Caracterización morfométrica de la gallina de cuello desnudo (Gallus domesticus nudicollis) en la región ch’ortí de Chiquimula, Guatemala / Morphometric characterization of chickens naked neck (Gallus domesticus nudicollis) in the ch’ortí, region, Guatemala

Se caracterizaron morfométrica, faneróptica y morfológicamente a gallinas y gallos de cuello desnudo (324 hembras, 60 machos) en los cuatro municipios de la región ch’ortí de Chiquimula. Las variables evaluadas fueron 18 cuantitativas para la hembra y 16 para el macho, nueve cualitativas y ocho índices zoométricos. El análisis de las variables zoométricas se realizó a través del procedimiento análisis univariado, con medidas de tendencia central y medidas de dispersión, y para analizar la proporcionalidad y armonía entre las diversas regiones corporales mediante la correlación de Pearson. Los resultados principales son: peso de 1.84 kg/hembra y 2.29 kg/macho; alzada 27.84 cm/hembra y 32.51 cm/macho; metatarso 10.25 cm/hembra y 11.76 cm/macho; ambos tienen más alzada que longitud, inclinados hacia adelante; en cuanto a sus perímetros, el abdominal es el mayor y curvado característica de las gallinas ponedoras y una grupa alargada con dorso plano. Sus índices corporales son aves alargadas, con capacidad reproductiva (índice pélvico 71.82%) y poca formación de músculo para la producción de carne (índice compacidad 6.80%/hembra y 7.03%/macho), cabeza alargada, tórax elíptico y miembros fuertes y altos. Las características morfológicas y fanerópticas describen un ave de piel blanca, metatarso amarillo, plumas en garganta, cresta simple con barbilla y orejuelas, los colores de pluma son la combinación de marrón, negro, gris y blanco, el color de la cáscara varia del blanco al marrón claro y con una armonización corporal hasta del 61% lo que le da una homogeneidad medianamente aceptable a la morfoestructura de la gallina.

Hens and roosters naked neck (324 females and 60 males) were characterized morphological and phenotypically in four villages of the ch’ortí area in the province of Chiquimula. Variables evaluated were 18 quantitative for females and 16 for males, nine qualitative and eight zoometrics ranges. The zoometric variables analyzed were made according to the univariate analysis procedure with measurements of central tendency and dispersion measurements to analyze the proportion and harmony between the different corporeal areas we used the Pearson correlation. In the results weight of 1.84 kg/female and 2.29 kg/male; raised 27.84 cm/female and 32.51cm/male; metatarsal 10.25 cm/female and 11.76 cm/male; the hen has more height than length, raised in the front, concerning to the perimeters, the abdominal is the biggest and curved, which is characteristic in lay eggs hens with flat dorsal. Corporeal indices, they are elongated birds, reproductive capability (pelvic index 71.82%) and less muscles developed to produce meat as food for humans (compactness index 6.80% female and 7.03% male), elongated head, elliptical thorax and long and strong extremities. Phenotypically and morphologically characteristics describe a bird with white skin, yellow metatarsus, feathering on the throat, simple crest, chin and earlobes, the feathering colors are a combination of brown, black, grey, and white, and the colors of the egg shell are from white to light brown, and also has a good corporal harmony up to 61%, which brings an acceptable mild homogeneity comparable to the structure of a hen.

Aortic valve stenosis planimetry by means of three-dimensional transesophageal echocardiography in the real clinical setting: feasibility, reliability and systematic deviations.

AIMS: To assess the feasibility and reliability of aortic valve area (AVA) planimetry by means of three-dimensional transesophageal echocardiography (3DTEE) as compared with the transthoracic echocardiogram (TTE) calculation of AVA, to determine the systematic deviations between measurements, and to describe the distribution of mean systolic in relation with 3DTEE anatomical AVA. METHODS AND RESULTS: Three hundred seven patients with aortic valve stenosis (AVS) underwent both TTE and 3DTEE for AVA measurement by means of the continuity equation and direct anatomical planimetry, respectively. AVA planimetry was achieved in 282 (91.9%) of patients. Severity of the aortic valve calcification was independently associated with a poorer performance of planimetry. Intraclass correlation coefficient yielded a 0.848 (95% CI: 0.807-0.879) value. 3DTEE rendered a mild constant underestimation of AVA in comparison with TTE. Severe aortic stenosis according to the area criterion (<1 cm(2) ) despite mean systolic gradient below 40 mm Hg was detected in 37.6% of the study population, and in 33.7% of the subset of patients with preserved left ventricular ejection fraction. CONCLUSIONS: Reliability of AVA planimetry by 3DTEE in comparison with the calculation by TTE is good, but 3DTEE underestimates slightly the measurement. Feasibility of the technique is good but independently affected by valvular calcification. Inconsistent classification of AVS severity as graded by AVA or mean systolic gradient is observed in the overall population and in patients with preserved systolic function.

Estenosis aórtica grave con bajo gradiente y fracción de eyección normal: una cuestión de mala clasificación / Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue

Introducción y objetivos. La estenosis aórtica grave con gradientes bajos y fracción de eyección normal es una entidad discutida. Las discrepancias sobre su pronóstico indican que podría tratarse de una incorrecta clasificación de su gravedad. La planimetría del área aórtica mediante ecografía transesofágica tridimensional podría esclarecer estas dudas. Los objetivos de este trabajo son valorar la concordancia de la medida del área valvular aórtica obtenida mediante ecuación de continuidad en ecocardiografía transtorácica y la obtenida por planimetría mediante ecocardiografía transesofágica tridimensional en pacientes con estenosis aórtica grave y bajo gradiente paradójico. Métodos. Estudio transversal descriptivo de pacientes consecutivos remitidos por estenosis aórtica grave, a los que se practicó ecocardiografía transtorácica y transesofágica tridimensional. Se consideró estenosis aórtica con bajo gradiente paradójico la presencia de un área efectiva < 1 cm2, gradiente ventricular medio < 40 mmHg y fracción de eyección >= 50%. Se estudió la concordancia entre las dos técnicas. Resultados. Estudiamos a 212 pacientes consecutivos con estenosis aórtica grave. De ellos, 63 casos (29,7%) satisfacían los criterios de bajo gradiente paradójico y en 61 se obtuvieron imágenes adecuadas para la comparación de los métodos. La planimetría tridimensional confirmó un área valvular < 1 cm2 en 52 pacientes (85,2%). El coeficiente de correlación intraclase entre las técnicas fue 0,505 (intervalo de confianza del 95%, 0,290-0,671; p < 0,001). Conclusiones. La estenosis aórtica grave con bajo gradiente paradójico es una entidad real que se confirma en el 85% de los pacientes evaluados mediante ecocardiografía transesofágica tridimensional (AU)

Introduction and objectives. Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. Methods. Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm2, mean ventricular gradient<40mmHg, and ejection fraction >=50%. Concordance between the two techniques was evaluated. Results. Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm2. The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). Conclusions. Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography (AU)

Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue?

INTRODUCTION AND OBJECTIVES: Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. METHODS: Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm(2), mean ventricular gradient<40 mmHg, and ejection fraction ≥ 50%. Concordance between the two techniques was evaluated. RESULTS: Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm(2). The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). CONCLUSIONS: Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography.

Characteristics of sudden death in inherited heart disease.

INTRODUCTION AND OBJECTIVES: Cardiomyopathy and channelopathy are major causes of sudden death (SD). The little information available on the context in which SD occurs has come from only a few referral centers. The objective was to investigate the circumstances surrounding SD in families with inherited heart disease. METHODS: The study included 152 SD patients (mean age 43+/-19 years) from 103 families. The reasons for inclusion were resuscitated SD in 7%, recent SD in 8%, and a diagnosis of cardiomyopathy or channelopathy in a living relative in 72%. Also, 13% were athletes. Family trees were constructed and each death's circumstances were recorded. Autopsy and medical records were reviewed. RESULTS: Overall, 18% of SDs occurred during physical exercise, 32% during normal daily activities, and 37% during rest or sleep. There was a significant association between male sex and SD: 111 males (73%) vs. 41 females (27%; P=.03). Exercise-related SD was associated with young age (P=.01). The percentage of SDs associated with exercise, stress or normal daily activities was significantly greater with cardiomyopathy than channelopathy (61% vs. 41%; P=.057). All athletes were male and the majority died during exercise (50% vs. 11% of non-athletes; P=.0002). Patients with Brugada syndrome had the highest percentage of SDs during rest or sleep (i.e. 47%). No clear trigger could be identified in 33%. CONCLUSIONS: SD was common in inherited heart disease, which accounted for a significant number of cases. Males clearly predominated over females (ratio 3:1) among SD cases (irrespective of pathological type). Most SDs occurred during exercise or normal daily activities in cardiomyopathies and during rest or sleep in channelopathies. The percentage of exercise-related SDs (i.e. 18%) was higher than expected.

Características de la muerte súbita en las cardiopatías hereditarias / Characteristics of sudden death in inherited heart disease

Introducción y objetivos. Las miocardiopatías (MCP) y las canalopatías (CP) son causas importantes de muerte súbita (MS). Existe poca información en la literatura sobre el contexto en el que se produce la MS, y proviene de unos pocos centros de referencia. El objetivo del presente trabajo es estudiar las circunstancias de la MS en familias con cardiopatías hereditarias. Métodos. Se registraron 152 casos de MS en un total de 103 familias (media de edad, 43 ± 19 años). Los motivos de inclusión fueron: MS resucitada, 7%; MS reciente, 8%; diagnóstico de MCP o CP en un familiar vivo, 72%. El 13% eran deportistas. Se trazaron árboles familiares y se recogieron los detalles sobre las circunstancias del fallecimiento. Se revisaron historias clínicas e informes autópsicos. Resultados. El 18% de las MS ocurrieron durante el ejercicio físico, el 32% en actividades cotidianas y el 37% en reposo/sueño. Hubo una asociación estadística entre el sexo varón y la MS (111 [73%] frente a 41 [27%]; p = 0,03). La MS relacionada con el ejercicio se asoció con la edad joven (p = 0,01). En el grupo de MCP se registró de forma significativa un mayor porcentaje de MS en relación con ejercicio/estrés/actividad cotidiana respecto al grupo de CP (el 61 frente al 41%; p = 0,057). Todos los deportistas eran varones y la mayoría de ellos fallecieron realizando ejercicio (el 50 frente al 11% de los no deportistas; p = 0,0002). El grupo de síndrome de Brugada presentó el porcentaje más elevado de MS en reposo/sueño (47%). En el 33% del total no fue posible identificar claramente el desencadenante. Conclusiones. La MS es frecuente en las cardiopatías hereditarias y supone un número importante de casos. Entre los casos de MS (independientemente del tipo de afección) los varones predominan claramente sobre las mujeres (3:1). La mayoría de las MS ocurrieron realizando ejercicio o una actividad cotidiana en las miocardiopatías y durante el reposo o el sueño en las canalopatías. El porcentaje de MS relacionadas con el ejercicio (18%) es superior al esperado (AU)

Introduction and objectives. Cardiomyopathy and channelopathy are major causes of sudden death (SD). The little information available on the context in which SD occurs has come from only a few referral centers. The objective was to investigate the circumstances surrounding SD in families with inherited heart disease. Methods. The study included 152 SD patients (mean age 43±19 years) from 103 families. The reasons for inclusion were resuscitated SD in 7%, recent SD in 8%, and a diagnosis of cardiomyopathy or channelopathy in a living relative in 72%. Also, 13% were athletes. Family trees were constructed and each death’s circumstances were recorded. Autopsy and medical records were reviewed. Results. Overall, 18% of SDs occurred during physical exercise, 32% during normal daily activities, and 37% during rest or sleep. There was a significant association between male sex and SD: 111 males (73%) vs. 41 females (27%; P=.03). Exercise-related SD was associated with young age (P=.01). The percentage of SDs associated with exercise, stress or normal daily activities was significantly greater with cardiomyopathy than channelopathy (61% vs. 41%; P=.057). All athletes were male and the majority died during exercise (50% vs. 11% of non-athletes; P=.0002). Patients with Brugada syndrome had the highest percentage of SDs during rest or sleep (i.e. 47%). No clear trigger could be identified in 33%. Conclusions. SD was common in inherited heart disease, which accounted for a significant number of cases. Males clearly predominated over females (ratio 3:1) among SD cases (irrespective of pathological type). Most SDs occurred during exercise or normal daily activities in cardiomyopathies and during rest or sleep in channelopathies. The percentage of exercise-related SDs (i.e. 18%) was higher than expected (AU)

Systolic aortic regurgitation: a not-so-rare phenomenon.

In a normal cardiac cycle, aortic and pulmonary regurgitation are diastolic phenomena. Aortic regurgitation has been observed in ventricular systole in patients with arrhythmias, extracorporeal circulation and palliative surgical correction of complex congenital heart disease. Systolic aortic regurgitation is explained as the inability of the ventricular beat to overcome the aortic pressure in patients with valvular incompetence. Beyond its potential as an elegant quiz about heart physiology, clinical association of systolic aortic regurgitation with heart failure and syncope has been described. Illustrative examples of both aortic and pulmonary systolic regurgitation are presented, an image of "continuous" aortic regurgitation is displayed, and technical issues on its diagnosis are briefly commented.

Real-time three-dimensional transoesophageal echocardiography in the assessment of aortic valve stenosis.

AIMS: To determine the feasibility of real-time three-dimensional transoesophageal echocardiography (3D-TOE) in the evaluation of aortic valve stenosis, to study its reliability, and to test the concordance of this new method when compared with transthoracic two-dimensional echocardiography (2D-TTE) as the diagnostic standard. METHODS AND RESULTS: Fifty-nine consecutive patients with moderate-to-severe aortic valve stenosis were assessed by means of 2D-TTE and 3D-TOE by independent blinded observers. Aortic valve planimetry was possible in 94.9% of patients. Inter-observer intraclass correlation coefficients (ICC) were 0.892 (CI 95% 0.818-0.936; P < 0.001), and 0.871 (CI 95% 0.780-0.925; P < 0.001) for 2D-TTE and 3D-TOE, respectively. Bland-Altman plot showed a mean difference in aortic valve area (AVA) of 0.040 cm(2), with 2D-TTE yielding larger values than 3D-TOE. ICC of both methods was 0.724 (CI 95% 0.530-0.839; P < 0.001). CONCLUSION: Assessment of AVA by means of 3D-TOE is feasible in most patients with aortic valve stenosis. Reliability of the measurement is good. However, there is some disagreement with standard 2D-TTE that needs further investigation.

Penetrance and risk profile in inherited cardiac diseases studied in a dedicated screening clinic.

Genetically transmitted cardiomyopathies can affect several members in a family. Identification of high-risk patients could lead to a preventive treatment. We report the results of a 5-year experience of a dedicated clinic. Family screening was offered to 493 consecutive unrelated patients; 2,328 subjects (40 +/- 19 years old, 52% men) were evaluated (mean 4.4 relatives/family). Electrocardiography and echocardiography were performed in all cases; additional tests were indicated depending on the disease. Familial study was recommended because of a proband with hypertrophic cardiomyopathy (HC) in 57%, idiopathic dilated cardiomyopathy (IDC) in 14%, arrhythmogenic right ventricular cardiomyopathy (ARVC) in 2%, left ventricular noncompaction in 2%, Brugada syndrome (BS) in 15%, long QT syndrome (LQTS) in 3%, and other conditions in 6%. Familial disease was confirmed in 164 (39%); 43% with HC, 47% with IDC, 25% with ARVC, 33% with left ventricular noncompaction, 28% with BS, and 30% with LQTS. Two hundred twenty-two (44 +/- 20 years old, 60% men) affected relatives were identified (129 of whom were newly diagnosed). Sixty-four patients were newly diagnosed with HC, 40 with IDC, 2 with ARVC, 5 with left ventricular noncompaction, 14 with BS, and 2 with LQTS, in whom appropriate risk stratification and medication, if needed, were initiated (specific medication in 40, 31.0%). Cardioverter-defibrillator implantation was indicated in 4 relatives for primary prevention. Ninety-two (18.7%) had a family history of sudden death (FHSCD). Consanguinity was rare but significantly associated to a higher percentage of family disease (75.0% vs 38.3%, p = 0.003) and family history of sudden death (42.1% vs 17.8, p <0.001). In conclusion, the prevalence of familial disease in inherited cardiac conditions is high. Systematic familial study identified many asymptomatic affected patients who could benefit from early treatment to prevent complications. Dedicated clinics and multidisciplinary teams are needed for proper screening programs.

Treatment of right heart thromboemboli: the need of a randomized multicentre trial.

Currently, there are not solid evidence-based recommendations on the treatment of in-transit right heart thromboemboli. We present a case of acute pulmonary embolism with right ventricular entrapped thrombus detected by echocardiography. Surgical thrombectomy was successfully carried out. Treatment options are discussed and the need of a randomized trial is stressed.