Fungal and Bacterial Loads: Noninvasive Inflammatory Bowel Disease Biomarkers for the Clinical Setting.

Microbiome sequence data have been used to characterize Crohn's disease (CD) and ulcerative colitis (UC). Based on these data, we have previously identified microbiomarkers at the genus level to predict CD and CD relapse. However, microbial load was underexplored as a potential biomarker in inflammatory bowel disease (IBD). Here, we sought to study the use of fungal and bacterial loads as biomarkers to detect both CD and UC and CD and UC relapse. We analyzed the fecal fungal and bacterial loads of 294 stool samples obtained from 206 participants using real-time PCR amplification of the ITS2 region and the 16S rRNA gene, respectively. We combined the microbial data with demographic and standard laboratory data to diagnose ileal or ileocolonic CD and UC and predict disease relapse using the random forest algorithm. Fungal and bacterial loads were significantly different between healthy relatives of IBD patients and nonrelated healthy controls, between CD and UC patients in endoscopic remission, and between UC patients in relapse and non-UC individuals. Microbial load data combined with demographic and standard laboratory data improved the performance of the random forest models by 18%, reaching an average area under the receiver operating characteristic curve (AUC) of 0.842 (95% confidence interval [CI], 0.65 to 0.98), for IBD diagnosis and enhanced CD and UC discrimination and CD and UC relapse prediction. Our findings show that fecal fungal and bacterial loads could provide physicians with a noninvasive tool to discriminate disease subtypes or to predict disease flare in the clinical setting.IMPORTANCE Next-generation sequence data analysis has allowed a better understanding of the pathophysiology of IBD, relating microbiome composition and functions to the disease. Microbiome composition profiling may provide efficient diagnosis and prognosis tools in IBD. However, the bacterial and fungal loads of the fecal microbiota are underexplored as potential biomarkers of IBD. Ulcerative colitis (UC) patients have higher fecal fungal and bacterial loads than patients with ileal or ileocolonic CD. CD patients who relapsed harbor more-unstable fungal and bacterial loads than those of relapsed UC patients. Fecal fungal and bacterial load data improved prediction performance by 18% for IBD diagnosis based solely on clinical data and enhanced CD and UC discrimination and prediction of CD and UC relapse. Combined with existing laboratory biomarkers such as fecal calprotectin and C-reactive protein (CRP), microbial loads may improve the diagnostic accuracy of IBD and of ileal CD and UC disease activity and prediction of UC and ileal CD clinical relapse.

Evaluation of functionality of type II toxin-antitoxin systems of Clostridioides difficile R20291.

Clostridioides difficile is a nosocomial, Gram-positive, strictly anaerobic, spore-forming pathogen capable of colonizing and proliferating in the human intestine. In bacteria, it has been shown that the Toxin-Antitoxin systems mediate the cellular response to external stress by initiating processes such as biofilm formation and programmed cell death. This work aims to evaluate the functionality of four type II TA modules of Clostridioides difficile R20291. We performed bioinformatic analysis to search for putative TA systems using the TADB platform. Then we performed a heterologous expression assay to evaluate the functionality of these systems. Our results showed that the MazEF and RelBE systems were functional, suggesting that their corresponding toxins possess an endoribonuclease activity. In conclusion, MazEF and RelBE systems of C. difficile R20291 are functional in a heterologous expression system.

Ready-to-eat street food: a potential source for dissemination of multidrug-resistant Escherichia coli epidemic clones in Quito, Ecuador.

Ready-to-eat food contamination with ESBL-producing Escherichia coli is a growing health concern. Some of these strains also are epidemic clones and can cause community-associated infections that are difficult to treat. In this study, the occurrence of ESBL-producing E. coli contaminated ready-to-eat street food in Quito, Ecuador was evaluated. In total, 150 samples were collected randomly in the most crowded sites of the city. In all, 34 samples (34/150; 22·6%) were positive for total thermotolerant (44·5°C) coliforms resistant to cefotaxime. MALDI-TOF analysis identified that the E. coli was found in 20 food samples (20/34; 59%). ESBL gene blaCTX-M-55 was identified in nine isolates, blaCTX-M-15 in six isolates, blaCTX-M-14 in two isolates, and one isolate each harboured blaCTX-M-24 , blaCTX-M-65 , blaCTX-M-55 and blaCTX-M-8 . Phylogenetic groups like A and B1 were the most common, followed by groups D and B2. MLST analysis identified 12 different sequence types (STs), the most common was ST162. Recognized epidemic clonal groups ST410, ST131 and ST744 were encountered. Ready-to-eat street food is a potential way of spreading ESBL-producing E. coli epidemic clones in Quito, Ecuador. SIGNIFICANCE AND IMPACT OF THE STUDY: This study identified ESBL-producing Escherichia coli epidemic clones: ST131, ST410 and ST744 in ready-to-eat street food samples. Street food is a possible way to spread harm multidrug-resistant (MDR) E. coli strains in the community. Studies to identify the contamination sources of this kind of food are needed to tackle MDR E. coli dissemination.

Survivorship of wild caught Mepraia spinolai nymphs: The effect of seasonality and Trypanosoma cruzi infection after feeding and fasting in the laboratory.

Chagas disease is caused by Trypanosoma cruzi. Vector survival is an important variable affecting vectorial capacity to determine parasite transmission risk. The aims of this study are to evaluate vector survival under fasting/starvation conditions of wild-caught Mepraia spinolai after feeding and fasting, the pathogenicity of T. cruzi infection, the parasite burden and seasonal variation in parasite discrete typing units (DTU). The survivorship of M. spinolai nymphs after two continuous artificial feedings was evaluated, assessing their infection with microscopic observation of fecal samples and PCR. Later, insects were fasted/starved until death. We performed qPCR analyses of parasite load in the fecal samples and dead specimens. T. cruzi genotyping was performed using conventional PCR amplicons and hybridization tests. Infection rate was higher in M. spinolai nymphs in summer and spring than in fall. Parasite burden varied from 3 to 250,000 parasites/drop. Survival rate for starved nymph stage II was lower in insects collected in the spring compared to summer and fall. TcII was the most frequent DTU. Mainly metacyclic trypomastigotes were excreted. We conclude that M. spinolai infection rate in nymphs varies among seasons, suggesting higher transmission risk in warmer seasons. However, nymphs stage II collected in spring are more sensitive to starvation compared to other seasons. TcII in single or mixed infection does not seem relevant to determine vector pathogenicity. These results of vector survivorship after fasting/starvation are important to determine the competence of M. spinolai as a vector of T. cruzi, since they excrete metacyclic trypomastigotes and the parasitism with T. cruzi seems to be poorly pathogenic to the vector under a severe fasting/starvation condition.

[Cardiovascular Preparticipation Screening of young population. Position statement of Chilean Scientific Societies]. / Evaluación Preparticipativa Cardiovascular Pediátrica. Declaración de posición de la Sociedad Chilena de Pediatría (SOCHIPE), Sociedad Chilena de Medicina del Deporte (SOCHMEDEP) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR).

The Preparticipation Physical Evaluation (PPE), defined as "the health supervision of individuals, prior to the practice of physical activity and/or sports, which seeks to optimize their safe participation in sports and provide an opportunity to identify current and future risks to their health and quality of life", inclu des the Cardiovascular assessment, which aims to screen cardiovascular pathologies with the risk of worsening or sudden death during exercise. Although there is broad international consensus that the use of Pediatric Cardiovascular PPE in young athletes is useful, there is no consensus on whether this should be used in the entire pediatric population or on which is the best strategy to apply. This article presents the position of the scientific societies related to sport, physical activity and child health on the Pediatric Cardiovascular PPE.

Evaluación preparticipativa cardiovascular pediátrica: declaración de posición de la Sociedad Chilena de Pediatría (SOCHIPE), Sociedad Chilena de Medicina del Deporte (SOCHMEDEP) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR) / Cardiovascular preparticipation screening of young population: position statement of Chilean Scientific Societies

La Evaluación Preparticipativa (EPP) definida como "la supervisión de salud de individuos, previo a la práctica de la actividad física y/o deporte, que busca optimizar su participación deportiva segura y brindar una oportunidad para identificar los riesgos actuales y futuros de su salud y su calidad de vida" contempla la EPP Cardiovascular (EPPC), que tiene por objetivo la pesquiza de patologías cardio vasculares con riesgo de agravarse o presentar muerte súbita durante la práctica de ejercicio. Si bien existe amplio consenso internacional respecto a que la realización de la EPPC en jovenes deportistas es de utilidad, no existe consenso respecto a si esta debe ser realizada a toda la población pediátrica ni tampoco sobre cuál es la mejor estrategia a aplicar. En el presente trabajo se presenta la posición de las sociedades cientificas relacionadas al deporte, actividad fisica y salud infantil sobre la Evaluación Preparticipativa Cardiovascular Pediátrica.

The Preparticipation Physical Evaluation (PPE), defined as "the health supervision of individuals, prior to the practice of physical activity and/or sports, which seeks to optimize their safe participation in sports and provide an opportunity to identify current and future risks to their health and quality of life", inclu des the Cardiovascular assessment, which aims to screen cardiovascular pathologies with the risk of worsening or sudden death during exercise. Although there is broad international consensus that the use of Pediatric Cardiovascular PPE in young athletes is useful, there is no consensus on whether this should be used in the entire pediatric population or on which is the best strategy to apply. This article presents the position of the scientific societies related to sport, physical activity and child health on the Pediatric Cardiovascular PPE.

Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores / Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers

Objetivo. Analizar la influencia que la implantación de una guía de buenas prácticas (GBP) para prevenir caídas podría tener sobre la percepción de pacientes hospitalizados y cuidadores respecto a los cuidados proporcionados durante el ingreso y la adherencia (grado de seguimiento) a las recomendaciones recibidas tras el alta. Material y método. Diseño. Estudio cuasiexperimental, que incluyó pacientes>65años ingresados durante≥48h en el área médica del Complejo Hospitalario de Albacete. Muestra. Ciento cuatro sujetos (muestreo consecutivo enero-marzo de 2013). Grupo experimental (GE): ingresados en unidades con implantación de GBP. Grupo control (GC): unidades con cuidados habituales. Variables. Caídas previas y durante ingreso; estado cognitivo (Pfeiffer); independencia en las actividades vida diaria; satisfacción con cuidados e información recibida, utilidad percibida, adherencia a las recomendaciones al alta. Fuentes de datos. Historia clínica y entrevista. Análisis estadístico. Descriptivo y bivariante. Riesgo relativo. IC 95%. Resultados. Ciento cuatro pacientes, GE 46,2% (48) y GC 53,8% (56). Mujeres 51,9%, edad media 79,9 años (d.t.=7,8). Pfeiffer 4,3 (d.t.=3,7). Caídas previas 31,1%. En seguimiento una caída por grupo. Diferencias estadísticamente significativas entre GE/GC: edad, estado cognitivo e independencia para las actividades de la vida diaria. En el GE fue superior el porcentaje de percepción sobre la utilidad de las recomendaciones para prevenir caídas (p<0,001), mayor adherencia (p=0,0002) y estar muy o suficientemente satisfechos con la información (p<0,00004) y los cuidados recibidos (p=0,002). Conclusión. Aplicar recomendaciones siguiendo una GBP para prevenir caídas en personas mayores ha mostrado en usuarios y cuidadores mayor satisfacción con la información, mejor percepción sobre su utilidad y mayor adherencia a las recomendaciones (AU)

Objective. To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. Material and method. Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. Sample. 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. Variables. Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. Data sources. Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. Results. 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). Conclusion. To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations (AU)

[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]. / Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores.

OBJECTIVE: To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. MATERIAL AND METHOD: Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. SAMPLE: 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. VARIABLES: Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. DATA SOURCES: Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. RESULTS: 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). CONCLUSION: To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

A major fish stranding caused by a natural hypoxic event in a shallow bay of the eastern South Pacific Ocean.

A massive beaching and mortality of fishes occurred in Coliumo Bay, a shallow bay located along the coast of the eastern South Pacific Ocean on 3 January 2008. This stranding was a consequence of an abrupt decrease in the dissolved oxygen concentration throughout the whole water column, due to the effect of intense upwelling along the coast off central-southern Chile. The main objectives of this study were: (1) to characterize taxonomically and biologically the fish species assemblage present in this beaching; (2) to evaluate several physiological indicators for the condition of the beached species at the time of their death; and (3) to assess the possible cause-effect mechanisms involved in the fishes death and the changes that took place in the fish community throughout the time. In this beaching, 26 fish species were identified: 23 teleosts, one myxiniform and two elasmobranchs. Most beached specimens were juveniles. Haematological and histological evidence indicate that severe hypoxia that lasted for at least 48 h was the most plausible cause of death. The main conclusion of this study is that the presence of oxygen-poor equatorial sub-surface water in the shallow coastal zone due to intense regional-scale upwelling caused the fish stranding. Although the effect of the hypoxic event was severe for the fish assemblage of Coliumo Bay, the rapid recuperation observed suggests that hypoxic events at the local spatial scale can be buffered by migration processes from the fish community inhabiting close by areas non-affected by low oxygen conditions. The effect that severe hypoxic events may have on larger spatial scales remains unknown.

Efecto de la variedad y la fertilización en indicadores de calidad proteica in-vitro de dos variedades y una línea de garbanzo (cicer arietinum) / Variety and fertilization effect on indicators of protein quality in-vitro of two varieties and one line of chickpea (cicer arietinum)

Protein quality in relation to the degree of fertilization of two varieties (Costa and Blanco Sinaloa) and an advanced line (Hoga L10) of chickpeas obtained from the Campo Experimental Costa de Hermosillo, Sonora, Mexico from INFAP was evaluated. They were grown in similar conditions with 3 levels of nitrogen fertilization (60,120 and 200K/Ha.). Protein and non-protein nitrogen, digestibility and available lysine were analyzed. Significant differences between the varieties and the advanced line in protein and non-protein nitrogen and available lysine were found. The effect of the degree of fertilization on protein quality was significant, showing that a level ofl20KI Ha an increase is observed in protein and non-protein nitrogen and in the percent of digestibility. No significant differences were observed between 60 and 200KIHa. Available lysine was higher at the 200KIHa level. These indicators of protein quality can be used to complement commercial and agricultural aspects that are evaluated for improvement and selection of new varieties of chickpeas.

En este trabajo se evaluó la calidad proteica in-vitro en dos variedades y una línea avanzada de garbanzo, así como su relación con el grado de fertilización aplicado durante su cultivo. Se utilizaron dos variedades comerciales de garbanzo (Costa y Blanco Sinaloa) y una línea avanzada Hoga L10, sembradas en condiciones ambientales similares, con tres niveles de fertilización de nitrógeno (60, 120 y 200K/Ha.), las cuales fueron obtenidas del Campo Experimental Costa de Hermosillo, Sonora, México del INIFAP. Se llevó a cabo un análisis químico proximal, determinaciones de calidad proteica como: nitrógeno proteico y no proteico utilizando extracciones con ácido tricloroacético, digestibilidad in-vitro por el método multienzimático y lisina disponible. A excepción de digestibilidad in-vitro se observaron diferencias significativas entre las variedades y línea avanzada en: nitrógeno proteico, no proteico y lisina disponible. El efecto de la fertilización fue observado en todos las determinaciones de calidad proteica, los resultados indicaron que al aumentar el nivel de fertilización a 120K/Ha se obtiene un incremento significativo en el porcentaje de nitrógeno proteico y no proteico, así como el porcentaje de digestibilidad. Entre los niveles de 60 y 200K/Ha no se observaron diferencias significativas. La lisina disponible fue mayor en las variedades y líneas con nivel de fertilización de 200K/Ha. Estos indicadores de calidad proteica pueden complementar a los aspectos agronómicos y comerciales que son evaluados en los programas de mejoramiento, en la selección de nuevas variedades de garbanzo para su explotación comercial.

Identification of T-cell stimulating antigens from Giardia lamblia by using Giardia-specific T-cell hybridomas.

T-cell immune response plays an important role in controlling Giardia lamblia infections. Little is known about the G. lamblia-specific antigens that stimulate a cell-mediated immune response. The aim of the present study was to identify T-cell stimulating G. lamblia antigens. For this purpose, we generated a group of Giardia-specific T-cell hybridomas (2F9, 4D5, 6D10, 8B9, 9B10, 10F7 and 10G5). Hybridomas were screened for reactivity with G. lamblia protein extract by the CTLL bioassay. These T-cell hybridomas did not exhibit any significant activation either in the absence of G. lamblia protein extract or in the presence of irrelevant antigen (hen white egg lysozyme). To further characterize the T-cell hybridomas generated, we selected three hybridomas (10G5, 4D5 and 9B10). Giardia lamblia proteins of 90-110, 65-77 and 40-64 kDa showed T-cell stimulating activity for the hybridomas 10G5, 4D5 and 9B10, respectively, in a concentration-dependent manner. Protein extract obtained from different G. lamblia strains (GS/M-83-H7, WB C6 and a clinical isolate (YJJ)) stimulated all T-cell hybridomas, indicating that T-cell-stimulating antigens are expressed among different G. lamblia strains. In conclusion, we identified T-cell stimulating G. lamblia antigens by using Giardia-specific T-cell hybridomas. To our knowledge, these hybridomas are the first-described T-cell hybridomas specific for G. lamblia.

Isolation and properties of AMP deaminase from jumbo squid (Dosidicus gigas) mantle muscle from the Gulf of California, Mexico.

Adenosine monophosphate (AMP) deaminase was purified from jumbo squid mantle muscle by chromatography in cellulose phosphate, Q-Fast and 5'-AMP sepharose. Specific activity of 2.5U/mg protein, 4.5% recovery and 133.68 purification fold were obtained at the end of the experiment. SDS-PAGE showed a single band with 87kDa molecular mass, native PAGE proved a band of 178kDa, whereas gel filtration detected a 180kDa protein, suggesting the homodimeric nature of this enzyme, in which subunits are not linked by covalent forces. Isoelectric focusing of this enzyme showed a pI of 5.76, which agrees with pI values of AMP deaminase from other invertebrate organisms. AMP deaminase presented a kinetic sigmoidal plot with Vmax of 1.16µM/min/mg, Km of 13mM, Kcat of 3.48µM.s(-1) and a Kcat/Km of 267 (mol/L)(-1).s(-1). The apparent relative low catalytic activity of jumbo squid muscle AMP deaminase in the absence of positive effectors is similar to that reported for homologous enzymes in other invertebrate organisms.

Calidad de vida en madres de lactantes portadores de sibilancias recurrentes / Quality of life in mothers of infants with recurrent wheezing

Existe escasa información sobre la calidad de vida en madres de lactantes con sibilancias recurrentes. En este estudio aplicamos una encuesta de medición de calidad de vida a dos grupos de madres de lactantes con episodios recurrentes de obstrucción bronquial controlados uno por especialistas (MRI) y otro en Atención Primaria (AP). Doscientas madres respondieron la encuesta PACQLQ de Juniper. También 42 madres de lactantes sanos respondieron el cuestionario. Los puntajes, promedios ± DS, para MRI y AP respectivamente, fueron: 4,7 ± 1,7 y 3,9 ± 1,7 en área actividad; 4,7 ± 1,4 y 3,8 ± 1,2 en área emocional y 4,6 ± 1,4 y 3,9 ± 1,2 en puntaje total. Las diferencias fueron significativas (p < 0,05) en favor de MRI. Se concluye que las madres de pacientes portadores de sibilancias recurrentes atendidos por especialistas presentan menor compromiso de índices de calidad de vida que aquellas madres atendidas por médicos generales...

Regulation of Cbl molecular interactions by the co-receptor molecule CD43 in human T cells.

CD43, one of the most abundant glycoproteins on the T cell surface, has been implicated in selection and maturation of thymocytes and migration, adhesion, and activation of mature T cells. The adapter molecule Cbl has been shown to be a negative regulator of Ras. Furthermore, it may also regulate intracellular signaling through the formation of several multi-molecular complexes. Here we investigated the role of Cbl in the CD43-mediated signaling pathway in human T cells. Unlike T cell receptor signaling, the interaction of the adapter protein Cbl with Vav and phosphatidylinositol 3-kinase, resulting from CD43-specific signals, is independent of Cbl tyrosine phosphorylation, suggesting an alternative mechanism of interaction. CD43 signals induced a Cbl serine phosphorylation-dependent interaction with the tau-isoform of 14-3-3. protein. Protein kinase C-mediated Cbl serine phosphorylation was required for this interaction, because the PKC inhibitor RO-31-8220 prevented it, as well as 14-3-3 dimerization. Moreover, mutation of Cbl serine residues 619, 623, 639, and 642 abolished the interaction between Cbl and 14-3-3. Overexpression of Cbl in Jurkat cells inhibited the CD43-dependent activation of the mitogen-activated protein kinase (MAPK) pathway and AP-1 transcriptional activity, confirming nevertheless a negative role for Cbl in T cell signaling. However, under normal conditions, PKC activation resulting from CD43 engagement was required to activate the MAPK pathway, suggesting that phosphorylation of Cbl on serine residues by PKC and its association with 14-3-3 molecules may play a role in preventing the Cbl inhibitory effect on the Ras-MAPK pathway. These data suggest that by inducing its phosphorylation on serine residues, CD43-mediated signals may regulate the molecular associations and functions of the Cbl adapter protein.

Cirugía mayor ambulatoria / Ambulatory main surgery

En el Departamento y Servicio de Cirugía del Hospital del Salvador, se ha seguido desarrollando desde el el 1 de marzo de 1989 al 1 de marzo de 1999, el programa de Cirugía Mayor Ambulatoria (CMA), habiéndose operado 1.050 pacientes, con un seguimiento a 10 años. Se destacan los beneficios integrales comprobados, además de los buenos resultados y se recomienda su implementación en todo el país

Síndrome de Marfán y embarazo / Marfan's syndrome and pregnancy

El síndrome de marfan presenta graves complicaciones en la mujer embarazada. Se presenta un caso clínico de una paciente aquejada del síndrome en la cual no hubo complicaciones maternas ni fetales. Se realiza una revisión del cuadro clínico y las complicaciones que acompañan al síndrome

[Transesophageal echocardiography: experience with the first 500 consecutive cases]. / Ecocardiografía transesofágica: experiencia en los primeros 500 casos consecutivos.

The results of all the transesophageal echocardiographies (TEE) performed between June 1989 and February 1992 are analyzed. Five hundred patients (240 male) with a median age of 57 years (range 13-88) were examined; during the same period, 5180 transthoracic echocardiographies were performed. TEE were requested for the following reasons: valvular prosthesis disfunction in 132 patients, rheumatic valvulopathy in 103, search for embolic origins in 97, study of congenital cardiopathies in 48, bacterial endocarditis in 35, aortic dissection in 25 and miscellaneous in 78. Among congenital cardiopathies there were 29 cases of interauricular communication and among miscellaneous cases, 9 patients with cardiac tumors. No major complications occurred. The imaging quality of this technique renders it specially important in the study of prosthesis disfunction, mitral valve analysis before valvuloplasty, detection of cardiac origins of emboli and infective endocarditis complications and anatomical and dynamic analysis of aortic dissection. It is concluded that TEE is a safe technique that provides high quality images and visualizes segments of the heart and great vessels formerly inaccessible with transthoracic echocardiography. It has enlarged the diagnostic capacity of echocardiography and improved the support of therapeutic decisions.