the corrected QT interval with an increased risk of syncope, polymorphic ventricular tachycardia and sudden death. This is produced by an alteration in the function of ion channels responsible for the action potential of cardiac cells as a consequence of multiple mutations, the most common of which are in the sodium and potassium channels. The relationship with pregnancy and especially the presence of events in the postpartum period is clearly determined by the presence of ventricular arrhythmias or episodes of sudden death, that should lead to a thorough evaluation of prolonged QTc and its triggers or concomitant diseases. We present the clinical records of two patients who had sudden death during the postpartum and were diagnosed as congenital long QT Syndrome.

[Hamburger consumption patterns and exposure assessment for verocytotoxigenic Escherichia coli (VTEC): simulation model]. / Hábitos de consumo de hamburguesas y riesgo de exposición a Escherichia coli verotoxigénica (VTEC): modelo de simulación.

A quantitative risk assessment was developed for verocytotoxigenic Escherichia coli (VTEC) associated with hamburger consumption. The assessment (simulation model) considers the distribution, storage and consumption patterns of hamburgers. The prevalence and concentration of VTEC were modelled at various stages along the agri-food beef production system using input derived from Argentinean data, whenever possible. The model predicted an infection risk of 4.45 x 10(-4) per meal for adults. The risk values obtained for children were 2.6 x 10(-4), 1.38 x 10(-5) and 4.54 x 10(-7) for infection, Hemolytic Uremic Syndrome (HUS) and mortality, respectively. The risk of infection and HUS was positively correlated with bacterial concentration in meat (r = 0.664). There was a negative association between homemade hamburgers (r = -0.116) and the risk of illness; however this association has been considered due to differences between retail and domiciliary storage systems (r = -0.567) and not because of the intrinsic characteristics of the product. The most sensitive points of the production system were identified through the risk assessment, therefore, these can be utilized as a basis to apply different risk management policies in public health.