Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia.

Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.

Sexual steroid hormone receptors profiles of ovarian carcinoma in Mexican women.

The significance of the presence of androgen receptor (AR), estrogen receptor alpha (ER) and progesterone receptor (PR) in ovarian cancer patient survival has been a matter of numerous studies. This study was aimed to describe the expression profile of the three sexual steroid receptors in high-grade serous, endometrioid, mucinous and low-grade serous ovarian carcinoma and its association to the proliferation index in patients with primary ovarian carcinoma diagnosis, before any treatment. Eighty-one samples were obtained from the National Institute of Cancerology in Mexico City and were evaluated for the presence of AR, ER, PR and Ki67 by immunohistochemistry. The four subtypes of ovarian carcinoma displays a specific profile of the eight possible combinations of the steroid receptors with significant differences within the profile and the histological subtypes. High-grade serous carcinoma was characterized by a high frequency of both, triple-negative and AR+ ER- PR+ profiles. Endometrioid carcinoma presented a higher frequency of triple-positive profile. The presence of only AR+ profile was not observed in the endometrioid tumors. The relationship of the receptor profile with the proliferation index in the tumor epithelium shows that the expression of only ER is associated to a reduced proliferation index in endometrioid carcinoma. Steroid hormone receptor expression and co-expression could help characterize ovarian carcinoma.

Hemoglobina glicosilada y su relación con la fracción de eyección del ventriculo izquierdo en pacientes diabéticos tipo 2 y un primer infarto agudo de miocardio / Relationship between glycated haemoglobin and left ventricule ejection fraction in diabetes type 2 patients on their first acute myocardial infarction / Relação da hemoglobina glicada com a fração de ejeção do ventrículo esquerdo em pacientes diabéticos tipo 2 e um primeiro infarto agudo do miocárdio

Introducción: Dentro del espectro de las enfermedades cardiovasculares, la enfermedad isquémica del corazón se encuentra dentro de las dos patologías con mayor tasa de discapacidad y mortalidad. La Diabetes Mellitus tipo 2 es uno de los factores asociados a peor pronóstico en sujetos con esta enfermedad. Hoy en día se conoce que sobre el miocardio en isquemia, la hiperglicemia aumenta el estrés oxidativo, la hipoxia y por ende su necrosis. Objetivo: Establecer si existe una relación entre los niveles de hemoglobina glicosilada de pacientes diabéticos tipo 2 con un primer infarto agudo de miocardio y la función del ventrículo izquierdo intrahospitalaria, medida por la fracción de eyección. Materiales y Métodos: Estudio observacional en el que se realizó la caracterización de 36 pacientes con diabetes mellitus tipo 2 y un primer episodio de IAM hospitalizados en el Hospital Militar Central. Resultados: Con el test de exactitud de Fischer se obtuvo que los pacientes diabéticos tipo 2 con primer infarto agudo de miocardio y valores de hemoglobina glicosilada por encima de 8,5% presentaron una tendencia a tener fracciones de eyección por debajo de 50% (P= 0,019). Conclusiones: Se necesitan más estudios en los que se evalúen poblaciones más grandes de pacientes para lograr representar todo el espectro de valores de hemoglobina glicosilada y con ello, establecer un punto de corte más exacto a partir del cual sea válido sospechar una disminución de la función ventricular izquierda en el escenario de diabetes mellitus tipo 2 y un primer infarto agudo de miocardio.

Introduction: In the wide range of cardiovascular disease, ischemic heart disease is one of the mayor two pathologies that contribute with the greater disability and mortality rates. Type 2 Diabetes Mellitus is known to be one of the mayor risk factors associated with a worst prognosis among subjects who suffer from ischemic heart disease. Hyperglycemia augments oxidative stress in the ischemic myocardium and thus the hypoxemia and extent of necrosis. Objective: To establish if there is a relationship between glycosylated hemoglobin levels and admissions left ventricular function, measured by ejection fraction, in type 2 diabetic patients suffering from a first acute myocardial infarction. Materials and Methods: Observational study in which we characterized 36 type 2 diabetic patients suffering from a first acute myocardial infarction, hospitalized in The Hospital Militar Central. Results: Using Fischer’s exact test we found that that type 2 diabetics suffering from a first acute myocardial infarction and with glycosylated hemoglobin levels above 8.5% had a tendency to present an ejection fraction below 50% (P= 0.019). Conclusions: Larger studies are needed in order to include all the possible values of glycosylated hemoglobin, so a more accurate cut off point from which a valid suspicion of deteriorated left ventricular function can be made, in the setting of type 2 diabetics with a first acute myocardial infarction.

Introdução: Das doenças cardiovasculares, a doença isquêmica do coração e uma das duas patologias com maior taxa de discapacidade e mortalidade. A Diabetes Mellitus tipo 2 é um dos fatores associados ao pior prognóstico em pessoas com esta doença. Atualmente é conhecido que a hiperglicemia aumenta o estresse oxidativo, a hipóxia e a necroses no miocárdio isquêmico. Objetivo: Estabelecer se existe uma relação entre os níveis de hemoglobina glicada de pacientes diabéticos tipo 2 com um primeiro infarto agudo do miocárdio (IAM) e a função do ventrículo esquerdo, segundo a fração de ejeção. Materiais e Métodos: Estudo observacional, no qual foi feita a caracterização de 36 pacientes com Diabetes Mellitus tipo 2 e um primeiro IAM, hospitalizados no Hospital Militar Central. Resultados: Com o teste de Fischer, obteve-se uma tendência a frações de ejeção abaixo do 50% nos pacientes diabéticos tipo 2 com um primeiro IAM, e níveis de hemoglobina glicada acima de 8,5% (P= 0,019). Conclusões: Precisam-se mais estudos que avaliem um maior número de pacientes, com o fim de representar tudo o espetro de valores da hemoglobina glicada, estabelecendo um ponto de corte mais exato a partir do qual se possa suspeitar uma diminuição da função ventricular esquerda nos pacientes com diabetes mellitus tipo 2 e um primeiro IAM.

Estrogen and androgen receptor expression in surface epithelium and inclusion cyst in the ovary of premenopausal and postmenopausal women.

BACKGROUND: The importance of surface epithelium and epithelial inclusion cysts in the ovary arises from studies demonstrating that these structures are susceptible to epithelial ovarian cancer development. The expression of estrogen receptor alpha (ER alpha), androgen receptor (AR), in epithelial cells of the ovary from premenopausal and postmenopausal women is interesting because sexual steroid hormones are involved in cell growth and differentiation. METHODS: The presence of ER alpha, AR, and the orphan G protein-coupled receptor 30 (GPR30) was demonstrated by immunofluorescence in ovaries obtained from 79 pre and postmenopausal patients, undergoing histero-salpingo-oophorectomy for proliferative gynecological diseases. The proportion of patients that displayed positive reaction for estrogen and androgen receptors in epithelial cells of the ovary was evaluated according to menopausal status and associated pathology. RESULTS: The proportion of patients that displayed a positive receptor expression in the epithelial cells of the ovarian surface and cortical inclusion cysts shows that ER alpha is present in 20 of 79 patients (0.25), AR in 33 of 79 (0.42) and GPR30 in 38 of 55 (0.69). There are no differences in ER alpha, AR, and GPR30 expression between pre and postmenopausal patients and considering the associated pathology, proportions for ER alpha and GPR30 are similar. The patients with cervical cancer show a higher proportion of AR expression in epithelial cells of the ovary, which is statistically significant (P < 0.01) compared with patients with other proliferative diseases. CONCLUSIONS: The presence of ER alpha, AR, and GPR30 in the surface epithelial ovarian cells and its derivatives are observed with a proportion that is specific for each receptor. The proportion of expression for these receptors in the epithelial cells of the ovary does not change after menopause. The proportion of ovaries with AR positive epithelial cells in patients with cervical squamous carcinoma is higher compared with other gynecological pathologies.

Liderazgo en grupos de trabajo enfermeros. Percepciones / Leadership in Nursing Working Groups. Perceptions

Objetivos. Conocer la conducta de liderazgo que perciben los presidentes de los grupos de trabajo y sus colaboradores. Analizar los estilos de liderazgo comparando las conductas percibidas. Método. Estudio descriptivo transversal. Población: presidentes de los grupos de trabajo y miembros de éstos. Instrumento: cuestionario compuesto por 82 ítems con 5 opciones de respuesta. Variables analizadas: conductas del líder, estilos de liderazgo, esfuerzo extra, efectividad y satisfacción. Resultados. En el grupo de investigación el estilo más identificado por los miembros del grupo fue el transformacional y el más identificado por el líder fue el transaccional. En el grupo de protocolos el liderazgo más identificado por ambos fue el transformacional. En el grupo de calidad no se identificó claramente ningún tipo de liderazgo. En los 3 grupos los porcentajes que determinan el esfuerzo extra, la efectividad y la satisfacción fueron muy elevados. Discusión. Es importante prestar atención a los estilos de liderazgo de los diferentes gestores de unidades o de grupos, dado que es un elemento dinamizador importante en las organizaciones(AU)

Aims.To identify leadership behavior as perceived by the heads and members of working groups and to analyze leadership styles by comparing the perceived behaviors. Method. Cross sectional study. Population: heads and members of working groups. Instrument: 82-item questionnaire with 5 possible responses. Variables analyzed: behaviors of the heads, leadership styles, extra effort, effectiveness and satisfaction. Results. In the investigation group, the style most frequently identified by the group's members was the transformational style and that identified by the head was the transactional style. In the protocol group, the leadership style most frequently identified by both the head and members was the transformational style. In the quality group, no type of leadership was clearly identified. In the three groups, the percentages identifying extra effort, effectiveness and satisfaction were very high. Discussion. Paying attention to the leadership style of the managers of units or groups is important, since this factor is a strong dynamic element in organizations(AU)

[Leadership in nursing working groups. Perceptions]. / Liderazgo en grupos de trabajo enfermeros. Percepciones.

AIMS: To identify leadership behavior as perceived by the heads and members of working groups and to analyze leadership styles by comparing the perceived behaviors. METHOD: Cross sectional study. POPULATION: heads and members of working groups. INSTRUMENT: 82-item questionnaire with 5 possible responses. Variables analyzed: behaviors of the heads, leadership styles, extra effort, effectiveness and satisfaction. RESULTS: In the investigation group, the style most frequently identified by the group's members was the transformational style and that identified by the head was the transactional style. In the protocol group, the leadership style most frequently identified by both the head and members was the transformational style. In the quality group, no type of leadership was clearly identified. In the three groups, the percentages identifying extra effort, effectiveness and satisfaction were very high. DISCUSSION: Paying attention to the leadership style of the managers of units or groups is important, since this factor is a strong dynamic element in organizations.

Calidad del sueño, dolor y depresión en fibromialgia / Sleep quality, pain and depression in fibromyalgia

Objetivo:El objetivo de este trabajo fue valorar la relación entre eltrastorno depresivo, las alteraciones del sueño y su influenciacon el dolor en pacientes con fibromialgia.Material y métodos:Se ha estudiado una muestra de 31 pacientes diagnosticadosde fibromialgia según los criterios del Colegio Americanode Reumatología y 29 controles con características demográficas semejantes. Ambos grupos cumplimentaronla subescala del sueño del Multiphasic Personality Inventory(MMPI), el cuestionario para depresión de Beck (BDI),y se les realizó una valoración del umbral doloroso mediantealgómetro manual tanto en puntos que definen la enfermedadcomo en puntos control. Los resultados obtenidosfueron procesados mediante el programa SPSS V8. Se estimaronlas medias y las medidas de dispersión para ambosgrupos. La significación estadística de las diferencias fueestimada mediante tests paramétricos, dada la normalidadde las poblaciones; utilizándose como medida de asociaciónla regresión lineal y la regresión múltiple ajustada paralas variables continuas del estudio. La linealidad de las determinacionesvinculadas al tiempo de evolución se estimaronmediante el test de Levene.Resultados:Destacan como resultados más importantes las diferenciasen las alteraciones del sueño total (p < 0,001), y sus escalas,con excepción del sonambulismo y ciclo. La sintomatologíadepresiva valorada mediante el test BDI mostródiferencias entre casos y controles (p < 0,001), constatándoseen los pacientes un crecimiento lineal de las mediasasociadas al tiempo de evolución. El umbral doloroso resultóigualmente desproporcionado a favor de los casos frentea los controles (p < 0,001) en todos los puntos explorados.El análisis de regresión múltiple ajustada de estas variablesevidencia un efecto sinérgico entre dolor, alteracionesdel sueño y escala BDI mostrando un r2 ajustado de 0,834(p < 0,001) lo que establece según nuestra opinión una fuerteasociación entre la fibromialgia y un halo de síntomas quecondicionan sin duda la calidad de vida de los pacientes.Discusión:La sintomatología relacionada con el sueño se considerala segunda en importancia en este síndrome. Las alteracionesdel sueño y la depresión acompañarían al dolor, empeorandomás la calidad de vida de los pacientes. Cabe señalar,como aportación de nuestro estudio, que este complejosintomático se desarrolla a lo largo del tiempo, por lo queconsideramos de gran interés que la valoración individualde cada síntoma mediante instrumentos específicos se realicedesde el inicio del proceso

Objective:The aim of this study was to assess the relationship betweenthe depressive disorder, sleep disorders and their influenceon pain in patients with fibromyalgia.Material and methods:A population of 31 patients diagnosed of fibromyalgia accordingto the criteria of the American College of Rheumatologyand 29 controls with similar demographic characteristicswere studied. Both groups completed the sleep sub-scaleof the Multiphasic Personality Inventory (MMPI) and theBeck´s Depression Inventory (BDI) and underwent an assessmentof pain threshold with a hand-held algometer both indisease-defining points and in control points. Findings wereprocessed using the SPSS V8 software. Means and dispersionmeasurements were estimated for both groups. The statisticalsignificance of the differences found was estimatedthrough parametric tests, given the normal distribution ofthe populations. Lineal regression and multiple regressionadjusted for the continuous study variables were used tomeasure association. Linearity of determinations linked totime of evolution was estimated using the Levene test.Results:The most relevant results were the differences found intotal sleep disorders (p < 0.001) and its sub-scales, withthe exception of sleepwalking and cycle. Depressive symptomatologyassessed using the BDI test showed differencesbetween cases and controls (p < 0.001), confirming in thepatients a linear growth of the measures associated to timeof evolution. Pain Threshold was also significantly higherin cases versus controls (p < 0.001) at all time points examined.Adjusted multiple regression analysis of these variablessuggested a synergic effect between pain, sleep disordersand BDI score, with an adjusted r2 close associationbetween fibromyalgia and several symptoms that certainlyaffect the quality of life of patients.Discussion:Sleep-associated symptoms are considered the secondin relevance in this syndrome. Sleep disorders and depressionseem to accompany pain, further worsening the qualityof life of these patients. It must be stressed, as the contributionof our study, that this symptomatology evolveswith time, so we consider very important to perform an individualassessment of each symptom using specific toolssince the beginning of the process

La citología nasal en rinitis crónica como predictor de sinusitis paranasal / Nasal cytology in chronica rhinitis as a predicitive factor of paranasal sinusitis

Con el objeto de determinar si la citología nasal en niños con rinitis crónica tiene relación con sinusitis paranasal, se hizo un estudio prospectivo, descriptivo y comparativo en 48 niños entre 9 meses y 9 años, de ambos sexos, de septiembre de 1994 a agosto de 1996 por presentar datos clínicos compatibles con rinitis crónica. El grupo control fue de pacientes encamados en las salas de pediatría por padecimiento no respiratorios, hematológicos o inflamatorios. Se tomó citología exfoliativa de la mucosa nasal del cornete inferior en ambas fosas y se relacionaron los hallazgos considerados como inflamación crónica de la nariz con opacidad de los senos paranasales en radiografías simples. Se encontró relación significativa (p<0.05) entre la presencia de metaplasia y neutrófilos. Se concluye que la célula de metaplasia y neutrófilos. Se concluye que la célula de metaplasia escamosa puede ser una célula adaptada o en respuesta a la inflamación crónica de la mucosa nasal donde el neutrófilo es la célula inflamatoria predominante. La citología nasal con presencia de metaplasia escamosa y neutrófilos es un probable predictor de sinusitis

Disgenesia gonodal pura 46XX / Gonadal disgenesia pure 46XX

Se describe el caso de una paciente de 22 años de edad, ty con fenotipo femenino, sin estigmas somáticos, desarrollo mamario normal, vello axilar y púbico escaso y genitales externos normales, que acudió a consulta por esterilidad. El estudio hormonal mostró hipogonadismo hepergonadotropo. El cariotipo en linfocitos de sangre periférica fue 46XX; la citología de la mucosa oral y vaginal fue positiva. En la laparoscopia se observaron bandas blanquecinas en el sitio de los ovarios, la biopsia mostro estroma ovárico fibroso, sin folículos primordiales. Se estableció el diagnóstico de disgenesia gonadal pura 46XX. Este síndrome se conoce desde 1990 y hasta ahora solamente se ha informado de aproximadamente 130 casos. Se exponen los datos clínicos, hormonales, citogenéticos e histológicos del padecimiento.

Programa Basic para cálculo de aporte de sodio y agua / Basic program for calculation of natrium and water contribution

Se presenta un programa de computación en lenguaje basic, para calcular el aporte de agua y sodio en distintas alteraciones del balance hidrosalino (AU)

Programa Basic para cálculo de aporte de sodio y agua / Basic program for calculation of natrium and water contribution

Se presenta un programa de computación en lenguaje basic, para calcular el aporte de agua y sodio en distintas alteraciones del balance hidrosalino