[The role of nursing in right heart catheterization. Advantages from peripheral venous access]. / Papel de enfermería en el cateterismo cardiaco derecho. Ventajas del acceso venoso periférico.

INTRODUCTION: Pulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access. OBJECTIVE: To analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures. METHOD: A retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions. RESULT: A total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm2 vs 12.5Gycm2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001). CONCLUSIONS: The RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient.

Stability, spectroscopic, electrochemistry and QTAIM analysis of Cu-Znn-1On clusters for glucose sensing application: A study on theoretical and experimental insights.

Clusters of (ZnO)n (n = 2-4) have been shown to play a central role in the detection of glucose entity based on the existence of photo-induced electrons (PE), which facilitates the interaction between (ZnO)n clusters and glucose entity guests. The electrochemistry experiment has confirmed the detection of glucose by the title clusters. The optimization, energetic parameters, and vibrational frequency calculations have indicated that the Cu-Znn-1On-glucose are more stable than the (ZnO)n-glucose complexes. It has been demonstrated that the Cu doping enhanced the chemical behavior of the clusters and formed a high intramolecular charge transfer (ICT) in the system. The glucose sensing by all the forms of Cu-Znn-1On clusters showed that the Cu-Zn3O4, Cu-Wurtzite, and Cu-Rocksalt clusters are the most suitable for adsorbing the glucose guest. The HOMO/LUMO iso-surfaces of the complexes showed that the electron concentrations are localized in the d orbitals and mainly in the form of the d10 orbitals around Zn atoms. The molecular electrostatic potential (MEP) has clearly indicated that a high charge transfer occurs between the copper and the oxygen atoms, which facilitate the adsorption of glucose. The reactivity parameters also indicated that the Wurtzite-glucose complex has a high electrophilicity index (ω), which means a good acceptor behavior to interact with glucose. Additionally, the bond between the (ZnO)n clusters and the glucose polar element has been studied in detail by using QTAIM theory. Finally, the theoretical and experimental studies prove that the Cu-Znn-1On clusters are very suitable and competent compounds for detecting glucose.

Azo-methoxy-calix[4]arene complexes with metal cations for chemical sensor applications: Characterization, QTAIM analyses and dispersion-corrected DFT- computations.

In this work, the structures, quantum chemical descriptors, morphologic characterization of the azo-methoxy-calix[4]arene were investigated. The analyses and interpretation of the theoretical and the experimental IR spectroscopy results for the corresponding compounds was performed. The complexation of the azo-methoxy-calix[4]arene with Zn2+,Hg2+ , Cu2+ , Co2+, Ni2+ , Pb2+ and Cd2+metal cations has been calculated by the dispersion corrected density functional theory (DFT-D3). The values of the interaction energies show that the specific molecule is more selective to the Cu2+ cation. The study of the reactivity parameters confirms that the azo-methoxy-calix[4]arene molecule is more reactive and sensitive to the Cu2+ cation than that Co2+ and Cd2+. In addition, the investigation of the electrophilic and nucleophilic sites has been studied by the molecular electrostatic potential (MEP) analysis. The Hirshfeld surface (HS) analysis of the azo-methoxy-calix[4]arene-Cu2+ interaction have been used to understand the Cu⋯hydrogen-bond donors formed between the cation and the specific compound. The Quantum Theory of Atoms in Molecules (QTAIM) via Non covalent Interaction (NCI) analysis was carried out to demonstrate the nature, the type and the strength of the interaction formed between the Cu2+ cation and the two symmetrical ligands and the cavity. Finally, the chemical sensor properties based on the Si/SiO2/Si3N4/Azo-methoxy-calix[4]arene for detection of Cu2+ cation were studied. Sensing performances are determined with a linear range from 10-5.2 to 10-2.2 M. The Si/SiO2/Si3N4/azo-methoxy-calix[4]arene structure is a promoter to have a good performance sensor.

Alternativas para la sedación, analgesia, relajación y delirium en pacientes COVID-19. Revisión narrativa / Alternatives for sedation, analgesia, neuromuscular blockade and delirium in patients with COVID-19. A narrative review / Alternativas para sedação, analgesia, relaxamento e delírio em pacientes com COVID-19. Revisão narrativa

Resumen: En los últimos años, el mundo entero se vio enfrentado al manejo de pacientes con una patología totalmente nueva y desafiante en términos de su entendimiento fisiopatológico y estrategias de manejo, mientras que su tasa de contagio se incrementaba de manera importante. Se trata de la enfermedad COVID-19, originada por el virus SARS-CoV-2 y que puso en alerta a toda la humanidad. Por lo tanto, se presentaron grandes problemas de salud pública, incluyendo el desabastecimiento de medicamentos y recursos de primera línea para el control de la enfermedad, y en los pacientes críticos se afectó el manejo de soporte óptimo a medida que se superaba la compleja respuesta inmunológica, que terminaba afectando en sus primeros estadios el parénquima pulmonar, y según el estado fisiológico, mórbido y genético del huésped, generando una disfunción orgánica múltiple. En el presente documento se establecen las mejores alternativas para enfrentar un desabastecimiento de medicamentos asociados al abordaje integral de la analgosedación, prevención y manejo de delirium y abstinencia, así como la necesidad de relajación neuromuscular en cada una de las fases por las que atraviesa el paciente crítico hospitalizado en Unidades de Cuidado Intensivo con soporte respiratorio invasivo o no invasivo.

Abstract: In recent years, the entire world has been faced with the management of patients with a totally new and challenging pathology in terms of its pathophysiological understanding and management strategies, while its rate of infection was increased significantly. It is the COVID-19 disease, caused by the SARS-CoV-2 virus, and that put all of humanity on alert. Therefore, major public health problems arose, including shortages of medicines and first-line resources for disease control, and in critical patients, optimal support management was affected as the complex immune response was overcome, which ended up affecting the lung parenchymal in its early stages, and depending on the physiological, morbid and genetic state of the host, generating multiple organ dysfunction. This document establishes the best alternatives to face a shortage of medications associated with the comprehensive approach to analgesia and sedation, prevention and management of delirium and withdrawal, and the need for neuromuscular relaxation in each of the phases that critically hospitalized patients go through in Intensive Care Units with invasive or non-invasive respiratory support.

Resumo: Nos últimos anos, o mundo inteiro se deparou com o manejo de pacientes com uma patologia totalmente nova e desafiadora em termos de compreensão fisiopatológica e estratégias de manejo, enquanto sua taxa de contágio aumentava significativamente. Trata-se da doença COVID-19, causada pelo vírus SARS-CoV-2 que colocou toda a humanidade em alerta. Surgiram, assim, grandes problemas de saúde pública, incluindo a escassez de medicamentos e recursos de primeira linha para o controle da doença, em pacientes em estado crítico afetou-se o manejo do suporte ideal à medida que superavase a complexa resposta imune, que terminava afetando o parênquima pulmonar em seu estágio inicial, e dependendo do estado fisiológico, mórbido e genético do hospedeiro, gerando múltiplas disfunções orgânicas. Este documento estabelece as melhores alternativas para enfrentar a escassez de medicamentos associada à abordagem integral da analgesedação, prevenção e manejo do delirium e abstinência, e a necessidade de relaxamento muscular em cada uma das fases que atravessa o paciente em estado crítico internado na UTI com suporte respiratório invasivo ou não invasivo.

The Mexican consensus on the detection and treatment of early gastric cancer. / Consenso mexicano sobre detección y tratamiento del cáncer gástrico incipiente.

Gastric cancer is one of the most frequent neoplasias in the digestive tract and is the result of premalignant lesion progression in the majority of cases. Opportune detection of those lesions is relevant, given that timely treatment offers the possibility of cure. There is no consensus in Mexico on the early detection of gastric cancer, and therefore, the Asociación Mexicana de Gastroenterología brought together a group of experts and produced the "Mexican consensus on the detection and treatment of early gastric cancer" to establish useful recommendations for the medical community. The Delphi methodology was employed, and 38 recommendations related to early gastric cancer were formulated. The consensus defines early gastric cancer as that which at diagnosis is limited to the mucosa and submucosa, irrespective of lymph node metástasis. In Mexico, as in other parts of the world, factors associated with early gastric cancer include Helicobacter pylori infection, a family history of the disease, smoking, and diet. Chromoendoscopy, magnification endoscopy, and equipment-based image-enhanced endoscopy are recommended for making the diagnosis, and accurate histopathologic diagnosis is invaluable for making therapeutic decisions. The endoscopic treatment of early gastric cancer, whether dissection or resection of the mucosa, should be preferred to surgical management, when similar oncologic cure results can be obtained. Endoscopic surveillance should be individualized.

Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial.

BACKGROUND: Violence against women and girls (VAWG) is an urgent global health problem. Root causes for VAWG include the individual- and family-level factors of alcohol abuse, mental health problems, violence exposure, and related adverse experiences. Few studies in low- and middle-income countries (LMIC) have assessed the effectiveness of psychological interventions for reducing VAWG. This randomized controlled trial, part of the What Works to Prevent Violence Against Women and Girls consortium, examines the effectiveness of a common elements treatment approach (CETA) for reducing VAWG and comorbid alcohol abuse among families in Zambia. METHODS/DESIGN: Study participants are families consisting of three persons: an adult woman, her male husband or partner, and one of her children aged 8-17 (if available). Eligibility criteria include experience of moderate-to-severe intimate partner violence by the woman and hazardous alcohol use by her male partner. Family units are randomized to receive CETA or treatment as usual. The primary outcome is VAWG as measured by the Severity of Violence Against Women Scale, assessed along with secondary outcomes at 24 months post-baseline. Interim assessments are also conducted at 4-5 months (following CETA completion) and 12 months post-baseline. CONCLUSIONS: This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence-based common elements approach for reducing VAWG by targeting a range of individual- and family-level factors, including alcohol abuse. Results of this trial will inform policy on what interventions work to prevent VAWG in LMIC with local perspectives on scale up and wider implementation.

Guía retenida y anudada extravascular durante un cateterismo venoso central: reporte de un caso

El cateterismo venoso central (CVC) es un procedimiento común en la práctica médica de especialistas en salas de emergencia, cuidado intensivo y salas de cirugía. Su uso no está libre de complicaciones estas pueden ser de tipo mecánica, infecciosa y trombóticas. Dentro de las complicaciones mecánicas las asociadas con la guía tipo atrapamiento vascular es la más común, pero el anudamiento y el atrapamiento extravascular son muy infrecuentes. Presentamos el caso de una mujer con atrapamiento extravascular de la guía y neumotórax como complicaciones de un CVC subclavio.

Central venous catheterization is a common procedure in the medical practice of specialists of emergency rooms, critical care and surgery rooms. The use of central venous catheters is associated with mechanical infectious and thrombotic complications. Within the mechanical complications, those associated with the guidewire, especially extravascular entrapments are very infrequent. This work presents a case of a female patient with extravascular entrapment of the guidewire and pneumothorax as complications of right subclavian venous catheterization.

Glioblastoma multiforme y embarazo / Glioblastoma multiforme and pregnancy

Reportamos el caso de una paciente de 27 años de edad, G2P1, a quien se le diagnostica en la semana 20 de gestación un tumor supratentorial frontal izquierdo tipo glioblastoma multiforme, el cual se manifestó con una crisis de ausencia. La conducta tomada fue quirúrgica y la paciente fue sometida en la semana 28 a craneotomía bajo anestesia general, con monitoreo fetal, con resultados exitosos para la madre y el feto. Dado lo infrecuente de esta asociación, creemos importante su reporte.

This is a case report of a 27-year-old female patient, G2P1, diagnosed at 20 weeks of gestation with a left frontal supratentorial tumor of a glioblastoma multiforme type, which manifested in the form of ictal absence. The patient was taken to surgery on week 28 and underwent a craniotomy under general anesthesia and fetal monitoring, with a successful outcome for both the mother and the fetus. We consider it important to report this case given this rare association.

Factores relacionados con el retardo en la oportunidad en cirugía de cadera: estudio de corte transversal / Factors related to delayed opportunity in hip surgery

Existe gran controversia sobre el momento de intervenir la fractura de cadera, la mayoría de estudios propugnan por un manejo precoz (48-72 h) para prevenir y evitar deterioro en sus procesos concomitantes. Casi todos enfocan su objetivo en evaluar la morbilidad y mortalidad, pero el análisis de estos factores y, adicionalmente, los de tipo administrativo, no han sido tenidos en cuenta. Materiales y métodos: con el objetivo de evaluar los factores relacionados con la oportunidad en cirugía de cadera y los resultados finales, realizamos un estudio de corte transversal del que se excluyeron pacientes en los cuales no se pudo recolectar toda la información requerida. La muestra incluyó 95 pacientes, para el análisis se dividieron en dos grupos según manejo oportuno o no, de acuerdo con la definición adoptada. Se realizó análisis univariado, bivariado y, posteriormente, regresión binomial con el fin de evaluar posibles factores relacionados con el retardo de la oportunidad. Resultados: el manejo adicional fue la única variable influyente, con una probabilidad 8,62 veces mayor de producir retardo en la oportunidad (OR=8,62 IC 95% 1,07-69), y con un índice de complicaciones del 12,2%. Se requieren estudios prospectivos que pueden dar conclusiones extrapolables, y es necesaria una coordinación más ágil en el manejo multidisciplinario de los pacientes con patologías asociadas para una optimización más oportuna de los mismos.

Chimeric design, synthesis, and biological assays of a new nonpeptide insulin-mimetic vanadium compound to inhibit protein tyrosine phosphatase 1B.

Prior to its total synthesis, a new vanadium coordination compound, called TSAG0101, was computationally designed to inhibit the enzyme protein tyrosine phosphatase 1B (PTP1B). The PTP1B acts as a negative regulator of insulin signaling by blocking the active site where phosphate hydrolysis of the insulin receptor takes place. TSAG001, [V(V)O(2)(OH)(picolinamide)], was characterized by infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy; IR: ν/cm(-1) 3,570 (NH), 1,627 (C=O, coordinated), 1,417 (C-N), 970/842 (O=V=O), 727 δ̣ (pyridine ring); (13)C NMR: 5 bands between 122 and 151 ppm and carbonyl C shifted to 180 ppm; and (1)H NMR: 4 broad bands from 7.6 to 8.2 ppm and NH(2) shifted to 8.8 ppm. In aqueous solution, in presence or absence of sodium citrate as a biologically relevant and ubiquitous chelator, TSAG0101 undergoes neither ligand exchange nor reduction of its central vanadium atom during 24 hours. TSAG0101 shows blood glucose lowering effects in rats but it produced no alteration of basal- or glucose-induced insulin secretion on ß cells during in vitro tests, all of which excludes a direct mechanism evidencing the extrapancreatic nature of its activity. The lethal dose (LD(50)) of TSAG0101 was determined in Wistar mice yielding a value of 412 mg/kg. This value is one of the highest among vanadium compounds and classifies it as a mild toxicity agent when compared with literature data. Due to its nonsubstituted, small-sized scaffold design, its remarkable complex stability, and low toxicity; TSAG0101 should be considered as an innovative insulin-mimetic principle with promising properties and, therefore, could become a new lead compound for potential nonpeptide PTP1B inhibitors in antidiabetic drug research. In view of the present work, the inhibitory concentration (IC(50)) and extended solution stability will be tested.

Composición proximal y perfil de ácidos grasos de combos de hot dogs consumidos en cadenas de comidas rápidas en la Región Metropolitana de Chile / Proximate composition and fatty acids profile of food packs of hot dogs consumed in fast foods chains from the Metropolitan Region of Chile

El hotdog es una de las comidas rápidas mas populares y de alto consumo por la población de Santiago de Chile, los cuales, hoy en día, son consumidas generalmente junto a papas fritas, en lo que se conoce popularmente como ®combo¼. Esta investigación realizó una encuesta a 204 personas para determinar la preferencia por comidas rápidas y cadenas de comercialización. En base a esto, se seleccionó a cuatro tipos de combos de hotdog, a los cuales se les determinó el análisis proximal y perfil de ácidos grasos. Las muestras fueron seleccionadas de las cadenas de mayor preferencia y se escogieron 5 locales al azar, las que estaban compuestas por 5 réplicas de combos y todos los análisis fueron realizados en duplicado. Todos los combos analizados presentaron diferencias significativas (p<0.05) en los contenidos de grasa y proteínas, con valores de 13 a 16 g/100g y de 5 a 7 g/100g respectivamente. El aporte calórico de estos combos fluctuó entre 220 a 252 kcal por ciento. Para el perfil de ácidos grasos, no se observaron diferencias significativas y se obtuvo en las muestras valores de las razones AGPI/AGS y C18:2/C18:3 cercanas a 1 y 10 respectivamente. Estos productos presentan un alto aporte en grasa, cubriendo más de 50 por ciento de los requerimientos diarios de grasa.

Theoretical prediction of relative and absolute pKa values of aminopyridines.

This work presents a study aimed at the theoretical prediction of pK(a) values of aminopyridines, as a factor responsible for the activity of these compounds as blockers of the voltage-dependent K(+) channels. To cover a large range of pK(a) values, a total of seven substituted pyridines is considered as a calibration set: pyridine, 2-aminopyridine, 3-aminopyridine, 4-aminopyridine, 2-chloropyridine, 3-chloropyridine, and 4-methylpirydine. Using ab initio G1, G2 and G3 extrapolation methods, and the CPCM variant of the Polarizable Continuum Model for solvation, we calculate gas phase and solvation free energies. pK(a) values are obtained from these data using a thermodynamic cycle for describing protonation in aqueous and gas phases. The results show that the relatively inexpensive G1 level of theory is the most accurate at predicting pK(a) values in aminopyridines. The highest standard deviation with respect to the experimental data is 0.69 pK(a) units for absolute values calculations. The difference increases slightly to 0.74 pK(a) units when the pK(a) is computed relative to the pyridine molecule. Considering only compounds at least as basic as pyridine (the values of interest for bioactive aminopyridines) the error falls to 0.10 and 0.12 pK(a) units for the absolute and relative computations, respectively. The technique can be used to predict the effect of electronegative substituents in the pK(a) of 4-AP, the most active aminopyridine considered in this work. Thus, 2-chloro and 3-chloro-4-aminopyridine are taken into account. The results show a decrease of the pK(a), suggesting that these compounds are less active than 4-AP at blocking the K(+) channel.

La importancia de la disección axilar para la reconstrucción mamaria con TRAM libre microvascularizado / No disponible

El cancer de mama es la neoplasia maligna más frecuente en la mujer. La incidencia tiende a aumentar y su mortalidad a disminuir, como consecuencia del progreso en el diagnóstico precoz y en el manejo terapéutico. El desarrollo de la Cirugía Plástica ha producido grandes avances en el campo de la reconstrucción mamaria postmastectomía. Actualmente una de las técnicas más extendidas y reconocidas es el TRAM libre microvascularizado: la tranferencia del abdomen al tórax de un colgajo dermograso nutrido por el pedículo de la arteria epigástrica inferior del lado correspondiente. En nuestro Servicio, en un año, se han realizado 24 TRAM libres. La aplicación de esta técnica requiere una selección adecuada de las pacientes Nuestra experiencia y la revisión de la literatura al respecto nos hacen concluir que, practicamente todas las mujeres mastectomizadas, pueden ser reconstruidas mediante TRAM, siendo su versión libre microvascularizada la que presenta mejores resultados estéticos y funcionales, sobre todo si se practica de forma inmediata a la mastectomía. La realización de la microanastomosis se llevó a cabo sobre todo en la axila a nivel del pedículo toracodorsal que cumple las condiciones ideales para ser la zona receptora. El objetivo de este trabajo es presentar nuestra experiencia en la realización del TRAM libre, dando especial importancia al papel que la disección axilar que el cirujano oncológico lleva a cabo previamente, para el éxito ulterior en el desarrollo de nuestra técnica (AU)

Breast cancer is the most common malignant tumour among women. Its incidence tends to increase whereas its mortality tends to decrease thanks to early diagnosis and suitable treatment. The development in Plastic Surgery has caused significant advances in postmastectomy breast reconstruction. At present, free TRAM flap is a very extended technique because of its excellent results. In our Plastic Surgery unit, 24 free TRAM flaps have been carried out within a year. The application of this procedure requires an appropriate selection of patients. Our experience and the consulted literature on the subject lead us to think and conclude that almost every mastectomied woman can be reconstructed with TRAM flaps, out of which the Free TRAM flap is the best option for these cases due to both its aesthetic and functional results (which can even be improved when practiced immediately after the mastectomy) . In all the 24 cases, our unit carried out the microvascular suture on the axillar area, which has the best condition to be the receiver area. The aim of this study was to survey the role of axillar dissection in breast reconstruction procedure, whose success depends on both an accurate dissection and conservation of the axillar neurovascular structures (AU)

[Comparison of Trypanosoma cruzi infection in less than 10 years old children from the V Región, Chile, 1982-1995]. / Comparación de la infección por Trypanosoma cruzi en niños menores de 10 años de la V región, Chile. 1982-1995.

Evaluation of desinsectation programs carried out in the two Health Services from the V Region, was undertaken by comparing serologic prevalences of T. cruzi infection age groups exposed to the risk of infection in rural areas during the antivectorial campaign activities (1982 vs 1995). Thus, were studied 2,193 blood samples from children under 10 years of age, proceeding from six chagasic endemic provinces in which antitriatomic domiciliary insecticide sprayings had been performed. Indirect hemagglutination and ELISA tests were carried out to each of the blood samples. A total de 42 (1.9%) children resulted positive. As in five counties no positive cases were detected in the last five years it is possible to assume that vector transmission of T. cruzi should have been interrupted in them. When comparing prevalences existing in 1982 with the present ones, it is possible to observe a 63.5% of reduction of transmission in the V Region, been this reduction higher in the Aconcagua Health Service with 79.6% and lower in the Viña del Mar--Quillota Health Service with 55.6%. According to these results, comparison of prevalence of T. cruzi infection in children less than 10-year-old in diverse periods, allows evaluate the vectorial control of Triatoma infestans programs.

[The incidence of poisoning by Karwinskia humboldtiana in Mexico]. / Frecuencia de intoxicación con Karwinskia humboldtiana en México.

Intoxication produced by Karwinskia humboldtiana presents a neurological picture similar to that of poliomyelitis, Guillain-Barré syndrome or other polyradiculoneuritis with which it is frequently confused. The purpose of this paper is to report the frequency of this intoxication, by means of the antecedent of ingestion of the fruit and the detection of toxins in blood using a thin layer chromatography method. One hundred fifty four samples of cases with acute flaccid paralysis from 18 states of the country were received. The antecedent of ingestion in 56 of them was corroborated and the detection was positive in 50 of these. In 98 patients there was not antecedent of ingestion and detection was negative in 95 of them. We estimated that the sensibility and specificity of detection method are 89% and 96.9% respectively.

[Familial poisoning with Karwinskia humboldtiana]. / Intoxicación de una familia por Karwinskia humboldtiana (tullidora).

The ingestion of ripe fruit of the Karwinskia humboldtiana, a shrub commonly known as tullidora or coyotillo, produces an intoxication described in the literature as a symmetric flaccid paralysis of the hind limbs, progressive and ascendent, that in severe cases may cause bulbar paralysis and death. The cause of an acute accidental intoxication of an entire family is presented here, wherein ten out of thirteen members ingested the ripe fruit of the tullidora. Three died, the father and two daughters. For the first time the toxins determination in blood by thin layer chromatography method is described. This method supports the diagnosis with other polyradiculoneuritis such as poliomyelitis and the Guillain Barre's syndrome.

Cardiac surgery on Jehova's Witnesses at Instituto Cardiovascular-Hospital Pavia.

Jehovah's Witnesses (J.W.) can undergo successful cardiac operations. We have operated five J.W. patients. Of these patients, two had coronary artery bypass surgery and three had correction of congenital anomalies. These included an atrial septal defect with infundibular pulmonic stenosis, a tetralogy of Fallot and a patient with a ventricular septal defect. Our treatment protocol includes a meticulous surgery, the use of early heparinization to collect all shed blood into the pump oxygenator, observation in the operating room for early exploration if the patient bleeds and administration of iron preparations. Recombinant human erythropoietin, although available and in our treatment protocol, has not been used yet. All patients survived the operation and left the hospital with an excellent hemoglobin and hematocrit. The length of stay varied from 7 to 15 days.

The effect of superoxide dismutase and catalase on the extended preservation of the ex vivo heart for transplantation.

The applicability of heart transplantation remains limited in part by the inability to preserve the excised heart for long periods of time. Free radical scavengers have been shown to protect the anoxic myocardium by preventing damage to the cell membrane and may, therefore, be effective in extending successful preservation of donor hearts. We perfused 10 sheep hearts for 8 hours in an ex vivo perfusion system. The effect of superoxide dismutase combined with catalase, 60,000 units/L, was studied in five sheep, and five received placebo. Control determinations and determinations after 8 hours of preservation were obtained with the heart perfused with autologous blood at 37 degrees C at an aortic perfusion pressure of 60 mm Hg and flow of 180 to 200 ml/min. After control readings, the hearts were arrested and perfused with a cold (6 degrees to 8 degrees C) oxygenated buffered crystalloid solution with or without superoxide dismutase and catalase at a perfusion pressure of 30 cm H2O for 8 hours. Left and right ventricular compliance was measured sequentially with separate intraventricular balloons. After 8 hours of ex vivo preservation, hearts receiving superoxide dismutase and catalase had significantly better left and right ventricular performance, higher myocardial oxygen consumption, and lower lactate production than the control group. The hearts preserved with superoxide dismutase and catalase showed significantly better left and right ventricular compliance, much less increase in heart weight, and no change in the diastolic pressures. The results suggest that superoxide dismutase combined with catalase may be effective in extending ex vivo preservation of hearts for cardiac transplantation.

Effects of diltiazem cardioplegia on global function, segmental contractility, and the area of necrosis after acute coronary artery occlusion and surgical reperfusion.

We investigated the effects of diltiazem cardioplegia on myocardial function and infarct size in the region of the left anterior descending artery after acute occlusion and reperfusion during cardiopulmonary bypass. Sheep (30 kg) were subjected to 1 hour of regional myocardial ischemia by occlusion of the left anterior descending artery and assigned to a control (n = 8) or experimental group (n = 5). Control animals were placed on cardiopulmonary bypass and the heart arrested with potassium cardioplegia. The left anterior descending artery was released and two additional doses of 100 ml of cardioplegic solution were infused during the total cross-clamp time of 30 minutes. The animals were then weaned from bypass after 1 hour and beating, working reperfusion maintained for an additional 4 hours. The experimental group followed the same protocol except that the cardioplegic solution contained diltiazem (1.4 mg/L). Segmental myocardial function was determined by pairs of ultrasonic crystals in the area at risk, control segment, and minor axis. Global contractility was determined from maximum derivative of left ventricular pressure and cardiac output. The area at risk was determined by injecting monastral blue dye into the left atrium with the left anterior descending artery briefly reoccluded, and the area of necrosis was determined by measuring with a planimeter non-triphenyltetrazolium chloride stained areas in the sectioned left ventricle. After 5 hours of reperfusion, not only did the diltiazem group demonstrate better global contractility as defined by the derivative of left ventricular pressure (1853 +/- 292 versus 979 +/- 191, p = 0.05) but, in addition, the systolic shortening in the ischemic area improved significantly when compared with the control group (9.4 +/- 4 versus 2.13 +/- 0.77, p = 0.05). The group receiving diltiazem cardioplegia had an area of necrosis to area at risk ratio of 31.4% +/- 3%, which was significantly better than this ratio in the control group of 60.75% +/- 7% (p = 0.01). Diltiazem cardioplegia results in improved global and segmental contractility and limits the infarct size after occlusion of the left anterior descending artery and surgical reperfusion.

The effect of oxygen free radical scavengers on the recovery of regional myocardial function after acute coronary occlusion and surgical reperfusion.

This study investigated the effects of the oxygen free radical scavengers superoxide dismutase and catalase, the peroxide ion inhibitor, in crystalloid potassium cardioplegic solution on infarct size and global and regional myocardial function after occlusion of the left anterior descending artery and surgical reperfusion in young sheep on cardiopulmonary bypass. After 1 hour of occlusion, the animals were randomized to receive either routine potassium cardioplegia or cardioplegia with superoxide dismutase and catalase. Global hemodynamics measured by maximum rate of pressure rise showed significant improvement after 5 hours of reperfusion in the group treated with superoxide dismutase and catalase (1843 +/- 163 versus 979 +/- 191, p less than 0.001). Regional myocardial function was measured by ultrasonic crystals implanted in the ischemic area and in a nonischemic control segment. The percent systolic shortening or bulging was calculated. At end of reperfusion in the animals treated with superoxide dismutase and catalase, there was active shortening in the ischemic area after reperfusion of +9.2% +/- 0.4% versus 2.1% +/- 0.8% in untreated animals (p less than 0.001). Infarct size measured by triphenyltetrazolium chloride staining showed significant difference (p less than 0.001) between animals treated with superoxide dismutase and catalase (0.9% +/- 0.1%) and control animals (61% +/- 70%). Superoxide dismutase and catalase given in the cardioplegic solution before reperfusion of an acutely ischemic area of myocardium enhances recovery of contractile function and results in a significant reduction in infarct size, which suggests improved salvage of the ischemic myocardium.