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OBJECTIVES: There is little data evaluating procedural skills in current rural pediatric practices. In order to prepare a cadre of pediatricians to work in rural settings, we require an understanding of the unique procedural skills needed by rural pediatric providers. Our objective was to determine how often pediatricians performed various procedural skills, determine the importance of these skills to current practice, and how they differ between rural and urban pediatric providers. METHODS: A survey evaluating pediatrician utilization of the 13 required Accreditation Council Graduate Medical Education procedural skills in current practice was developed and distributed to pediatric providers in New Mexico. Descriptive statistics were used to profile participants and describe survey responses. Chi-square tests were used to evaluate differences by urban setting or IHS. Fisher's exact test was employed to assess differences if cell sizes were less than five. All p-values were two sided with alpha=.05. Benjamini-Hochberg method was used to control for type 1 errors. RESULTS: Fifty-two of 216 pediatric providers responded. The majority surveyed performed each of the 13 procedures less than monthly but competency in many of these procedures is important. Thirty-two respondents submitted free-text responses recommending competence with tracheostomy changes, gastrostomy-tube changes/cares, and circumcision. CONCLUSION: Majority of surveyed pediatricians performed the required procedures less than monthly but deemed several procedures to be important. Rural pediatricians recommended specific procedural skills needed in rural practice. All trainees receive procedural skills training. However, trainees interested in rural practice may need additional training in specific skills different than their non-rural counterparts.
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Resumen: La disección coronaria espontánea, también llamada disección coronaria primaria, se trata de una afección subdiagnosticada, dadas las características variables de manifestación clínica, que incluyen dolor precordial, síndrome coronario agudo, arritmias ventriculares y muerte súbita. Afecta frecuentemente a mujeres entre 30 y 40 años de edad, y con frecuencia afecta a mujeres embarazadas o que cursan el puerperio, que además se caracterizan por no tener factores de riesgo cardiovascular. Este artículo comunica el caso de una paciente de 43 años de edad en la que se estableció el diagnóstico de disección coronaria espontánea y realizamos una revisión del tema.
Abstract: Spontaneous coronary dissection or primary coronary dissection is an underdiagnosed condition, given the variable characteristics of clinical presentation including precordial pain, acute coronary syndrome, ventricular arrhythmias and sudden death. It frequently affects women between the ages of 30 and 40, and frequently affects pregnant or postpartum women, who are also characterized by a lack of cardiovascular risk factors. The following article discusses the case of a 43-year-old woman in whom a diagnosis of spontaneous coronary dissection was established, and we performed a brief review of the topic.
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Resumen: La adiponectina es una adipocina con acciones ubicuas, con propiedades antiinflamatorias y efectos antiapoptósicos. Entre sus acciones, esta proteína aumenta la sensibilidad a la insulina y disminuye el riesgo cardiovascular. Las concentraciones reducidas de adiponectina se asocian con mayor riesgo de diabetes mellitus tipo 2, síndrome metabólico, aterosclerosis y enfermedades cardiovasculares. Debido a esta evidencia, los esfuerzos de los estudios básicos y clínicos se han enfilado a ampliar la comprensión del metabolismo de esta proteína, así como al desarrollo de métodos para modular su concentración y su bioactividad como prometedoras herramientas terapéuticas. El objetivo de este trabajo es revisar el metabolismo de la adiponectina y explorar su utilidad como objetivo terapéutico.
Abstract: Adiponectin is an adipokine with ubiquitous actions, anti-inflammatory properties and antiapoptotic effects. Among its actions, this protein increases insulin sensitivity and reduces cardiovascular risk. A reduced level of adiponectin is associated with an increased risk of developing type 2 diabetes mellitus, metabolic syndrome, atherosclerosis and cardiovascular disease. Due to this evidence, the efforts of the basic and clinical studies have been directed to increase the understanding of the metabolism of this protein, as well as to develop methods to modulate its concentration and its bioactivity. The aim of this work is to review the metabolism of adiponectin and to explore its usefulness as a therapeutic target.
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OBJECTIVE: To assess the accuracy of RSR' patterns in lead V1 (RSR'-V1) in diagnosing atrial septal defects (ASDs) in children. STUDY DESIGN: Children who underwent an electrocardiogram (ECG) during 2010 were divided into 2 ECG groups: RSR'-V1 and normal (no RSR'-V1). Children who underwent an echocardiogram during 2010 were also divided into an ASD group and a normal echocardiogram group. The 4 groups were matched in a 2 × 2 table format where the RSR'-V1 was the "test" and ASD was the "disease." Sensitivity, specificity, positive/negative predictive values, and pre/post-test probabilities were calculated. RESULTS: There were 4658 ECG studies included in the analysis: 836 had RSR'-V1 and 3822 were normal without RSR'-V1. Of 4935 echocardiographic studies analyzed, 329 had an ASD and 4606 were normal; 1363 patients had both studies done during the study period. The ECG sensitivity for diagnosing an ASD was 36.1%, specificity was 80%, positive predictive value was 14.7%, and negative predictive value was 92.9% with an overall accuracy of 76.2%. Patients with ASD and RSR'-V1 were significantly older than patients with ASD and no RSR'-V1 pattern. CONCLUSION: RSR'-V1 is a poor screening test for the detection of ASD. It should not change the clinical suspicion or the decision to obtain an echocardiogram. Older children without RSR'-V1 on ECG are unlikely to have an ASD.