Estrategia fármaco-invasiva en el manejo del infarto agudo al miocardio con supradesnivel del ST / Pharmaco-invasive approach in the management of acute myocardial infarction. Analysis of 144 cases

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

[Pharmaco-invasive approach in the management of acute myocardial infarction. Analysis of 144 cases]. / Estrategia fármaco-invasiva en el manejo del infarto agudo al miocardio con supradesnivel del ST.

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

Are electrophysiological and oligodendrocyte alterations an element in the development of multiple sclerosis at the same time as or before the immune response?

Efficient communication between the glial cells and neurons is a bi-directional process that is essential for conserving normal functioning in the central nervous system (CNS). Neurons dynamically regulate other brain cells in the healthy brain, yet little is known about the first pathways involving oligodendrocytes and neurons. Oligodendrocytes are the myelin-forming cells in the CNS that are needed for the propagation of action potentials along axons and additionally serve to support neurons by neurotrophic factors (NFTs). In demyelinating diseases, like multiple sclerosis (MS), oligodendrocytes are thought to be the victims. Axonal damage begins early and remains silent for years, and neurological disability develops when a threshold of axonal loss is reached, and the compensatory mechanisms are depleted. Three hypotheses have been proposed to explain axonal damage: 1) the damage is caused by an inflammatory process; 2) there is an excessive accumulation of intra-axonal calcium levels; and, 3) demyelinated axons evolve to a degenerative process resulting from the lack of trophic support provided by myelin or myelin-forming cells. Although MS was traditionally considered to be a white matter disease, the demyelination process also occurs in the cerebral cortex. Recent data supports the notion that initial response is triggered by CNS injury. Thus, the understanding of the role of neuron-glial neurophysiology would help provide us with further explanations. We should take in account the suggestion that MS is in part an autoimmune disease that involves genetic and environmental factors, and the pathological response leads to demyelination, axonal loss and inflammatory infiltrates.

Hydrocarbon Degradation and Lead Solubility in a Soil Polluted with Lead and Used Motor Oil Treated by Composting and Phytoremediation.

Used lubricant oils and metals can be common soil pollutants in abandoned sites. When soil is contaminated with various hazardous wastes, the efficiency of biological treatments could be affected. The purpose of this work was to investigate the effect of combining phytoremediation and composting on the efficiency of hydrocarbon degradation and lead solubility in a soil contaminated with 31,823 mg/kg of total petroleum hydrocarbon (TPH) from used motor oil and 8260 mg/kg of lead. Mexican cactus (Opuntia ficus indica) and yard trimmings were added in the composting process, and lucerne (Medicago sativa) was used in the phytoremediation process. After a 9 week composting process, only 13% of the initial TPH concentration was removed. The following 20 week phytoremediation process removed 48% of TPH. The highest TPH degradation percentage (66%), was observed in the experiment with phytoremediation only. This work demonstrates sustainable technologies, such as biological treatments, represent low-cost options for remediation; however, they are not frequently used because they require long periods of time for success.

Lesiones en la sustancia blanca en el paciente anciano: Utilización de la terminología adecuada / White matter lesions in an elderly patient: Using the proper terminology

En Neurorradiología los cambios de la sustancia blanca periventricular o subcortical en pacientes ancianos son descritos generalmente con leucoaraiosis, fenómenos hipóxico-isquémicos crónicos, leucoencefalopatía microangiopática o simplemente con alteraciones en la densidad o intensidad según el método elegido. Sin embargo, ¿es correcto el empleo de estas denominaciones?, ¿funcionan como sinónimos?, ¿tienen un mismo mecanismo de producción? Las lesiones que afectan a la sustancia blanca se aprecian hipodensas en tomografía computada, hiperintensas en las secuencias ponderadas en T2 o FLAIR e hipointensas en la resonancia magnética en ponderación T1. Describimos las distintas entidades que pueden afectar selectivamente la sustancia blanca en el paciente anciano y sus probables mecanismos de acción, para establecer una correcta denominación y realizar los diagnósticos diferenciales.

In Neuroradiology the changes in the deep or sub-cortical white matter in elderly people are generally described as leukoaraiosis, chronic hypoxic-ischaemic processes, microangiopathic leucoencephalopathy, or they are simply mentioned as density or intensity changes according to the selected imaging method. However, are these terms correct?, Are they synonyms?, Do they have the same aetiology? The lesions that affect white matter are hypodense in computed tomography, hyperintense in T2-weighted or FLAIR, or hypointense in T1 images in magnetic resonance. A description is presented on the different conditions that can selectively affect the white matter in the elderly patient and their probable mechanisms of action in order to establish a correct nomenclature, as well as make differential diagnoses.

Estudio electrodiagnóstico en síndrome de Guillain Barré en adultos / Electrophysiological assessment in Guillain-Barré syndrome in adults

El síndrome de Guillain Barré es una poliradiculoneuropatía aguda con varias formas de presentación y actualmente la principal causa de parálisis aguda arrefléctica en el mundo, su diagnóstico es clínico y los exámenes de apoyo como el electrodiagnóstico son utilizados para realizar el diagnóstico diferencial, clasificar entre las distintas variantes (desmielinizantes o axonales) y definir pronóstico. El propósito de este trabajo es realizar una revisión narrativa de la literatura disponible, haciendo énfasis en el estudio electrofisiológico, hallazgos precoces y describir los errores más frecuentes, como también destacar la importancia de realizar la clasificación del cuadro para orientar las acciones de rehabilitación hacia la recuperación funcional.

Guillain Barré syndrome is an acutepolyradiculoneuropathy with differentforms ofpresentation and is currently the leading cause ofacute arreflexicparalysis in the world, its diagnosis is clinical and additional assesment as electrodiagnosis are used for differential diagnosis, rank among the variants (demyelinating or axonal) and define prognosis. The purpose of this paper is to make a narrative review of the literature, emphasizing the electrophysiological study, describing early findings, the most common mistakes, while highlighting the importance of classification chart to guide actions towards rehabilitation and functional recovery.

Response of Bemisia tabaci Genn. (Hemiptera: Aleyrodidae) biotype B to genotypes of pepper Capsicum annuum (Solanales: Solanaceae).

Bemisia tabaci Genn. biotype B is a widely distributed plant pest that represents one of the major constraints for horticultural crop production. The purpose of the present work was to evaluate the oviposition preference, survivorship, and development of B. tabaci biotype B on semi-cultivated genotypes of Capsicum annuum from southeast Mexico. In free-choice experiments to evaluate the oviposition preference, lower number of eggs laid by B. tabaci biotype B was observed in the genotypes Maax and Xcat´ik relative to that in the commercial genotype Parado. Egg hatchability was significantly lower in Pico Paloma, Bolita, Blanco, Chawa, Payaso, and Xcat´ik than in the rest of the genotypes, including the commercial genotype Jalapeño. Likewise, survivorship of nymphs was significantly lower in Pico Paloma, Bolita, and Blanco than in the remaining genotypes. Nymph developmental time and the period of development from egg to adult were the shortest in Amaxito. Therefore, sources of resistance to B. tabaci biotype B by antibiosis (accumulation of plant defense compounds) might be found in the semi-cultivated genotypes Pico Paloma, Bolita, and Blanco.

Association of the calcitonin gene (CA) polymorphism with osteoarthritis of the knee in a Mexican mestizo population.

Osteoarthritis (OA) is the most common form of destructive joint disease that is characterized by the degeneration of the articular cartilage, synovial membrane, joint capsule, and subchondral bone. The knee is a joint commonly affected for OA. Calcitonin (CT) has been suggested to have chondroprotective effects; therefore, could play a role in the pathogenesis of OA of the knee. Genetic variations in or adjacent to the CT gene may be associated with primary OA development. We conducted a case-control association study in which we examined the correlation between a dinucleotide (cytosine-adenine, CA) repeat polymorphism at the CT locus and OA of the knee in 88 patients with OA and in 111 control subjects from the Mexican mestizo population. Allele A and genotype AG frequencies were significantly higher in patients with OA than in control subjects (56.3 vs. 43.2%; p<0.001 and 40.9 vs. 26.1%; p=0.027, respectively), and were associated with the presence of OA of the knee (odds ratio [OR], 2.62; 95% confidence interval [95% CI], 1.30-5.27, and OR, 1.93; 95% CI, 1.04-3.58, respectively) using a logistic regression model adjusted for gender, age and Body mass index (BMI). The GG genotype was associated with a lower risk of OA development of the knee; thus, it may constitute a protective factor against this disease (OR, 0.40; 95% CI, 0.16-0.98). In summary, we conclude that the dinucleotide CA polymorphism in the CT gene may become a useful marker for genetic studies of OA of the knee in Mexican population.

Demonstration of Borrelia burgdorferi sensu stricto infection in ticks from the northeast of Mexico.

Borrelia burgdorferisensu lato infection has been confirmed in clinical cases in the northeast of Mexico; however, the bacterium has not been identified as infecting the tick vector Ixodes, Amblyomma and Dermacentor ticks were collected from mammals and plants in northeastern Mexico and examined for Borrelia. Eighteen of 214 ticks were PCR-positive for the fla and 16S rRNA genes and 15 for the ospA gene. Southern blotting with a fla probe and sequencing of ospA genes confirmed infection with B. burgdorferi sensu stricto. These findings, together with reports of indigenous cases, fulfil the criteria that allow northeastern Mexico to be considered as a zone endemic for Lyme disease.

A mathematical function to evaluate surgical complexity of cleft lip and palate.

The objective of this work is to show the modeling of a similarity function adapted to the medical environment using the logical-combinatorial approach of pattern recognition theory, and its application comparing the condition of patients with congenital malformations in the lip and/or palate, which are called cleft-primary palate and/or cleft-secondary palate, respectively. The similarity function is defined by the comparison criteria determined for each variable, taking into account their type (qualitative or quantitative), their domain and their initial space representation. In all, we defined 18 variables, with their domains and six different comparison criteria (fuzzy and absolute difference type). The model includes, further, the importance of every variable as well as a weight which reflects the surgical complexity of the cleft. Likewise, the usefulness of this function is shown by calculating the similarity among three patients. This work was developed jointly with the Cleft Palate Team at the Reconstructive Surgery Service of the Pediatric Hospital of Tacubaya, which belongs to the Health Institute of the Federal District in Mexico City.

Inter-chromosome texture as a feature for automatic identification of metaphase spreads.

This paper reports results for a new measure of texture coarseness, as a step towards automation of metaphase finding in cell-proliferation studies. This measure is highly specific to grey-level inter-chromosome coarseness features in microscopic images of metaphase spreads and allows the texture quantification of cytological objects, analysing the intensity profile between chromosome-extrema samples. Chromosome fragments produce patterns of pixels at low resolution, and the local neighbourhood of their individual extrema presents a characteristic coarseness along intensity profiles, on randomly oriented test lines. Results of the use of this new measure on microscope images of fields of metaphases and artifacts are compared with some representative texture measures and the performance of reported metaphase finders. This new measure outperforms the latter, when applied in metaphase detection and elimination of artifacts. This coarseness feature provides a specific metaphase signature that can be used in conjunction with other morphological and textural parameters for automated metaphase discrimination.

[Ultrastructure of the eggshell of hatched and non hatched eggs of Kinosternon angustipons (Testudinata: Kinosternidae)]. / Ultraestructura de la cáscara de huevos eclosionados y no eclosionados de Kinosternon angustipons (Testudinata: Kinosternidae).

The ultrastructure of eggshells of Kinosternon angustipons is described and compared with the ones of K. leucostomum and K. scorpoides. Four eggs from captive turtles (30 sections) were studied with Scanning Electron Microscopy (SEM). the shell has three layers, cuticle or external, calcereous or intermediate and testacean or internal. Hatched and non-hatched eggs have similar characteristics in their external surface: fanned units and proteic fibers superposed at random. They differ in the presence of spongelike structures and more external porosity in non-hatched eggs. The intermediate and testacean layers of the hatched eggs have lance point like spaces and are thin in the proteic fibers. The ultrastructural evidence shows that during the embryonic development the thickness of the peal decreases. Non-hatched K. angustipons shells are thicker than in the other two kinosternon species of costa Rica.

Death caused by perioperative fasting and sedation in a child with unrecognized very long chain acyl-coenzyme A dehydrogenase deficiency.

An adopted 3(1/2)-year-old girl with no prior medical problems died after a routine dental procedure. More than 2 years later, acylcarnitine analysis of dried blood found on her bedding revealed she had very long chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency. Perioperative oral fasting, without intravenous administration of glucose, may be detrimental to children with certain metabolic and endocrine disorders. Newborn screening by tandem mass spectrometry will detect disorders of fatty acid oxidation such as VLCAD and allow early and preventive treatment.

[Persistent symptomatology in workers industrially exposed to organophosphate pesticides]. / Sintomatología persistente en trabajadores industrialmente expuestos a plaguicidas organofosforados.

OBJECTIVE: To describe the patterns of persistent symptomatology in workers industrially exposed to organophosphate pesticides. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study was performed. A questionnaire was applied to managers of a factory and to 89 workers, whose erythrocytic cholinesterase level was measured with the Magnotti and Lovibond method. Information is described through rates, central tendency measures and dispersion. Differences between groups were evaluated with the chi 2 test and the odds ratio was calculated. RESULTS: Persistent symptomatology was found in 6.3 per 10 workers. 50% had six or more symptoms. No significant differences were found as to the risk of suffering from persistent symptomatology with respect to age, length of service or position at work. However, the highest proportion of symptoms was found in workers of 31 to 40 years of age, with 6 to 13 years of service, from the maintenance area, working as general operators or supervisors. Among the 13 workers with previous intoxication, the prevalence of persistent symptomatology was 6.9 against 6.1 in workers who had not been intoxicated before. The risk of acute poisoning in workers with more than 14 years of service was 4 times greater than in workers with less than 14 years of service (p < 0.005). Average level of blood cholinesterase was normal (4.4 u/ml). CONCLUSIONS: Results show a relationship between exposure to organophosphate pesticides and presence of persistent symptoms. It is necessary to study the prevalence of this symptomatology in exposed and non-exposed populations.

The development of a course in basic physical examination skills.

Basic clinical skills of most medical school undergraduates continue unobserved and deficiencies have been detected in a significant number of physicians during residency. Nevertheless, our health care system is calling for competent graduates with solid basic clinical skills and a larger representation of qualified generalists in the increasingly important managed care environment. The need for a better introduction to Clinical Skills course was identified by students and clinical faculty at Ponce School of Medicine. In response to these concerns a new curriculum was developed with clear objectives, effective instructional strategies, and performance-based evaluation, with adult learning principles as its framework. The musculoskeletal examination unit of the curriculum was pilot tested and the course evaluation strategies revealed satisfaction with objectives, instructional and evaluation strategies, as well as improved confidence, and sense of usefulness for the learned skills. A curriculum in basic clinical skills that incorporates adult learning principles with solid instructional strategies can increase the confidence and skills of the learners and should lead to improved outcomes.

The development of a course in basic physical examination skills

Basic clinical skills of most medical school undergraduates continue unobserved and deficiencies have been detected in a significant number of physicians during residency. Nevertheless, our health care system is calling for competent graduates with solid basic clinical skills and a larger representation of qualified generalists in the increasingly important managed care environment. The need for a better introduction to Clinical Skills course was identified by students and clinical faculty at Ponce School of Medicine. In response to these concerns a new curriculum was developed with clear objectives, effective instructional strategies, and performance-based evaluation, with adult learning principles as its framework. The musculoskeletal examination unit of the curriculum was pilot tested and the course evaluation strategies revealed satisfaction with objectives, instructional and evaluation strategies, as well as improved confidence, and sense of usefulness for the learned skills. A curriculum in basic clinical skills that incorporates adult learning principles with solid instructional strategies can increase the confidence and skills of the learners and should lead to improved outcomes

Fragmentación plaquetaria durante la cirugía de bypass coronario / Plaquetaria fragmentation during the coronary surgery of bypass

Estudio realizado durante el período 1992-1993, para determinar el comportamiento de las micro partículas plaquetarias (PMP) durante la cirugía de bypass coronario. Se estudiaron los valores de PMP en 15 pacientes diagnosticados con angina de pecho inestable, a los cuales se les realizó cirugía (control), 10 minutos durante la circulación extracorpórea, y al día siguiente desppués de la cirugía en la sala de cuidados intensivos. Los valores de micropartículas plaquetarias se encontraron elevados durante la ciruclación extracorpórea. Los valores de PMP después de la cirugía se encontraron significativamente bajos comparados a los 10 minutos de circulación extracorpórea, pero aún elevados en comparación al control (antes de la cirugía). Los niveles elevados de PMP en estos pacientes sometidos a circulación extracorporea, sugiere que las plaquetas fueron activadas durante este tiempo. Como la fragmentación plaquetaria es un componente fisiológico esencial en la hemostasis de la sangre que acompaña a la activación plaquetaria, se puede decir que estas micropartículas plaquetarias pueden ser utilizadas como marcadores de la actividad plaquetaria. Esta información podría ser de gran utilidad en el proceso de ainticoagulación durante la circulación extracorporea y en el futuro manejo de la enfermedad coronaria isquémica...

Effect of short-term carbon tetrachloride administration on blood lactic acid levels.

1. A short-term CCl4 administration was used in vivo as a model to produce a rise in lactic acid levels and to explain the probable interaction of CCl4 and lactic acid elevation with hepatic fibrogenesis. 2. A single dose of CCl4 produced an increase in lactic acid levels from 16.6 +/- 3.57 to 24.2 +/- 4.2 mg/dl. Three consecutive doses produced an elevation to 33.28 +/- 10.07 mg/dl, thus describing a direct relationship between lactic acid levels and CCl4 administration in a short-term fashion. 3. A morphological evaluation was performed to show hepatic changes caused by CCl4 administration. No clue of fibrogenesis was found. However, we conclude that an elevation in lactic acid exists, prior to cirrhosis. Therefore, chronic presence of lactic acid may lead to cirrhosis.