Uso de nuevos anticoagulantes en la Unidad Coronaria del Hospital Privado del Sur de Bahía Blanca / Use of news anticoagulants in the Coronary Unit of Hospital Privado del Sur in Bahía Blanca

Introducción: La utilización de los nuevos anticoagulantes orales (NACOs), en reemplazo de los clásicos antagonistas de la vitamina K (AVK), es una nueva opción terapéutica para el manejo de enfermedades tromboembólicas. Objetivo: Iniciar un estudio retrospectivo acerca de la utilización de los NACOS con pacientes del Servicio de Cardiología del HPS, para disponer de datos propios respecto al uso de estos nuevos anticoagulantes. Materiales y Métodos: Estudio retrospectivo, observacional y longitudinal, con la base de datos del Servicio de Cardiología del HPS (Junio de 2016-Mayo de 2017). Población: pacientes con Fibrilación Auricular (FA) y Tromboembolismo pulmonar (TEP) tratados con NACOs. La recolección de datos fue mediante encuesta telefónica voluntaria a pacientes o familiares con un formulario preestablecido. Resultados: Se registró un evento hemorrágico mayor en un paciente con bajo riesgo hemorrágico. No se registró ningún evento cardioembólico. Discusión: Los nuevos anticoagulantes orales resultaron ser seguros en cuanto a sus complicaciones y mejor aceptados por los pacientes que los AVK. La principal limitante de la continuidad de su uso fue la diferencia de costos, respecto a los clásicos antagonistas de la Vitamina K.

Cardiomiopatía de Tako-tsubo y síndrome de QT largo congénito / Tako-tsubo cardiomyopathy and congenital long QT syndrome

La miocardiopatía de Tako-tsubo (MT) y síndrome de QT largo congénito (SQTLc) son dos entidades que presentan un retardo de la repolarización cardíaca y su asociación ha sido publicada en reportes de casos. Presentamos el caso de una paciente de 55 años, con antecedentes de SQTLc, que ingresó a nuestro hospital por dolor precordial, luego de un evento estresante, diagnosticándose MT. Evolucionó con prolongación del intervalo QT en el electrocardiograma, persistiendo luego de la externación, sin presentar episodios de arritmias ventriculares ni síncope

Takobsubo cardiomyopathy (TC) and congenital long QT syndrome (LQTS) are two entities that present a delay of cardiac repolarization and their association has been published in case reports. We present the case of a 55-year-old female patient with medical history of congenital LQTS, who was admitted to our hospital due to precordial pain after a stressful event and TC was diagnosed. She evolves with QT interval prolongation on the ECG that remains after the externalization, without presenting any episodes of ventricular arrhythmia or syncope

A cardiomiopatia de Tako-tsubo (CT) e a síndrome do QT longo congênito (SQTLc) são duas entidades que apresentam um atraso da repolarização cardíaca e sua associação foi publicada em relatos de casos. Apresentamos o caso de uma paciente de 55 anos de idade com história médica de SQTLc, admitida em nosso hospital devido a dor precordial após um evento estressante, com diagnóstico de CT. Ela evolui com prolongamento do intervalo QT no ECG que permanece após a externalização, sem apresentar nenhum episódios de arritmias ventriculares ou síncope

Muerte súbita cardíaca asociada a puente miocárdico / Sudden cardiac death associated with myocardial bridge

La muerte súbita cardíaca en deportistas genera un gran impacto social y familiar, afortunadamente su incidencia es baja. En atletas menores de 35 años las causas más frecuentes son las anomalías genéticas y las miocardiopatías. Presentamos el caso de un paciente masculino de 17 años que presentó muerte súbita reanimada mientras realizaba actividad física. El electrocardiograma post animación evidenció una injuria subepicárdica en cara anterior, encontrándose en la cinecoronariografía como único hallazgo, la existencia de un puente muscular en tercio medio de la arteria descendente anterior.

Cardiac arrest in athletes has a high impact in family and society, fortunately its incidence is low. In athletes younger than 35 years old the most frequent causes are genetic anomalies and cardiomyopathies. We report the case of a 17 years old male patient who presented cardiac arrest and reanimation while doing physical activity. The post-reanimation electrocardiogram showed a subepicardial injury in the anterior face, detecting in cinecoronariography as only finding the presence of myocardial bridging in the middle third of anterior descending artery.

A parada cardíaca em atletas tem um alto impacto na família e na sociedade, felizmente sua incidência é baixa. Em atletas menores de 35 anos as causas mais freqüentes são anomalias genéticas e cardiomiopatías. Relatamos o caso de um paciente do sexo masculino de 17 anos de idade que apresentou parada cardíaca e reanimação durante atividade física. O eletrocardiograma pós-reanimação mostrou lesão subepicárdica na face anterior, detectar na cinecoronariografia como apenas encontrar a presença de ponte miocárdica no terço médio da artéria descendente anterior.

Taquicardia ventricular como manifestación de sarcoidosis cardíaca. Reporte de un caso / Ventricular tachycardia as a manifestation of cardiac sarcoidosis. Case report

La sarcoidosis es una enfermedad inflamatoria crónica que posee una amplia variabilidad de presentaciones clínicas. El compromiso cardíaco de esta patología oscila en el orden del 5%, pudiendo variar desde anormalidades en la conducción hasta la falla cardíaca. Existe poco conocimiento sobre los beneficios de su tratamiento y no hay datos que evalúen la reducción de la mortalidad a largo plazo, por lo que genera este tipo de pacientes un gran desafío para el profesional. A continuación presentamos el caso de un masculino de 37 años con taquicardia ventricular como debut cardiológico de una sarcoidosis.

Murine sperm capacitation, oocyte penetration and decondensation following moderate alcohol intake.

Male chronic alcohol abuse causes testicular failure and infertility. We analyzed the effects of moderate sub-chronic alcohol intake on sperm morphology, capacitation, fertilization and sperm head decondensation. CF-1 male mice were administered 15% ethanol in drinking water for 15 days; control mice received ethanol-free water. Similar patterns of tyrosine phosphorylation were observed in capacitated spermatozoa of control and treated males. Percentage of hyperactivation (H) and spontaneous (SAR) and progesterone-induced (IAR) acrosome reaction significantly decreased at 120 and 150 min of capacitation in treated males compared to controls (H: 14.1 ± 2.5 vs 23.7 ± 2.6, P < 0.05; SAR-T120 min: 17.9 ± 2.5 vs 32.9 ± 4.1, P < 0.01; IAR-150 min: 43.3 ± 3.5 vs 73.1 ± 1.1, P < 0.001, n = 6). During in vitro fertilization (2.5, 3.5 and 4.5 h post-insemination), there was an increased percentage of fertilized oocytes (with a decondensed sperm head and one or two pronuclei) in treated males (P < 0.001, n = 7). After 60 min of in vitro decondensation with glutathione plus heparin, the percentage of decondensed sperm heads was significantly higher in treated males than in controls (mean ± s.d.: 57.1 ± 5.6 vs 48.3 ± 4.5, P < 0.05, n = 5). The percentage of morphologically normal sperm heads was significantly decreased in treated males with respect to controls (P < 0.001, n = 9). These results show that short-term moderate alcohol consumption in outbred mice affect sperm morphology, hyperactivation, acrosomal exocytosis, and the dynamics of in vitro fertilization and in vitro sperm nuclear decondensation.

Registro de pacientes con insuficiencia cardíaca aguda en la unidad coronaria del Hospital Privado del Sur de Bahía Blanca / Recording of patients with acute heart failure in the coronary care unit at Hospital Privado del Sur in Bahía Blanca

Introducción: La insuficiencia cardíaca (IC) es una entidad clínica con alta prevalencia que implica una elevada morbi-mortalidad. Conocer nuestros registros es una herramienta fundamental para intervenir en el abordaje de esta patología. Objetivo: Analizar el registro de pacientes ingresados a la unidad coronaria (UCO) del Hospital Privado del Sur de Bahía Blanca (HPS), que fueron diagnosticados con IC. Material y Métodos: Estudio descriptivo transversal de los pacientes ingresados a UCO del HPS durante el período julio 2016 -julio 2017 con diagnóstico de alta de IC. De la base de datos de UCO del HPS se obtuvieron las siguientes variables: edad, sexo, factores de riesgo cardiovascular (FRC), causas desencadenantes, comorbilidades, fracción de eyección (FEY), necesidad de inotrópicos y asistencia respiratoria mecánica, días de internación y número de reinternaciones. Análisis estadísticos: En el análisis de variables cualitativas se utilizaron frecuencias absolutas y relativas. Para variables cuantitativas se empleó la mediana. La recopilación y análisis estadístico se realizó con el programa informático SPSS.Resultados: Se registraron 85 pacientes, 58 hombres (68,2%); 70 (82,4%) fueron mayores de 65 años; Patologías: 66 (77,6 %) hipertensos, 27 (31,8 %) diabéticos, 37 (43,5 %) dislipémicos, 30 (35,3 %) tenían antecedentes de IAM, 17 (20,0 %) de fibrilación auricular. Las causas desencadenantes más frecuentes fueron transgresión dietaria, arritmia e infección. Tuvieron Fraccione de Eyección (FEY) menor de 40 %: 45 pacientes (52,9 %). La mediana de días de internación fue 5 (2-53); 7 (8,2%) pacientes se reinternaron, cuya mediana fue 1 (Score 1-5). Conclusiones: Entre las causas desencadenantes, los Factores de Riesgos Cardiovascular y los días de internación, fueron similares a los reportados en la bibliografía, Sin embargo, las reinternaciones se presentaron en un número menor de pacientes y se asociaron mayoritariamente a FEY reducida.

Introduction: heart failure (HF) is a high prevalence clinical condition with a high morbidity and mortality rate. Knowledge of our records is an essential tool to approach this disease. Objetive: to analyze the record of patients admitted to the coronary care unit (CCU) at the Hospital Privado del Sur (HPS) in Bahía Blanca, who were diagnosed with HF. Materials and Methods: cross-sectional descriptive study of patients admitted at the CCU in the HPS from July 2016 to July 2017 with a discharge diagnosis of HF. From the CCU database the following variables were obtained: age, gender, cardiovascular risk factors (CRF), trigger causes, co-morbidities, ejection fraction (EF), need for inotropics and mechanical ventilation, number of days in hospital and number re-admissions. Statistical Analysis: In the qualitative variable analysis absolute and relative frequencies were analyzed. Median was used for quantitative variables. Statistical data collection and analysis was performed using the SPSS software. Results: 85 patients were registered, 58 males (68.2%); 70 (82.4%) older than 65 years; pathologies: 66 (77.6 %) presented HBP, 27 (31.8 %) diabetes, 37 (4.5 %) dyslipidemia, 30 (35.3 %) a history of Acute Myocardial Infarction (AMI), and 17 (20.0 %) auricular fibrillation. The most frequent triggers were dietary transgression, arrhythmia and infection. They presented Ejection Fractions (EF) lower than 40 %: 45 patients (52.9 %). The median of days in hospital was 5 (2-53). Seven (8.2%) patients were re-admitted into hospital, whose median was 1 (Score 1-5). Conclusions: Among triggers, cardiovascular risk factors and number of days in hospital were similar to those reported in the bibliography. However, re-admission rate was lower and mainly associated to reduced EF.

Tromboembolia venosa en el embarazo: Reporte de un caso / Venous thromboembolism in pregnancy: A case report / Tromboembolia venosa na gravidez: Relato de caso

La tromboembolia venosa es una enfermedad relativamente frecuente con importante morbimortalidad. En pacientes embarazadas presentan un riesgo incrementado en 5 veces respecto de las no embarazadas, siendo la segunda causa de muerte en dicha población. La prevención, el diagnóstico y el manejo terapéutico se ven complicados por la escasez de abordajes y evidencia validados. Presentamos el caso de una gestante de 9,2 semanas de embarazo con diagnóstico de tromboembolia venosa que evoluciona con compromiso hemodinámico y necesidad de uso de trombolíticos.

Venous thromboembolism is a relatively frequent condition with a high morbidity and mortality rate. The risk in pregnant patients is five times greater than in not pregnant ones. It's the second cause of death amongst them. Prevention, diagnosis and therapeutic management are complicated by scarcity of approaches and validated evidence. We report the case of a pregnant 9.2 weeks of pregnancy diagnosed with venous thromboembolism evolving with hemodynamic compromise and the need for use of thrombolytics.

A tromboembolia venosa é uma doença relativamente comum com significativa morbidade e mortalidade. Em pacientes grávidas, o risco é 5 vezes maior em comparação com não-grávidas, sendo a segunda causa de morte nesta população. Prevenção, diagnóstico e manejo terapêutico são complicados pela carência de abordagens e provas validadas. Relatamos o caso de uma paciente grávida de 9,2 semanas de gravidez com diagnóstico de tromboembolia venosa evoluindo com comprometimento hemodinâmico e a necessidade de uso de trombolíticos.

Dermatan sulfate synergizes with heparin in murine sperm chromatin decondensation.

The mammalian sperm nucleus contains an unusually condensed chromatin, due to replacement of the majority of histones by protamines. However, soon after the spermatozoon penetrates the ooplasm at fertilization, decondensation of this densely packed chromatin must occur to allow formation of the male pronucleus and syngamy. Decondensation is accomplished by protamine disulfide bond reduction by oocyte glutathione and replacement of protamines by oocyte histones with the aid of an acceptor molecule. Previous results from our laboratory have demonstrated that heparan sulfate (HS) present in the ooplasm functions as protamine acceptor during human sperm decondensation in vivo. In the present paper, we analyze the role of heparin, structural analogue of HS, and dermatan sulfate (DS) in murine sperm chromatin decondensation in vitro, including the possibility of a synergistic effect between both glycosaminoglycans. Decondensation was assessed under phase contrast microscopy following incubation of murine spermatozoa with glutathione and either heparin, DS, or a combination of both. Ultrastructural changes taking place during decondensation were analyzed by transmission electron microscopy. Both glycosaminoglycans were able to promote the decondensation of murine spermatozoa in vitro but the decondensing ability of heparin was significantly higher. Use of both glycosaminoglycans together revealed the existence of a synergistic effect. Transmission electron microscopy analysis of decondensing spermatozoa supported these findings. Synergism between heparin and DS was observed both in capacitated and non-capacitated spermatozoa but decondensation kinetics was faster in the former. The results obtained indicate a new potential role for dermatan sulfate in murine sperm decondensation at fertilization and provide evidence of differences in the degree of chromatin condensation throughout the murine sperm nucleus.

Interleukin-1 beta regulates metalloproteinase activity and leptin secretion in a cytotrophoblast model.

Implantation is one of the most regulated processes in human reproduction, by endocrine and immunological systems. Cytokines are involved in embryo-maternal communication and an impaired balance could result in pregnancy loss. Here we investigated the effect of interleukin 1-beta on the activity of two important metalloproteinases (MMP-2 and MMP-9) that are involved in extracellular matrix remodeling as well as the secretion of leptin, one of the reproductive hormones actively regulating their activity and secretion. We found that IL-1 beta activates matrix metalloproteinase activity as well as increases leptin secretion. We propose that this interleukin, through the regulation of leptin, in turn activates matrix metalloproteinases which results in an increased cytotrophoblast invasion.

Interleukin-1 beta regulates metalloproteinase activity and leptin secretion in a cytotrophoblast model

Implantation is one of the most regulated processes in human reproduction, by endocrine and immunological systems. Cytokines are involved in embryo-maternal communication and an impaired balance could result in pregnancy loss. Here we investigated the effect of interleukin 1-beta on the activity of two important metalloproteinases (MMP-2 and MMP-9) that are involved in extracellular matrix remodeling as well as the secretion of leptin, one of the reproductive hormones actively regulating their activity and secretion. We found that IL-1 beta activates matrix metalloproteinase activity as well as increases leptin secretion. We propose that this interleukin, through the regulation of leptin, in turn activates matrix metalloproteinases which results in an increased cytotrophoblast invasion.

Interleukin-1 beta regulates metalloproteinase activity and leptin secretion in a cytotrophoblast model

Implantation is one of the most regulated processes in human reproduction, by endocrine and immunological systems. Cytokines are involved in embryo-maternal communication and an impaired balance could result in pregnancy loss. Here we investigated the effect of interleukin 1-beta on the activity of two important metalloproteinases (MMP-2 and MMP-9) that are involved in extracellular matrix remodeling as well as the secretion of leptin, one of the reproductive hormones actively regulating their activity and secretion. We found that IL-1 beta activates matrix metalloproteinase activity as well as increases leptin secretion. We propose that this interleukin, through the regulation of leptin, in turn activates matrix metalloproteinases which results in an increased cytotrophoblast invasion.(AU)

Interferon-gamma inhibits metalloproteinase activity and cytotrophoblast cell migration.

PROBLEM: Establishment of a successful pregnancy relies on a complex fetal-mother communication that starts with the embryo adhering and invading the endometrium. This requires remodeling of extracellular matrix, performed by metalloproteinases. Cytokines, such as interferon-gamma (IFN-gamma), play a role in implantation and could affect the success of pregnancy. METHOD OF STUDY: Using JEG-3 cell line as model, we cultured the cells in the presence or absence of IFN-gamma and determined the activities of MMP-2 and MMP-9 using zymography and the secretion of leptin using Western blot. RESULTS: Interferon-gamma inhibits gelatinase activity from MMP-2 and MMP-9 in a dose-dependent manner, reducing the secretion of leptin (not because of a general inhibition on protein synthesis) and impairs cell migration on Matrigel. CONCLUSION: Our results correlate with previous reports from our laboratory indicating that IFN- gamma is deleterious for mouse embryo outgrowth, having an effect on metalloproteinases activity as well as leptin secretion.