Tratamiento fibrinolítico intravenoso en el manejo del ictus isquémico agudo asociado a mixoma auricular izquierdo: a propósito de un caso / Intravenous fibrinolysis for acute ischaemic stroke associated with left atrial myxoma: A case report

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[Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico]. / Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México.

INTRODUCTION: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. CLINICAL CASE: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. DISCUSSION: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

INTRODUCCIÓN: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. CASO CLÍNICO: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). DISCUSIÓN: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Remote ischemic postconditioning: does it protect against ischemic damage in percutaneous coronary revascularization? justification and design of a randomized placebo-controlled clinical trial.

OBJECTIVE: Myocardial damage that is associated with percutaneous coronary intervention (PCI) partially affects the results of the procedure, and is related to medium-term cardiovascular death. Remote postischemic conditioning might reduce the myocardial lesions that are associated with PCI, but perhaps less so in diabetics. The aim of this study was to evaluate the protective effect of remote postischemic conditioning in patients undergoing elective PCI for stable angina or non-ST elevation acute coronary syndrome with troponin <1 ng/ml at the time of randomization. METHODS: This randomized single-blinded single-center clinical trial involved 320 patients undergoing elective PCI who were randomized to either receive three 5-min cycles of ischemia by inflation of a cuff on the non-dominant arm to 200 mm Hg (remote postischemic conditioning) or to placebo (uninflated cuff). The primary outcome variable was the maximum increase in troponin in the first 24 h. The secondary outcome variable was readmission due to heart failure or cardiovascular mortality after 1 year of follow-up. In addition, a diabetic population was studied. CONCLUSIONS: This clinical trial evaluated the possible reduction in intervention-related myocardial damage that was attributable to remote postischemic conditioning.

Antimicrobial properties of moderately halotolerant bacteria from cenotes of the Yucatan peninsula.

AIMS: Isolation and antimicrobial evaluation of aquatic bacterial strains from two cenotes. METHODS AND RESULTS: A total of 258 bacterial strains were isolated from the water and sediment of two cenotes in the Yucatan peninsula, all of which were screened against six pathogenic micro-organisms. Antimicrobial activity was detected in 46 of the isolated strains against at least one of the target strains tested. Antimicrobially active isolates were identified as: Aeromonas, Bacillus, Burkholderia, Photobacterium, Pseudomonas, Serratia, Shewanella, Stenotrophomonas genera, and 13 remained unidentified. All antimicrobially active strains were able to grow in salt medium at a concentration of 75 g l(-1), thus classifying as moderately halotolerant bacteria. Most of the antimicrobially active strains exhibited a broad action spectrum, where 61% was because of uncharacterized antimicrobial substances, 25% because of bacteriocins and 13% because of siderophores. Ten strains were able to biosynthesize biosurfactant metabolites. CONCLUSIONS: Native bacteria from the Yucatan peninsula showed an interesting antimicrobial activity, diverse mode of action and moderate halotolerance to salt. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report on bacterial isolates from cenotes of the Yucatan peninsula and their antimicrobial characterization, with great potential for future biotechnological applications.

[Trends of hospitalizations for chronic heart failure in Andalusia in the last decade]. / Evolución de las hospitalizaciones por insuficiencia cardíaca en Andalucía en la última década.

BACKGROUND AND OBJECTIVES: The cost of hospitalization represents the greatest proportion of total expenditure due to heart failure. Our objective was to analyze the trends of morbidity of chronic heart failure in Andalusia between 1990-2000. MATERIAL AND METHODS: The data on hospitalizations in Andalusia (title 428 of the ninth revision of the International Disease Classification) were obtained from the National Survey of Hospital Morbidity of the National Institute of Statistics. The rates, standardized by age and gender, of admission due to heart failure were calculated by the direct standardization method. RESULTS: The absolute number of hospitalizations due to hear failure in people over 45 years was 4,345 in 1990 and 10,153 in 2000 (a relative increase of 230%) and it represents 14.2% hospitalizations in Spain. The increase was focused on those over 65 years and the standardized rates were slightly greater in women than in men. CONCLUSIONS: Hospitalization discharge rates increased mostly in the population older than 65 and women showed hospitalization rates slightly greater than men.

Evolución de las hospitalizaciones por insuficiencia cardíaca en Andalucía en la última década / Trends of morbidity of chronic heart failure in Andalusia in the last decade

Fundamento y objetivos. Las hospitalizaciones ocasionan la mayor parte del gasto sanitario por insuficiencia cardíaca. Nuestro objetivo es analizar las tendencias de estas hospitalizaciones en Andalucía en el período 1990-2000. Material y método. Los datos sobre hospitalizaciones en Andalucía (rúbrica 428 de la novena revisión de la Clasificación Internacional de Enfermedades) se tomaron de la Encuesta Nacional de Morbilidad Hospitalaria del Instituto Nacional de Estadística. Mediante el método de estandarización directa se calcularon las tasas, estandarizadas por edad y sexo, de ingreso por insuficiencia cardíaca. Resultados. El número absoluto de hospitalizaciones por insuficiencia cardíaca en mayores de 45 años pasó de 4.345 en 1990 a 10.153 en el año 2000, lo que representa un crecimiento relativo de un 230% y correspondió al 14,2% de los ingresos en España en el año 2000. El aumento se centró en mayores de 65 años y las tasas estandarizadas fueron ligeramente superiores en mujeres que en hombres. Conclusiones. El número de hospitalizaciones por insuficiencia cardíaca en Andalucía en la década de los noventa creció de forma importante, y esto se produjo fundamentalmente en mayores de 65 años, tanto en mujeres como en hombres

Background and objectives. The cost of hospitalization represents the greatest proportion of total expenditure due to heart failure. Our objective was to analyze the trends of morbidity of chronic heart failure in Andalusia between 1990-2000. Material and methods. The data on hospitalizations in Andalusia (title 428 of the ninth revision of the International Disease Classification) were obtained from the National Survey of Hospital Morbidity of the National Institute of Statistics. The rates, standardized by age and gender, of admission due to heart failure were calculated by the direct standardization method. Results. The absolute number of hospitalizations due to hear failure in people over 45 years was 4,345 in 1990 and 10,153 in 2000 (a relative increase of 230%) and it represents 14.2% hospitalizations in Spain. The increase was focused on those over 65 years and the standardized rates were slightly greater in women than in men. Conclusions. Hospitalization discharge rates increased mostly in the population older than 65 and women showed hospitalization rates slightly greater than men

A phylogenetic analysis of basal metabolism, total evaporative water loss, and life-history among foxes from desert and mesic regions.

We measured basal metabolic rate (BMR) and total evaporative water loss (TEWL) of species of foxes that exist on the Arabian Peninsula, Blanford's fox (Vulpes cana) and two subspecies of Red fox (Vulpes vulpes). Combining these data with that on other canids from the literature, we searched for specialization of physiological traits among desert foxes using both conventional least squares regression and regressions based on phylogenetic independent contrasts. Further, we explored the consequences of reduced body size of foxes on life history parameters such as litter size and neonate mass. For Blanford's foxes, Red foxes from the central desert of Arabia, and Red foxes from the more mesic Asir mountains, body mass averaged 1,285 +/- 52 g, 1,967 +/- 289 g, and 3,060 +/- 482 g, respectively, whereas mean BMR, during summer, was 304.5 +/- 32.3 kJ/day, 418.0 +/- 32.4 kJ/day, and 724.1 +/- 120.2 kJ/day (+/- SD). An analysis of covariance with body mass as a covariate showed no statistical differences in BMR among foxes. Analysis of covariance indicated that Red fox from the Asir mountains had a higher TEWL than Red foxes from central Arabia or than Blanford's foxes also from the mountains. Comparisons of all species of desert and mesic foxes showed no significant differences in BMR, nor did desert foxes have a significantly lower BMR than other carnivores. TEWL of desert foxes was lower than other more mesic carnivores; deviations in TEWL ranged from -17.7% for the Fennec fox (Fennecus zerda) to -57.4% for the Kit fox (Vulpes velox). Although desert foxes have a BMR comparable to other more mesic species, it appears that desert foxes do have a smaller body mass, lowering overall energy requirements. We attribute this reduction in body size to the "resource limitation hypothesis" whereby natural selection favors smaller individuals in a resource-limited environment, especially during periods of severe food shortage. However, until common garden experiments are performed, developmental plasticity and acclimation cannot be ruled out as contributors to this pattern.

Proliferative activity in the cerebellar external granular layer evaluated by bromodeoxyuridine labeling.

We have optimised an indirect immunoperoxidase technique demonstrating bromodeoxyuridine (BrdU) incorporation into dividing cells for cerebellar tissue sections of four-day-old rats injected with this marker. This permits confident identification of granule-cell precursors engaged in DNA synthesis in the external granular layer of the developing cerebellum. Preservation of BrdU immunoreactivity is attained using methanol/acetic acid fixation and different pretreatments before immunostaining, while unlabeled nuclei can be recognized clearly after Feulgen or hematoxylin counterstaining. We established conditions to ensure satisfactory BrdU uptake without affecting cell-cycle progression during the postlabeling time period. The dose of BrdU employed provides saturation S-phase labeling from at least 1 h after BrdU delivery. Various kinetic parameters and phase durations have been determined in experiments involving a single injection or cumulative labeling sequences, and the cycle time was calculated based on two models of generative behavior: steady-state and exponential growth. The working hypothesis of steady-state kinetics can be adopted successfully if the existence of neuroblasts with different proliferation rates is taken into account.