Increases in drug-related infant mortality in the United States.

OBJECTIVES: We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022. METHODS: We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death. RESULTS: In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364 days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning due to exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics. CONCLUSIONS: Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations.

Trends in Cigarette Smoking Among United States Adolescents.

Background: Cigarette smoking remains the leading avoidable cause of premature death in the United States, accounting for approximately 500,000, or 1 in 5, deaths annually. We explored trends in cigarette smoking among US adolescents. Methods: We used data for adolescents in grades 9 through 12 from 1991 to 2021 from the Youth Risk Behavior Survey provided by the US Centers for Disease Control and Prevention. We explored trends overall as well as by sex, race/ethnicity, and school grade. Results: All cigarette use-assessed as ever, occasional, frequent, or daily-among adolescents declined markedly from 1991 to 2021. Specifically, ever use significantly decreased from 70.1% in 1991 to 17.8% in 2021 (P<0.05), an almost 4-fold decline. Occasional use significantly decreased from 27.5% in 1991 to 3.8% in 2021 (P<0.05), a greater than 7-fold decline. Frequent use significantly decreased from 12.7% to 0.7%, a greater than 18-fold decline. Daily use declined from 9.8% in 1991 to 0.6% in 2021, a greater than 16-fold decline. Cigarette smoking significantly decreased from 1999 to 2021 across sex, race/ethnicity, and school grade (P<0.05). In 2021, daily use was higher in boys vs girls; Hispanic/Latino and White youth vs Black and Asian youth; and 12th graders vs 9th, 10th, and 11th graders. Conclusion: These data show large and significant decreases in cigarette use among US adolescents in high school grades 9 through 12 from 1991 to 2021. Nonetheless, the data also suggest residual clinical and public health challenges that will require targeted interventions.

Evolving Trends in US Mortality from Opioid Overdose: Heroin and Beyond.

OBJECTIVE: Our objective was to explore evolving trends in US drug overdose mortality, overall and by age, sex, race, urbanization, and geography from 1999-2020. METHODS: This is a descriptive epidemiologic study. We used the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research and Multiple Cause of Death files from the National Center for Health Statistics. We used crude and age-adjusted cause of death and mortality rate ratios as measures of effects and 95% confidence limits to test for significance. RESULTS: From 1999-2020, drug overdoses caused 1,013,852 deaths and 4.3-fold increase in mortality rate ratios. Subgroup findings were sex (4.5 men, 4.0 women), race (4.6 White, 3.9 Black or African American, 4.0 Asian or Pacific Islanders, 5.1 Native Americans or Alaskan Natives), age (highest 5.6 in 25-34 years, lowest 1.1 in 75-84, and 0.77 in 85+), geography (highest 6.0 in Midwest, lowest 2.6 in West), and urbanization (highest 6.2 in non-metro, lowest 3.7 in metro). CONCLUSIONS: Drug overdoses in the United States from 1999-2020 increased 4.3-fold, with the highest increase in White and Native American or Alaskan Native populations, and Midwest and non-metro areas. The data create preventive and therapeutic challenges, including restrictions on pharmaceutical industries and enhanced efforts by health care providers in safer prescribing. Addiction care should be integrated into all clinical practices, regardless of specialty, and into undergraduate, graduate, and continuing medical education. Targeted interventions are needed to adequately assess patients and provide care. Analytic studies designed a priori are necessary to test hypotheses formulated from these data.

A Systematic Review to Evaluate a Possible Association Between Congenital Toxoplasmosis and Preterm Labor.

BACKGROUND: Congenital toxoplasmosis (CT) is a widespread infection in several countries, and it is defined as an infection of a fetus, newborn, or infant under 1 year of age. Moreover, it represents a thread to pregnant women globally. The objective of our study is to evaluate a potential association between prematurity and CT and whether intrauterine transmission impacts gestational length during pregnancy. METHODS: PubMed, Cochrane Library and Google Scholar databases were searched from 1950 to 2019. Case-control studies, retrospective, and prospective cohort studies were eligible. Seven studies were included from a total of 314. The Newcastle-Ottawa scale was used to establish the quality of the articles included. RESULTS: Based on our review, an association between CT and preterm labor was not established, which may reflect heterogeneity in screening, treatments administered, and differing reported incidences of CT across continents over 69 years. A multicenter prospective cohort study powered to investigate a potential association is indicated. CONCLUSION: Further studies are needed including multicenter prospective cohort studies powered to investigate key clinical associations such as vertical transmission and preterm birth.

Cross-Sectional Survey of Smoking Patterns During the COVID-19 Pandemic in a Tobacco Cessation and Lung Cancer Screening Program.

Background: Coronavirus disease 2019 (COVID-19) produces a wide array of deleterious consequences, some of which are unintended. Data are sparse on whether, and if so, how, current cigarette smoking habits are affected by COVID-19. We describe changes to smoking habits and their correlates during the COVID-19 pandemic among participants in a tobacco cessation and lung cancer screening program. Methods: Between June and October 2020, we conducted a cross-sectional survey of a convenience sample of 150 participants in a lung cancer screening and tobacco cessation program. The survey consisted of 3 parts: (1) changes in tobacco use, (2) impact and coping strategies toward COVID-19, and (3) COVID-19 exposure and use of protective measures. Demographic variables included age, sex, race/ethnicity, and marital status. Results: All 150 participants who were contacted agreed to participate in this cross-sectional survey. The statistically significant correlates of increased tobacco use were high uncertainty about the future (P<0.001), loneliness because of social distancing or self-isolating (P<0.001), anger or frustration with how the pandemic has disrupted daily life (P<0.001), boredom resulting from inability to work or engage in regular daily activities/routines (P<0.001), desire to cope using alcohol or drugs (P=0.002), sadness or feelings of hopelessness (P=0.003), and worry or fear about challenges to securing basic needs such as groceries or medication (P<0.001). In contrast, those who smoked less were more likely to practice social distancing (P=0.002) and use protective measures (P=0.005). Conclusion: Among those who decreased or stopped smoking, correlates included greater use of protective measures for COVID-19, including social distancing and testing. These data may aid healthcare providers to identify and provide counsel to cigarette smokers at greater risks for increasing tobacco consumption during stresses such as COVID-19.

Key Informants' Perspectives on Implementing a Comprehensive Lung Cancer Screening Program in a Safety Net Healthcare System: Leadership, Successes, and Barriers.

Implementing evidence-based practice (EBP) in a safety net healthcare system is challenging. This study examined factors associated with feasibility and potential facilitators and barriers which might affect the implementation of a new evidence-based comprehensive primary care and community health-based program aiming to promote efficient and equitable delivery of Lung Cancer Screening and Tobacco Cessation (LCS-TC). Fifty-three key informants were interviewed. Informants discussed their perceptions of adoption of screening and appropriate referral practices across 15 community health centers. They also identified barriers and facilitators to implementing the LCS-TC program. Interview data were analyzed using inductive thematic analysis. Three major themes representing facilitators and barriers were identified: (1) Allocation of resources and services coverage; (2) need for a collaborative process to engage stakeholders and identify champions; and (3) stakeholders need different types of evidence to support implementation. The top three activities identified as essential for success included provision of sufficient resources for radiologic screening (30%); using non-physician staff for screening (30%); and minimizing the time healthcare providers need to contribute (23%). Conversely, the top three barriers were lack of resources for screening and treatment (60%); insufficient time to address complex patient problems (36%); and perceived lack of patient buy-in (30%). Models for EBP implementation provide stepwise guidance; however, particular contextual factors act as facilitators or barriers to the process. Findings inform EBP implementation efforts regarding resources and key barriers to success around organizational-level supports and promotion of suitable EBP programs.

Smoking history and adherence to cancer-related recommendations in a primary care setting.

Public health prevention efforts have led to overall reductions in mortality from screening-preventable cancers. We explored cancer screening behaviors of smokers, former smokers, and nonsmokers among patients of large primary care practices to discover the relationship between smoking status and previous adherence to the United States Preventive Services Task Force breast, cervical, and colorectal cancer screening recommendations. Our descriptive study of electronic medical record data included 6,029 established primary care patients. Multi-predictor log-binomial regression models yielded prevalence ratios (PRs) and 95% confidence intervals (CIs) to determine associations between smoking status and the likelihood of nonadherence. All models were adjusted for race/ethnicity, age, insurance, primary care specialty, number of comorbidities, and sex. Smoking history was obtained from all participants in January 2020. Current smokers accounted for 4.8%, while 22.7% were former smokers, and 72.5% were never smokers. Current smokers (compared to never smokers) were 63% more likely to be mammogram nonadherent (PR: 1.63, 95% CI: 1.31 to 2.02), 26% more likely to be Pap smear nonadherent (PR: 1.26, 95% CI: 1.04 to 1.53), and 39% more likely to be colonoscopy nonadherent (PR: 1.39, 95% CI: 1.16 to 1.66). Current smokers and former Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation smokers had on average 2.9 comorbidities while never smokers had on average 2.1 comorbidities. Our findings showed that current smokers experienced significantly lower rates of cancer screening compared to never smokers. Further research is needed to investigate and identify best practices for increasing cancer screening uptake in this population.

Potential distribution in Colombia of the introduced fish Pangasianodon hypophthalmus (Siluriformes: Pangasiidae) and implications for endangered native fish / Distribución potencial en Colombia del pez introducido Pangasianodon hypophthalmus (Siluriformes: Pangasiidae) e implicaciones para los peces nativos en peligro de extinción

Abstract Introduction: One of the significant threats to aquatic ecosystems is introducing non-native species in natural environments. This represents one of the principal causes of biodiversity loss in the world. Pangasianodon hypophthalmus is an introduced species in Colombia that shares life characteristics and habitat with endangered native species, such as Ageneiosus pardalis, Sorubim cuspicaudus, and Pseudoplatystoma magdaleniatum. However, its distribution is little-known, and scientists have barely explored the effects on the native fauna. Objectives: To evaluate the P. hypophthalmus invasive potential in some of the Colombian basins, which drain into the Caribbean Sea. Methods: Using records available in various databases, we performed a niche conservatism analysis between the native and introduced records of P. hypophthalmus using the R package Ecospat. Subsequently, we modeled the potential invasion area of P. hypophthalmus and the distribution areas of three native species, performing ecological niche modeling (ENM) using the Maxent algorithm. Finally, we calculated a geographic niche overlap between the non-native and native species. Results: The Ecospat spatial analysis indicated that P. hypophthalmus retains some environmental niche attributes through space. For this reason, we can use ENM as an approximation to its range of distribution in the invaded area. Our results using ENM demonstrated that the four species analyzed prefer low and slightly rocky regions; therefore, the geographical overlap of the three native species' ecological niches and the introduced species exceed 80 %. Conclusions: There are adequate conditions in the study basins to fully establish the species P. hypophthalmus, representing a high risk for aquatic ecosystems and native ichthyofauna. Knowledge of the potential distribution areas is essential to implement control of the species.

Resumen Introducción: Una de las amenazas importantes para los ecosistemas acuáticos es la introducción de las especies no nativas en ambientes naturales. Esto representa una de las principales causas de pérdida de biodiversidad en el mundo. Pangasianodon hypophthalmus es una especie introducida en Colombia que comparte características de vida y hábitat con especies nativas en peligro de extinción como: Ageneiosus pardalis, Sorubim cuspicaudus y Pseudoplatystoma magdaleniatum. Sin embargo, poco se conoce de su distribución y los efectos en la fauna nativa han sido poco explorados. Objetivo: Evaluar el potencial invasivo de P. hypophthalmus en algunas de las cuencas colombianas que desembocan en el Mar Caribe. Métodos: Utilizando registros disponibles en varias bases de datos, realizamos un análisis de conservadurismo de nicho entre los registros nativos e introducidos de P. hypophthalmus usando el paquete de R Ecospat. Posteriormente, modelamos el área potencial de invasión de P. hypophthalmus y las áreas de distribución de tres especies nativas realizando modelos de nicho ecológico (MNE) utilizando el algoritmo de Maxent. Finalmente, calculamos una superposición de nicho geográfico entre las especies nativas y no nativas. Resultados: El análisis espacial de Ecospat indica que P. hypophthalmus conserva algunos atributos del nicho ambiental a través del espacio. Por esta razón, podemos usar los MNE como una aproximación a su rango de distribución en el área invadida. Nuestros resultados usando MNE demostraron que las cuatro especies analizadas prefieren regiones bajas y ligeramente rocosas; por ello, la superposición geográfica de los nichos ecológicos de las tres especies nativas y la especie introducidas superan el 80 %. Conclusiones: Existen condiciones adecuadas en las cuencas de estudio para el establecimiento completo de la especie P. hypophthalmus, lo que representa un alto riesgo para los ecosistemas acuáticos y la ictiofauna nativa. El conocimiento de las áreas de distribución potencial es fundamental para implementar controles sobre la especie.

A descriptive study of racial inequalities in mortality from hepatocellular cancer before and after licensure of lifesaving drugs for hepatitis C virus in the United States.

BACKGROUND: Since 1979, mortality from hepatocellular cancer (HCC) has doubled in the United States (US). Lifesaving drugs, prohibitively expensive for some, were approved and marketed to treat hepatitis C virus (HCV), a major risk factor for HCC, beginning in 1997. After the prior introduction of other lifesaving innovations, including active retroviral drug therapy for human immunodeficiency virus and surfactant for respiratory distress syndrome of the newborn, racial inequalities in their mortalities increased in the US. In this descriptive study, we explored racial inequalities in mortality from HCC before and after licensure of HCV drugs in the US. METHODS: The US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) were used to describe HCC mortality rates from 1979 to 2016 in those 55 years of age and older, because they suffer the largest disease burden. Joinpoint regression was used to analyze trends. To estimate excess deaths, we applied White age-sex-specific rates to corresponding Black populations. FINDINGS: From 1979 to 1998, racial inequalities in mortality from HCC in the US were declining but from 1998 to 2016 racial inequalities steadily increased. From 1998 to 2016, of the 16,770 deaths from HCC among Blacks, the excess relative to Whites increased from 27.8% to 45.4%, and the trends were more prominent in men. Concurrently, racial inequalities in mortality decreased for major risk factors for HCC, including alcohol, obesity and diabetes. INTERPRETATION: These descriptive data, useful to formulate but not test hypotheses, demonstrate decreasing racial inequalities in mortality from HCC which were followed by increases after introduction of lifesaving drugs for HCV in the US. Among many plausible hypotheses generated are social side effects, including unequal accessibility, acceptability and/or utilization. Analytic epidemiological studies designed a priori to do so are necessary to test these and other hypotheses.

Different Trends in US Tobacco Use: Inpatient Databases and Population-Based Surveys.

OBJECTIVES: There is considerable evidence to support the effectiveness of inpatient tobacco cessation interventions. However, national trends data in tobacco-use disorder among hospitalized patients in the United States is scarce. We compared temporal trends (2002-2017) in diagnoses of tobacco-use disorder among hospitalized patients with estimates of current and former smoking in the general population, based on 2 multiyear national databases. METHODS: We used data from the National Inpatient Sample (NIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS) to establish annual estimates of current and former smoking. We assessed temporal trends (Joinpoint regression analysis) overall and within levels of several sociodemographic factors. To describe the burden and risk of tobacco-use disorder in inpatient settings, we used principal codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that corresponded with the highest volume (burden) and rates (risk) of tobacco-use disorder. RESULTS: There were contrasting trends in the prevalence of current tobacco-use disorder between the NIS population (significantly increasing) and BRFSS (significantly decreasing). Concordance (at 16%) was only recorded in 2017, with approximately 5,022,000 hospitalizations with a recorded diagnosis of tobacco-use disorder. Among all hospitalizations, the highest number of cases of tobaccouse disorder occurred for mood disorders (n = 2,415,985), chronic obstructive pulmonary disease and bronchiectasis (n = 2,406,551), and acute myocardial infarction (n = 1,873,326). CONCLUSIONS: Despite the underestimation of current smoking by NIS, we believe the trends toward improved identification and documentation-which is likely leading to the increasing prevalence we observed among hospitalized patients of all ages-bodes well for future utilization of smoking data in the NIS for epidemiological and health services research.

Cocaine, ethanol, cannabis and benzodiazepines co-consumption among patients assisted at the emergency room.

INTRODUCTION: Cocaine and ethanol (EtOH) co-consumption is a risk factor for physiologically and clinically negative outcomes. We describe the occurrence of cocaine consumption alone or co-consumption with EtOH and others psychotropics. PATIENTS AND METHODS: The descriptive research used data on medical records of patients positive to cocaine test who attended an emergency room between 2016 and 2017. We determined the frequency of cocaine consumption alone and co-consumption with EtOH, cannabis or benzodiazepines (BZDs). RESULTS: Over one year period, 88 patients (13.3%) were positive to cocaine test, mainly attended on weekends, in holiday months, young adults or men. Among those positive for cocaine, 72% were also positive for EtOH, cannabis or BZD. Cocaine co-consumption with one or two out of three substance was 55.2% (CI95%; 44.7-65.8%) and 16.4% (CI95%;8.58-24.3%), respectively. Co-consumption was more frecuently wih EtOH, followed by cannabis or BZD. CONCLUSION: Co-consumption of cocaine with EtOH is very common and could be associated with acute or chronic consumption of cannabis or acute exposure to BZDs. It is important that emergency physicians use a systematic approach to diagnose and treat more than one psychotropic substance in cocaine positive patients.

Hipocapnia en neuroanestesia: estado actual / Hypocapnia in Neuroanesthesia: Current Situation

Introducción: La hiperventilación ha sido una maniobra común en el manejo anestésico de procedimientos neuroquirúrgicos. Hace unos años había escepticismo entre los médicos sobre si esto resultaba en isquemia cerebral. Hoy sabemos que es perjudicial y deteriora el estado y el pronóstico del paciente. Objetivo: Hacer una revisión de los efectos adversos de la hipocapnia en diferentes órganos, principalmente el cerebro, e identificar las recomendaciones actuales de su utilidad. Métodos: Realizamos una búsqueda de la literatura en la base de datos de PubMed utilizando términos MeSH incluidos en las palabras clave; se amplió con la revisión de algunos textos y la bibliografía de los artículos más relevantes. Resultados: Con la revisión de la literatura, se ha demostrado que la hipocapnia es perjudicial tanto para el cerebro como para otros tejidos, y la recomendación actual es utilizarla sólo en dos situaciones (en caso de herniación inminente y para mejorar el campo quirúrgico) y por 20 min. Conclusiones: La hiperventilación no debe ser una intervención anestésica rutinaria en el manejo del paciente neuroquirúrgico; debe tener una indicación precisa y, una vez la indicación haya cesado, la intervención debe ser retirada lo más pronto posible.

Introduction: Hyperventilation has been a usual maneuver in the management of anesthesia in neurosurgical procedures. A few years back there used to be some medical skepticism about the potential of cerebral ischemia and today we know that it is detrimental and worsens the patient’s condition and prognosis. Objective: To review the adverse effects of hypocapnia on various organs -mainly the brain- and to identify the current recommendations about its use. Methodology: We conducted a PubMed literature search using MeSH terminology including the key words. The search was expanded to include a review of several texts and the bibliography of the most relevant articles. Results: The literature review showed that hypocapnia is harmful for the brain and for other tissues and the current recommendation is to use it for two situations only: in case of imminent herniation and to improve the surgical field, limited to 20 minutes. Conclusions: Hyperventilation should not be a routine anesthetic intervention for the management of the neurosurgical patient; there must be a precise indication and once the situation is corrected, the intervention must be immediately withdrawn.

Race, outpatient mental health service use, and survival after an AIDS diagnosis in the highly active antiretroviral therapy era.

We examined the relationships between survival after AIDS diagnosis and outpatient mental health service use among men with history of highly active antiretroviral therapy (HAART). Analysis involved 1913 black and 1684 white men with AIDS who received HIV care in 2003 in the Veterans Affairs health care system. Negative binomial regression was used to assess the association between service use and length of AIDS diagnosis. Patients with longer survival after AIDS had higher rates of outpatient visits for stress and adjustment disorders as well as for mood, anxiety, and sexual disorders. Blacks had more visits for stress and adjustment disorders (7.4 versus 5.1; p < 0.05). Multiple regression analysis showed that prolonged survival after AIDS (incident rate ratios [IRR] = 1.87; 95% confidence interval [CI] = 1.25-2.77), having CD4 cell count less than 200 cells/mm(3) (IRR = 1.91; 95% CI = 1.19-3.04), and mortality (IRR = 3.84; 95% CI = 1.29-11.43) were associated with greater number of visits for mood, anxiety, and sexual disorders. Injection drug users (IRR = 3.52; 95% CI = 1.94-6.38), men who have sex with men (IRR = 2.87; 95% CI = 1.62-5.06), and patients with AIDS-defining illness (IRR = 2.48; 95% CI = 1.47-4.17) had greater rates of visits for stress and adjustment disorders. Survival after AIDS is associated with mental health service use. As more HIV-infected persons survive longer, adequate risk assessment of mental health concerns that considers race and HIV risk factors should be undertaken to effectively address the impact of mental health on treatment outcomes and mortality.

Vasoespasmo cerebral secundario a hemorragia subaracnoidea por ruptura de aneurisma intracerebral / Cerebral spasmus

La enfermedad cerebrovascular (ECV) es la tercera causa de muerte en países industrializados. De todos los tipos de EVC, la hemorragia subaracnoidea (HSA) es responsable de 22 por cien a 29 por cien de la mortalidad. Alrededor de 30 por cien de los pacientes con hemorragia subaracnoidea (HSA) secundaria a ruptura de aneurisma cerebral, desarrollan vasoespasmo arterial y con ello el déficit neurológico asociado aumenta. Esta complicación empeora el pronóstico de los pacientes, puesto que un 25 por cien de ellos mueren y otro 30 por cien a 35 por cien sufren de déficit neurológico permanente. Entonces, el vasoespasmo cerebral es el factor modificable más importante para mejorar la tasa de morbimortalidad en pacientes con hemorragia subaracnoidea secundaria a ruptura de aneurisma. Estos puntos nos obligan a definir esquemas de intervención bien desarrollados y esquematizados, en donde el primer objetivo sea la prevención, permitiendo hacer un diagnóstico ultra temprano y que incluya un esquema de intervención bien definido que pueda ayudar a frenar el curso de la devastadora historia natural de esta complicación.

Determinacion electrocardiografica del area de necrosis y fraccion de eyeccion postinfarto de miocardio / Electrocardiogram stimate of necrosis area and the ejection fraction after myocardial infarction

Objetivo: comparar los resultados de la fracción de eyección y del área de necrosis en porcentaje ( por ciento) obtenidos por el método de puntuación del QRS electrocardiográfico (score de Selvestre) (1), con los reportados en los estudios de ecocardiografía Modo M 2D y Doppler y la gamagrafía con Te pirofosfato, en pacientes con el primer evento de infarto agudo de miocardio tipo "Q" (IMAQ). Metodología: se realizó un estudio prospectivo, descriptivo de corte transversal en donde se tomaron 46 pacientes ( 31 hombres y 15 mujeres), con un rango de edad entre los 33 y 82 años, que ingresaron a la Clínica Cardiovascular Santa María, con un primer evento de infarto agudo de miocardio tipo "Q". Se les realizó un electrocargiograma de superficie a todos los pacientes que consultaron con IMAQ. Para hallar la fracción de eyección mediante aplicación del método de puntuación del "score" del QRS (Método de Selvestre), comparándola con la hallada por ecocardiografía. A 11 pacientes escogidos de forma aleatoria se les realizó una gamagrafía con Te991" pirofosfato para estimar el porcentaje de área de necrosis y confrontarlo con el resultado obtenido por el método electrocardiográfíco de puntuación del QRS. Resultados: la fracción de eyección obtenida por el método de puntuación del QRS y la obtenida por ecocardiografía, presentaron una diferencia del 5 por ciento en 31 de los pacientes. Se encontró una correlación de r =0.786 y una p < 0.001 entre los dos métodos estudiados. De los 11 pacientes a los que se les realizó la gamagrafía, 8 fueron positivos para IMAQ y 3 no cuantificables para el mismo. Al comparar estos resultados con los obtenidos por el método de puntuación del QRS se encontró una p < 0.01 y una correlación r = 0.894. Conclusión: encontramos correlación entre los resultados de la fracción de eyección obtenida por el método de puntuación del QRS electrocardiográfíco y los hallados por ecocardiografía, también se encontró correlación electrocardiográfíca con los resultados hallados en porcentaje de necrosis mediante gamagrafía con Te99"1 pirofosfato y puntuación de Selvestre. Se puede deducir que el EKG puede proporcionar información cuantitativa indirecta acerca de la función ventricular izquierda (fracción de eyección) después de un IMAQ y el porcentaje de necrosis

Respuesta inmune humoral a la vacuna antisarampionosa en niños menores de 5 años

Es Estado de inmunidad humoral y los títulos de anticuerpos séricos en respuesta a la inmunización con la vacuna antisarampiosa fueron medidos en 100 niños menores de 5 años, eutróficos y con desnutrición subclínica. Los resultados sugieren que ambos grupos se ven eventualmente afectados con un 98% de estado inmune y un 2% no inmunes en esta población, y que aún niños con desnutrición subclínica puden alcanzar títulos de anticuerpos mayores que los eutróficos que han sido vacunados

Evaluación comparativa de atropina y propantelina sobre la secreción salival / Atropine and propantheline evaluative comparation of the bodily scretion

Un grupo de 25 pacientes adultos sanos, recibió Atropina parenteral o Propantelina oral, con el fin de valorar y comparar su efecto antimuscarínico, previa estimulación de la secreción salival. Se presentan los resultados obtenidos, al evaluar tanto el efecto farmacológico deseado, como aquellos derivados de la interacción medicamentosa con receptores colinérgicos no ubicados en glándulas salivales.