Analysis of Spanish vocational radiographers' education through clinical training and perceptions of core subject teachers: A survey.

INTRODUCTION: This work presents a prospective analysis of the key aspects involved in the Spanish radiographer's perception of the weaknesses of the current educational curriculum in terms of teaching staff's qualifications and composition in the clinical training and core subjects. The goal is to show clinical training and professional's perception of the teaching quality and to characterise the weakness detected within the context of the European radiographer's academic system. METHODS: The perception of the quality of the training received by the professionals was collected through an anonymous survey. A total of 758 valid responses were received, and were analysed to three hypotheses: the variability of the teachers' qualifications in the core subjects, the variability in terms of internships time carried out by the students, and assessment about teaching quality of the teachers. RESULTS: The results prove there is a huge variability and little academic affinity of the teachers' degrees with the core subjects. On the other hand, the results shows there is a scarcity of clinical training hours in Spain, especially compared to European standards. It was demonstrated that teachers with a specific radiographer degree obtained the best scores. CONCLUSION: It is mandatory to adjust the criteria for selecting clinical imaging teachers to improve the teaching quality in Spain and increase the clinical training period of the Spanish radiographers to match their European counterparts. IMPLICATION FOR PRACTICE: Improving the training of Spanish radiographers will contribute to standardising the training quality of the whole European profession.

Valvulopatía mitral y tricuspídea: diagnóstico y tratamiento. Posicionamiento conjunto de la Sección de Valvulopatías y las Asociaciones de Imagen, Cardiología Clínica y Cardiología Intervencionista de la SEC / Mitral and tricuspid valve disease: diagnosis and management. Consensus document of the Section on Valvular Heart Disease and the Cardiovascular Imaging, Clinical Cardiology, and Interventional Cardiology Associations of the Spanish Society of Cardiology

El diagnóstico y el tratamiento de la valvulopatía mitral y tricuspídea han sufrido unos cambios extraordinarios en los últimos años. La irrupción de las intervenciones percutáneas y la generalización de las nuevas técnicas de imagen han modificado las recomendaciones para el diagnóstico y el tratamiento de estas afecciones. La ingente cantidad de publicaciones y estudios en este campo obliga a una continua actualización de nuestros protocolos. La publicación de la guía de la Sociedad Europea de Cardiología de 2021 sobre el tratamiento de las valvulopatías no cubre algunos aspectos novedosos de estos tratamientos y, además, el número de intervenciones realizadas en los países de nuestro entorno es muy variable, lo que exige una adecuación de las recomendaciones al contexto local. Además, es indispensable un resumen de toda esta información para que se pueda generalizar su uso. Por estos motivos, se considera necesario el posicionamiento común de la Asociación de Cardiología Intervencionista, la Asociación de Imagen Cardiaca, la Asociación de Cardiología Clínica y la Sección de Valvulopatías y Patología Aórtica de la Sociedad Española de Cardiología para el diagnóstico y el tratamiento de la valvulopatía mitral y tricuspídea (AU)

The diagnosis and management of mitral and tricuspid valve disease have undergone major changes in the last few years. The expansion of transcatheter interventions and widespread use of new imaging techniques have altered the recommendations for the diagnosis and treatment of these diseases. Because of the exponential growth in the number of publications and clinical trials in this field, there is a strong need for continuous updating of local protocols. The recently published 2021 European Society of Cardiology guidelines for the management of valvular heart disease did not include some of the new data on these new therapies and, moreover, the number of mitral and tricuspid interventions varies widely across Europe. Therefore, all this information must be summarized to facilitate its use in each specific country. Consequently, we present the consensus document of the Section on Valvular Disease, Cardiovascular Imaging, Clinical Cardiology, and Interventional Cardiology Associations of the Spanish Society of Cardiology for the diagnosis and management of mitral and tricuspid valve disease (AU)

Analysis of Ecuador's SCOPUS scientific production during the 2001-2020 period by means of standardized citation indicators.

An analysis of the scientific production of Ecuador is performed by means of the composite indicator computed for Ecuador-based authors as compared to their counterparts of other South American countries. The dataset employed was obtained from the Databricks platform of the ELSEVIER's International Center for Science Research, ICSR. Therefore, this analysis is limited to the metadata of the documents published in journals indexed in SCOPUS. Comparison of the results obtained for two decades: 2001-2010 and 2011-2020 showed that the number of Ecuador-based researchers has significantly increased in different areas of knowledge. Moreover, comparison between the total number of authors that worked in Ecuador at any given year of the 2011-2020 period and the number of authors that are still working in this country up to the date of the data extraction (i.e., June 2021) showed an average of ∼68% of permanency. Analysis of the percentage distribution in terms of range quarters of the composite indicator (i.e., Q4: 0-1.5, Q3: 1.5-3.0, Q2: 3.0-4.5, and Q1: 4.5-6.0) showed that nearly the totality of the Ecuador-based researchers has composite indicators that lay in the Q4 and Q3 ranges for all the scientific fields considered. The latter was observed to be an effect of the scientific impact of South American countries, with larger investments in science and technology in comparison to Ecuador (i.e., Argentina, Brazil, and Chile). Exclusion of this group of countries in the calculation of the composite indicator of Ecuador-based authors resulted in a noticeable increment of scientists with composite indicators within Q2. Finally, our results suggest, in agreement with previous studies, a correlation between the sustained growth of scientific productivity in the decade 2011-2020 with the scientific programs and policies created by the state, where the initiative of scientific culture is shown as a strategy for growth and development.

Inicio de un nuevo programa de cuidados paliativos pediátricos en un hospital general: características de la población y uso de recursos / Starting of a new pediatric palliative care program in a general hospital: characteristics of the population and use of resources

Se describen las características de los pacientes susceptibles de cuidados paliativos pediátricos (CPP) de un hospital de segundo nivel, así como la frecuencia de visitas a urgencias, de ingresos y de dispositivos tecnológicos empleados. Estudio retrospectivo de los pacientes atendidos desde el inicio del programa de CPP (enero 2017 a enero 2020) en un hospital de nivel secundario. Se incluyeron 29 niños, 58,6% varones y edad media a la entrada en el estudio de 2,3 años (DE: 2,4); el 44,8% procedían del ámbito rural. El 41% presentaron multimorbilidad, con mayor frecuencia de patología neurológica. La causa más frecuente de atención en urgencias (n = 360) y hospitalización (n = 145) fue la infeccioso-respiratoria. El 51,7% de los pacientes eran dependientes de dispositivos médicos. Conocer el uso de recursos de esta población puede ayudar a un mejor reparto de los mismos para poder ofrecer CPP con independencia del lugar de residencia.(AU)

This article sets out to describe the characteristics of patients at a second-level hospital who are likely to receive pediatric palliative care (PPC), the frequency of visits to the emergency room, admissions and technological devices used. A retrospective study was carried out of the patients who received care from the start of the PPC program (January 2017 to January 2020) at a secondary-level hospital. Twenty-nine patients were included, 58.6% male with mean age at entry into the study of 2.3 years (SD: 2.4); 44.8% of them were from rural areas. The prevalence of multimorbidity was 41%, with a higher frequency of neurological pathology. Respiratory infection was the most frequent cause of emergency care (n = 360) and hospitalization (n=145). Half of patients (51.7%) depended on medical devices. Better knowledge of the resources used by this population can lead to more effective distribution/management that in turn can enable PPC to be offered regardless of the place of residence.(AU)

[Starting of a new pediatric palliative care program in a general hospital: characteristics of the population and use of resources].

This article sets out to describe the characteristics of patients at a second-level hospital who are likely to receive pedi-atric palliative care (PPC), the frequency of visits to the emergency room, admissions and technological devices used. A retrospective study was carried out of the patients who received care from the start of the PPC program (January 2017 to January 2020) at a secondary-level hospital. Twenty-nine patients were included, 58.6% male with mean age at entry into the study of 2.3 years (SD: 2.4); 44.8% of them were from rural areas. The prevalence of multimorbidity was 41%, with a higher frequency of neurological patholo-gy. Respiratory infection was the most frequent cause of emergency care (n = 360) and hospitalization (n=145). Half of patients (51.7%) depended on medical devices. Better knowledge of the resources used by this population can lead to more effective distribution/management that in turn can enable PPC to be offered regardless of the place of residence.

Deficiencia radial longitudinal. Análisis de resultados clínicos y radiológicos / Radial longitudinal deficiency. Analysis of clinical and radiological results

Introducción: La deficiencia radial longitudinal comprende anormalidades óseas, musculotendinosas y neurovasculares de etiología multifactorial del lado radial de la extremidad superior. El tratamiento incluye mejorar la longitud, la apariencia y el funcionamiento de la mano. El objetivo del trabajo es mostrar la experiencia en una serie de pacientes atendidos en los últimos 15 años y describir resultados clínicos y radiológicos. Metodología: Estudio retrospectivo de pacientes con deficiencia radial longitudinal entre 2000 a 2016. Se analizaron variables y se identificaron asociaciones de edad al momento de cirugía, sexo, lateralidad, grado de la deformidad según la clasificación Bayne-Klug modificada, técnica quirúrgica realizada, daño de la fisis, enfermedades asociadas, resultados funcionales y radiológicos. Resultados: Cuarenta y siete casos de 65 cumplían con criterios de inclusión. La edad promedio de la cirugía fue de 19 meses, 61% de sexo femenino. Según la clasificación el tipo IV fue el 60%, el tipo III el 19%, el tipo 0 el 17% y tipo I el 4%. La intervención practicada fue la centralización en el 72,3%, la radialización en el 8,5% y hubo un caso de alargamiento. Se realizó osteotomía de cúbito en el 55,3%. Hubo daño de la fisis en el 31%. La posición radiológica postoperatoria fue neutra en el 48,9%. Conclusiones: En pacientes con centralización a un año se observa una buena corrección clínica y radiológica, sin embargo esta se va perdiendo con el tiempo. El tratamiento de los tejidos blandos previo a la centralización se cree que permite obtener mejores resultados. El uso de clavo intramedular del cúbito al carpo podría estar asociado con daño de fisis del cúbito distal

Introduction: radial longitudinal deficiency (RLD) includes bone, musculotendinous and neurovascular abnormalities of multifactorial aetiology of the radial side of the upper extremity. Treatment includes improving the length of the limb, the appearance and functioning of the hand. The aim of this study was to present our experience in a series of patients attended over the past 15 years and to describe the clinical and radiological results. Methodology: a retrospective study of patients with RLD between 2000 and 2016. Variables were analyzed and age associations were identified at the time of surgery, sex, laterality, type of deformity according to the modified Bayne-Klug classification, surgical technique, physis damage, associated diseases, functional and radiological results. Results: 47 cases of 65 met the inclusion criteria. The average age of surgery was 19 months, 61% female. According to classification 60% were type IV, type III 19%, type 0 in 17% and type I in 4%. The intervention was centralization 72.3%, radialization 8.5% and one case of lengthening. Ulna osteotomy was performed in 55.3%. There was damage to the physis in 31%. The postoperative radiological position was neutral in 48.9%. Conclusions: In patients with centralization at 1year, good clinical and radiological correction were observed, however this was lost over time. The management of soft tissues prior to centralization is believed to give better results. The use of intramedullary nail from the ulna to the carpus could be associated with damage to the distal ulna

Radial longitudinal deficiency. Analysis of clinical and radiological results. / Deficiencia radial longitudinal. Análisis de resultados clínicos y radiológicos.

INTRODUCTION: radial longitudinal deficiency (RLD) includes bone, musculotendinous and neurovascular abnormalities of multifactorial aetiology of the radial side of the upper extremity. Treatment includes improving the length of the limb, the appearance and functioning of the hand. The aim of this study was to present our experience in a series of patients attended over the past 15 years and to describe the clinical and radiological results. METHODOLOGY: a retrospective study of patients with RLD between 2000 and 2016. Variables were analyzed and age associations were identified at the time of surgery, sex, laterality, type of deformity according to the modified Bayne-Klug classification, surgical technique, physis damage, associated diseases, functional and radiological results. RESULTS: 47 cases of 65 met the inclusion criteria. The average age of surgery was 19 months, 61% female. According to classification 60% were type IV, type III 19%, type 0 in 17% and type I in 4%. The intervention was centralization 72.3%, radialization 8.5% and one case of lengthening. Ulna osteotomy was performed in 55.3%. There was damage to the physis in 31%. The postoperative radiological position was neutral in 48.9%. CONCLUSIONS: In patients with centralization at 1year, good clinical and radiological correction were observed, however this was lost over time. The management of soft tissues prior to centralization is believed to give better results. The use of intramedullary nail from the ulna to the carpus could be associated with damage to the distal ulna.

Theoretical investigation of the mechanism for the reductive dehalogenation of methyl halides mediated by the CoI-based compounds cobalamin and cobaloxime.

Theoretical calculations focusing on the cleavage of the C-X bond in methyl halides (CH3X; X = Cl, Br, I) as mediated by CoI-based systems have been carried out using the hybrid functional ωB97-XD together with the basis set 6-311++G(2d,2p). A total of seven CoI-based compounds were evaluated: cob[I]alamin (CoICbl) in its base-on form and cobaloxime (CoICbx) with either no ligand or different ligands (either pyridine (PYR), tributylphosphine (TBP), dimethyl sulfide (DMS), cyclohexylisocyanide (CI), or 5,6-dimethylbenzimidazole (DMB)) at the lower axial position. For the large CoICbl system, an ONIOM scheme was employed, where the high layer was described at the DFT level and the low layer was computed using the semi-empirical method PM6. A full DFT model was employed for the CoICbx cases. An SN2-like mechanism was evaluated in all cases. The intrinsic reaction coordinate profiles suggested early transition states with activation energies of ≈ 12 kcal/mol, ≈ 10 kcal/mol, and ≈ 5 kcal/mol for C-Cl, C-Br, and C-I cleavage, respectively, which is consistent with the leaving group abilities of these halides. The evolutions of the atomic charges in and the bond orders of Co-C and C-X were computed, and the results confirmed the existence of early transition states (δBav≈ 40%), where the polarization Cδ+-Xδ- (%Ev ≈ 43%) is the determining factor in the reaction process. Finally, a comparison of all the determined parameters showed that the reaction in the DMB-CoICbx system resembles the process that occurs in the larger CoICbl, suggesting that the former system could be a reliable model for the study of reductive dehalogenation mediated by vitamin B12, which is key to the anaerobic microbiological treatment of halocarbon contaminants.

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Embryo cell allocation patterns are not altered by biopsy but can be linked with further development.

It has been suggested that first embryo cleavage can be related with the embryonic-abembryonic axis at blastocyst stage in mice. Thus, cells of the 2-cell embryo might be already biased to form the inner cell mass or trophectoderm. This study was conducted to observe the possible effects of embryo biopsy on cell allocation patterns during embryo preimplantation in two different mouse strains and the effects of these patterns on further development. First, one blastomere of the 2-cell embryo was injected with a lipophilic tracer and cell allocation patterns were observed at blastocyst stage. Blastocysts were classified into orthogonal, deviant or random pattern. For the first experiment, embryos were biopsied at 8-cell stage and total cell counts (TCC) were annotated. Furthermore, non-biopsied blastocysts were transferred into foster mothers. Then, pups and their organs were weighed two weeks after birth. Random pattern was significantly recurrent (≈60%), against orthogonal (<22%) and deviant (<22%) patterns among groups. These patterns were not affected by biopsy procedure. However, TCC on deviant embryos were reduced after biopsy. Moreover, no differences were found between patterns for implantation rates, litter size, live offspring and organ weights (lungs, liver, pancreas and spleen). However, deviant pups presented heavier hearts and orthogonal pups presented lighter kidneys among the group. In conclusion, these results suggest that single blastomere removal does not disturb cell allocation patterns during pre-implantation. Nonetheless, the results suggest that embryos following different cell allocation patterns present different coping mechanisms against in vitro manipulations and further development might be altered.

Theoretical analysis of C-F bond cleavage mediated by cob[I]alamin-based structures.

In the present work, C-F bond cleavage mediated by the super-reduced form of cobalamin (i.e., CoICbl) was theoretically studied at the ONIOM(BP86/6-311++G(d,p):PM6) + SMD level of theory. Dispersion effects were introduced by employing Grimme's empirical dispersion at the ONIOM(BP86-D/6-311++G(d,p):PM6) + SMD level. In the first stage of the study, cobalamin was characterized in terms of the coordination number of the central cobalt atom. The ONIOM(BP86/6-311++G(d,p):PM6) results showed that the base-off form of the system is slightly more stable than its base-on counterpart (ΔE = E base-off - E base-on ~ -2 kcal/mol). The inclusion of dispersive forces in the description of the system stabilizes the base-on form, which becomes as stable as its base-off counterpart. Moreover, in the latter case, the energy barrier separating both structures was found to be negligible, with a computed value of 1.02 kcal/mol. In the second stage of the work, the reaction CoICbl + CH3F → MeCbl + F- was studied considering the base-off and the base-on forms of CoICbl. The reaction that occurs in the presence of the base-on form of CoICbl was found to be kinetically more favorable (ΔE ≠ = 13.7 kcal/mol) than that occurring in the presence of the base-off form (ΔE ≠ = 41.2 kcal/mol). Further reaction-force analyses of the processes showed that the energy barrier to C-F bond cleavage arises largely due to structural rearrangements when the reaction occurs on the base-on form of the CoICbl complex, but is mainly due to electronic rearrangements when the reaction takes place on the base-off form of the complex. The latter behavior emerges from differences in the synchronicity of the bond strengthening/weakening processes along the reaction path; the base-on mode of CoICbl is able to decrease the synchronicity of the chemical events. This work gives new molecular-level insights into the role of Cbl-based systems in the cleavage of C-F bonds. These insights have potential implications for research into processes for degrading fluorine-containing pollutants.

First trimester fetal heart rate as a predictor of newborn sex.

OBJECTIVE: To predict the sex of newborns using first trimester fetal heart rate (FHR). METHODS: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student's t-tests while categorical variables were compared using Chi-square test. RESULTS: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0 ± 9.1 bpm and for male fetuses 167.3 ± 10.1 bpm (p = 0.62). There was no significant difference in crown rump length between female and male fetuses (4.01 ± 1.7 versus 3.98 ± 1.7 cm; p = 0.78) or in gestational age at birth (38.01 ± 2.1 versus 38.08 ± 2.1 weeks; p = 0.67). The males were significantly heavier than females (3305.3 ± 568.3 versus 3127.5 ± 579.8 g; p < 0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants. CONCLUSIONS: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.

Evaluación laparoscópica de hernia inguinal contralateral en niños: está justificada su exploración / Laparoscopic evaluation of contralateral inguinal hernia in children: is there a justification to explore it / Avaliação laparoscópica da hérnia inguinal contralateral em crianças: sua exploração se justifica

La alta incidencia de un conducto peritoneo vaginal permeable contralateral ha llevado al desarrollo de nuevas técnicas laparoscópicas, las cuales han revivido una controversia alrededor de la exploración contralateral. Con el presente estudio observacional, analítico, prospectivo de cohorte, realizado en niños entre los 0 y los 15 años en el Servicio de Cirugía Pediátrica del Hospital Militar Central en el periodo comprendido entre mayo de 2005 y agosto de 2008, se evaluó la utilidad de la laparoscopia en el diagnóstico de la hernia inguinal contralateral. El estudio permitió determinar por medio de la laparoscopia, que pacientes cursaban con hernia inguinal contralateral para así realizar su corrección quirúrgica durante el mismo procedimiento, evitando así la posibilidad de una hernia complicada contralateral metacrónica, un nuevo riesgo anestésico y con el costo adicional de una segunda hospitalización; igualmente estos resultados se pudieron contrastar con las estadísticas mundiales...

The high incidence of a contralateral patent processus vaginalis has led to the development of new laparoscopic techniques which have revived the controversy around the contralateral exploration. With this project we evaluate the usefulness of laparoscopy in the diagnosis of contralateral inguinal hernia. It was performed in children between 0 and 15 years in the pediatric surgery service of the Central Military Hospital in the period between May 2005 and August 2008, through an observational, analytical, prospective cohort study. The study allowed us to determine through laparoscopy, which patients had contralateral inguinal hernia, making the correction in the same surgical time, avoiding the possibility of a complicated metachronous contralateral hernia, a new anesthetic risk and the cost of a second hospitalization; similarly these results were confonted with global statistics...

A alta incidência de ducto vaginal peritoneal permeável contralateral levou ao desenvolvimento de novas técnicas de laparoscopia, que reviveram a controvérsia em torno da exploração contralateral. Com este projeto foi avaliada a utilidade da laparoscopia no diagnóstico de hérnia inguinal contralateral. Foi realizado em crianças entre 0 e 15 anos no departamento de cirurgia pediátrica, Hospital Militar, no período entre maio de 2005 e agosto de 2008, através de um estudo, observacional analítico, prospectivo de coorte. O estudo constatou através de laparoscopia, que os pacientes que foram registrados com hérnia inguinal contralateral, realizando a correcção no mesmo tempo cirúrgico, evitaba a possibilidade de uma hérnia contralateral metachronous complicado, um novo risco anestésico e os custos de uma segunda internação e comparados com as estatísticas mundiais...

Evolución inesperada del trauma traqueobronquial leve en niños con recosntrucción tardia exitosa: reporte de un caso / Unexpected Outcome in children with nild Tracheobronchial trauma undergoing a delayed, succesful reconstrucction: case report

Las lesiones traqueobronquiales por trauma cerrado de tórax son una entidad rara a cualquier edad y más aún en la población pediátrica. La mayoría de pacientes con este tipo de lesiones mueren antes de llegar al hospital, a causa de lesiones severas asociadas. Presentamos el caso de una niña de 2 años quien sufrió una lesión del bronquio fuente izquierdo, como consecuencia de un trauma cerrado de tórax en accidente autopedestre. A su ingreso se documenta neumomediastino y enfisema subcutáneo, por lo que se sospecha lesión de vía aérea la cual se confirma con tomografía y fibrobroncoscopia. Se maneja inicialmente en forma conservadora, con posterior reconstrucción de la vía aérea con una evolución excelente.

[Control of the systolic blood pressure and related factors in patients with high cardiovascular risk]. / Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular.

OBJECTIVE: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. MATERIAL AND METHOD: A cross-sectional observational study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. RESULTS: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 +/- 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 +/- 8.9%, average follow-up was 16.5 +/- 8 months, means SBP was 158 +/- 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis (with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005). In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). CONCLUSIONS: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control.

Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular / Control of the systolic blood pressure and related factors in patients with high cardiovascular risk

Objetivos: Estudiar el grado de control de la tensión arterial sistólica (TAS) y, los factores que pudieran influir en él, en una población de alto riesgo cardiovascular (RCV) con buen cumplimiento terapéutico. Material y método: Estudio observacional realizado en una población hipertensa con RCV elevado en Cáceres. Se recogieron distintas variables biológicas, así como la medición de TA en su primera y última visita. Resultados: De 388 pacientes hipertensos con RCV global elevado se seleccionaron 199 (51,3%) por su buen cumplimiento del tratamiento antihipertensivo. La edad media fue de 63 ± 11 años, 109 (54,1%) varones, 61 (30,7%) diabéticos, el RCV global a 10 años fue del 22,25 ± 9,8%, seguimiento medio 16,5 ± 8 meses, la TAS media fue,158 ± 22 mmHg. El 59,5% realizó tratamiento combinado, generalmente diuréticos con otro antihipertensivo. El 23,9% de los hipertensos presentó cifras de TAS inferiores a 140 mmHg y, el 13,5% de los diabéticos inferiores a 130 mmHg. El control de la TAS fue más probable en los hipertensos con menos de 5 años de conocimiento de su HTA, respecto a los de más evolución (33,8 vs. 15,7%, p 60 mmHg 30,3 (10,6-87: p < 0,0001), influyeron negativamente en el control de la TA. Conclusiones: El control de la TAS en una población de alto RCV con buen cumplimiento terapéutico es difícil de conseguir, más aún en los pacientes diabéticos. El tiempo de evolución de la hipertensión superior a 5 años y, una PP mayor de 60 mmHg, influyen negativamente en el control de la HTA

Objetive: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. Material and method: A cross-sectional observacional study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. Results: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 ± 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 ± 8.9%, average follow-up was 16.5 ± 8 months, means SBP was 158 ± 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis ( with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005).In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). Conclusions: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness.

OBJECTIVE: This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker METHODS: Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999. Telemetry was performed during the first clinic visit, and we observed how many pulse generators retained nominal output settings of the manufactures indicating the absence of reprogramming until that date. After evaluation of the capture threshold, reprogramming of pacemakers was performed with a safety margin of 2 to 2.5:1, and we compared the estimated longevity based on battery current at the manufacturer's settings with that based on settings achieved after reprogramming. RESULTS: In 95% of the cases, the original programmed setting was never reprogrammed before the patients attended the pacemaker clinic. Reprogramming the pacemaker prolonged estimated pulse generator life by 19.7+/-15.6 months (35.5%). CONCLUSION: The majority of the pacemakers evaluated had never been reprogrammed. Estimated pulse generator longevity can be prolonged significantly, using this simple, safe, efficacious, and cost-effective procedure.

Design and evaluation of a cryogenic soft tissue fixation device -- load tolerances and thermal aspects.

Mechanical studies of soft connective tissues often encounter methodological difficulties, particularly in the secure fixation of the tissues. A simple, inexpensive technique which allowed stable cryofixation of soft tissues in uniaxial loading machines was developed. The cryogenic fixation device was evaluated in terms of its fixation strength and the temperature gradients within the tested tissues. Human patellar ligaments and quadriceps tendons were tested successfully to an average failure load of 2219N (S.D. 448N) with mid-substance failures occurring in 90% of the specimens. The temperature gradients within porcine flexor and extensor tendons were determined and found to exhibit a typical diffusion profile. The fixation quality was dependent upon the initial block temperature and the desired testing time. In summary, the cryofixation device presented here is an effective tool for soft tissue fixation but the effect of this type of fixation on internal tissue temperatures and possible testing times must be acknowledged.

Herniorrafia preperitoneal: experiencia en el Hospital Universitario San Ignacio / Preperitoneal repair of inguinal hernia. Experience at San Ignacio University Hospital, Bogotá

Se presenta la experiencia del Hospital Universitario de San Ignacio (HUSI) en reparos herniarios por via preperitoneal, con una morbilidad y recurrencia dentro de los rangos publicados en la literatura. Se analizan los resultados de la cirugia en casos de hernias incarceradas, crurales y reproducidas que hasta el momento constituyen las principales indicaciones del procedimiento, el cual se proyecta hacia el futuro como una tecnica util y segura que permite su empleo en casi todos los tipos de defectos herniarios.