Echocardiographic markers of cardiac amyloidosis in patients with heart failure and left ventricular hypertrophy.

BACKGROUND: Cardiac amyloidosis (CA), following a non-invasive diagnosis, constitutes an increasingly prevalent heart failure (HF) etiology. This study aims to determine which echocardiography findings help to diagnose CA in patients with left ventricular hypertrophy (LVH) admitted for decompensated HF. METHODS: The present study is a retrospective observational study on a cohort of 85 LVH patients admitted for HF decompensation, in which 99mTc-DPD scanning was performed to rule out transthyretin CA. The echocardiographic findings obtained were compared between CA and non-CA groups. RESULTS: From a total number of 85 patients, 49 (57.6%) met the CA criteria and 36 (42.3%) were ruled out for the disease. Interventricular septum thickness (16 ± 3 mm vs. 14 ± 3 mm), left ventricular posterior wall thickness (14 ± 3 mm vs. 11 ± 2 mm), left ventricular mass (259 ± 76 g vs. 224 ± 53 g), left ventricular end-diastolic diameter (48 ± 7 mm vs. 53 ± 6 mm), left ventricular end-diastolic indexed volume (51 ± 18 cm3/m2 vs. 59 ± 16 cm3/m2), tricuspid annular plane systolic excursion (16 ± 5 mm vs. 20 ± 4 mm), right atrial area (27.4 ± 8.4 cm2 vs. 22.2 ± 5.7 cm2) and strain relative apical sparing (2.2 ± 0.9 vs. 1.03 ± 0.4; p = 0.04) were significantly associated with the diagnosis of CA. CONCLUSIONS: In patients with LVH admitted for HF decompensation, there are several echocardiographic features (LVH, reduced left ventricular cavity size, strain relative apical sparing, right atrial dilation, and altered right ventricular function) that are associated with the diagnosis of cardiac amyloidosis.

Feasibility and safety of zero-fluoroscopy left bundle branch pacing: An initial experience.

INTRODUCTION: Left bundle branch pacing (LBBP) has emerged in recent years as a new pacing modality, providing patients with a narrower paced QRS than conventional pacing and stable pacing parameters. At the same time, there is a growing concern about the use of fluoroscopy in pacemaker implantations, given its harmful effects on both patients and operators. However, there are no prior experiences of zero-fluoroscopy in LBBP procedure. METHODS: We conducted an observational prospective study recruiting consecutive patients that underwent zero-fluoroscopy LBBP pacemaker implantation. A 6-month follow-up visit was programmed for every patient. The main goal of our study was to assess the efficacy, feasibility, and safety of the procedure. RESULTS: From January 2021 to February 2022, we included 10 patients, 8 males. The average age was 63 ± 4 years. The procedure was successful in all patients. We observed a significant reduction in paced QRS width compared with basal QRS width (149 ± 31.9 vs. 116 ± 15.6 ms, p = .02). All device parameters remained stable at 6-month follow-up: no significant differences in mean impedance (700.5 ± 136.4 vs. 494 ± 72.7 Ohm, p = .09), capture threshold (0.67 ± 0.2 vs. 0.83 ± 0.2 V @ 0.4 ms, p = .27) or endocardial V-wave amplitude (10.6 ± 5.2 vs. 13.9 ± 6.3 mV, p = .19). No complications were reported in any case. CONCLUSION: Zero-fluoroscopy LBBP is feasible and safe, and it may be considered in cases where radiation exposure is contraindicated or especially undesirable. Future randomized clinical trials are needed for the widespread use of this new technique.

Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach.

Introduction: A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. Methods: We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. Results: A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. Conclusions: LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.

Impacto de la enfermedad de pequeño vaso en la inestabilidad del anciano. Estudio descriptivo transversal / Vestibular Pathology and Instability in the Elderly and its Relationship with Small Vessel Disease. Cross-Sectional Descriptive Study

Introducción y objetivo: La elevada prevalencia de mareo e inestabilidad en los ancianos, su complejo diagnóstico e importantes consecuencias (caídas y lesiones derivadas) constituyen un grave problema sanitario. El presente estudio tiene como objetivo principal determinar si existe relación entre dichos síntomas y la presencia de enfermedad de pequeño vaso. Secundariamente intentaremos describir las causas más frecuentes de mareo e inestabilidad en los pacientes ancianos. Método: Se realiza un estudio descriptivo transversal con 214 pacientes mayores de 70 años remitidos por vértigo, mareo o inestabilidad. Se valoran los diagnósticos más frecuentes y se comparan tres grupos: 1) Patología vestibular periférica, 2) mareo o inestabilidad de causa desconocida y 3) grupo de control. Para ello se utiliza la escala de Fazekas que determina la magnitud de las lesiones de sustancia blanca por imágenes de resonancia magnética. Resultados: El vértigo posicional paroxístico benigno fue el diagnóstico más frecuente (17,3%), seguido de la enfermedad de Ménière (15%). Un 20% de los pacientes fueron clasificados como origen desconocido o multifactorial. La enfermedad de pequeño vaso se encontró con mayor frecuencia en el grupo con mareo de causas desconocidas (p=0,034). Conclusiones: se reafirma la asociación entre las lesiones de sustancia blanca, sugerentes de enfermedad de pequeño vaso, y la mayor aparición de mareo e inestabilidad en los ancianos; siendo la prevalencia de la enfermedad mucho menor en el grupo de control que en aquellos con mareo de causa desconocida. Asimismo, se determina que el vértigo posicional paroxístico benigno es el diagnóstico más frecuente de mareo e inestabilidad en el anciano. (AU)

Patrones de costos de atención a pacientes con enfermedades isquémicas del corazón en el Instituto Nacional Cardiovascular, 2019 / Cost patterns of care for patients with ischemic heart disease at the Instituto Nacional Cardiovascular, 2019

RESUMEN Introducción. La enfermedad isquémica del corazón (EIC) es actualmente un problema de salud pública en el Perú, y su tratamiento tiende a ser muy costoso para el sistema de salud. Objetivo. Establecer los patrones de costos de atención de las EIC en el Instituto Nacional Cardiovascular (INCOR) de la Seguridad Social en Salud del Perú (EsSalud). Métodos. Se utilizaron las bases de datos de atenciones, cirugías, egresos y valor bruto de la producción del INCOR de la población diagnosticada y atendida con EIC en el año 2019 (879 pacientes). Se estimaron los costos de las atenciones mediante costeo basado en actividad; se utilizó un modelo econométrico para establecer los determinantes de los costos, y con el método de distancia euclidiana se formaron "clústeres" con características similares para establecer patrones de costos. Resultados. El costo de atención de EIC más alto fue de 148 567 soles (US$ 44 830) para un paciente con 40 días de estancia. Fueron principales determinantes del costo de la atención la estancia hospitalaria y el número de ingresos al establecimiento. Se identificó que los "clúster" que tuvieron un costo mayor, fueron pacientes con edad de 70 y 72 años como mediana, con altos número de días de estancia y con alguna cirugía de alta complejidad. Conclusión. Los patrones de costos de la atención de la EIC estuvieron asociados a la estancia y los reingresos al establecimiento de salud. Los "clústers" con mayor costo estuvieron relacionados a la edad y complejidad de la cirugía.

ABSTRACT Introduction. Ischemic heart disease (IHD) is currently a public health problem in Peru, and its treatment tends to be very expensive for the health system. Goal. Establish the patterns of care costs of the EIC in the National Cardiovascular Institute (INCOR) of the Social Security in Health of Peru (EsSalud). Methods. The databases of care, surgeries, discharges and gross value of INCOR production of the population diagnosed and treated with IHD in 2019 (879 patients) were used. Costs of care were estimated using activity-based costing; an econometric model was used to establish the determinants of costs, and with the Euclidean distance method, "clusters" with similar characteristics were formed to establish cost patterns. Results. The highest cost of EIC care was 148 567 soles (US$ 44 830) for a patient with a 40-day stay. The main determinants of the cost of care were the hospital stay and the number of admissions to the establishment. It was identified that the "clusters" that had a higher cost were patients with a median age of 70 and 72 years, with a high number of days of stay and with some highly complex surgery. Conclusion. Cost patterns for IHD care were associated with length of stay and readmissions to the health facility. The "clusters" with the highest cost were related to age and complexity of the surgery.

Coexistence of Positive 99mTc-DPD Scintigraphy and Monoclonal Gammopathy: A Frequent Challenge.

Background: Cardiac involvement is common in amyloidosis, and the vast majority of cases of amyloid cardiomyopathy are attributed to primary amyloidosis or transthyretin amyloidosis (ATTR). Although the coexistence of scintigraphy suggestive of ATTR with monoclonal gammopathy of undetermined significance is well documented, the correct diagnosis is still challenging in non-referral centers. Methods: We performed a retrospective study reviewing all amyloid cardiomyopathy cases diagnosed at our center over the last 5 years, and described our experience and diagnostic approach. Results: During the last 5 years, 74 patients with positive scintigraphy were identified. Of these patients, 41 were included in this study as they had all necessary tests for a complete diagnosis. Two of these 41 patients had variant ATTR and 29 had wild-type ATTR. Ten patients had monoclonal gammopathy (24.4%), and it was consequently impossible to obtain a specific diagnosis. During follow-up, 14 patients (34.1%), five of them from the monoclonal gammopathy group, died, reflecting the severity of disease. Conclusions: In patients with ATTR-suggestive scintigraphy, monoclonal gammopathy frequently occurs concomitantly, thus not allowing to establish a specific diagnosis. A biopsy could only be replaced by genetic testing in selected cases.

Patrony: A mobile application for pattern recognition learning.

Pattern recognition is an important skill of Computational Thinking and is one of the most important competences for solving a problem that involves finding similarities or patterns in small problems to solve more complex ones. In this work, we present the mobile application software Patrony. The main contribution of this work is to promote the learning of Computational Thinking, especially pattern recognition, in specific sectors of education in Mexico through the simple use of a software application. To evaluate the effectiveness of the mobile application, tests were carried out in two elementary schools with a total of 43 students, which were divided into 2 groups: a control group and an experimental group. The results of the tests showed that the learning gain (M = 6.50 in postest compared to M = 4.94 on pretest) of the students who used our mobile application produces a significant difference with respect to students who learned using a traditional method of classroom teaching. The results also infer that computational thinking applications can be used as effective learning tools within some important Mathematics topics in public and private schools in Mexico.

Ingreso de nitrógeno y fósforo al lago Atitlán (Guatemala) vía deposición atmosférica / Input of Nitrogen and Phosphorus to Lake Atitlán (Guatemala) via atmospheric deposition

La deposición de nutrientes por vía atmosférica tiene graves impactos sobre la ecología de bosques y cuerpos de agua templados. Sin embargo, su importancia en cuerpos de agua neotropicales casi no ha sido estudiada. En este artículo se cuantifica la contribución de nitrógeno inorgánico disuelto (NID, [NO3--N + NH4+-N]) y fósforo inorgánico soluble (FIS, [PO4-3-P]) depositados en bulto sobre superficies húmedas por vía atmosférica hacia el lago Atitlán (Guatemala). Las cargas estimadas de NID y FIS consecuencia de la deposición atmosférica directa (depositada sobre la superficie del lago) fueron de 151.2 ton/año y 5.6 ton/año, respectivamente. Con estos resulta-dos, se estima que el aporte de FIS por deposición atmosférica al lago Atitlán es comparable al de sus principales ríos tributarios, y de casi el doble para el ingreso de NID. Las estimaciones para el lago Atitlán son mayores que lo reportado para otros lagos. Nuestro estudio proporciona información básica para entender la eutrofización del lago Atitlán, enfatizado en la importancia de la deposición atmosférica como contribuyente al deterioro de este cuerpo de agua. Además, demuestra la necesidad de extender este tipo de estudio a otras cuencas neotropicales y la importancia de minimizar este impacto.

Atmospheric nutrient deposition has serious impacts on the ecology of forests and temperate water bodies nevertheless its importance in Neotropical water bodies has hardly been studied. Here we quantify the contribution of bulk atmospheric deposition on wet surfaces of dissolved inorganic nitrogen (DIN,[NO3--N + NH4+-N])and soluble inorganic phosphorus (SIP, [PO4-3-P])into Lake Atitlán (Guatemala). The estimated NID and SIP loads from this direct deposition on the lake surface were respectively, 151.2 tons/year and 5.6 tons/year. With these results, we estimated that the SIP input from atmospheric deposition to Lake Atitlán is comparable to that from the lake's main tributary rivers, whereas for DIN entry this is almost twice as much. Estimates for Lake Atitlán are higher than those reported for many lakes. Our study provides basic information towards understanding the eutrophication of Lake Atitlán, emphasizes the importance of atmospheric deposition in this process and the need for additional studies to document the process in neotropical watersheds.

[Anatomy variant of the papillary muscles as a cause of mitral regurgitation. Case report of a parachute-like asymmetric mitral valve] / Variante de la anatomía de los músculos papilares como causa de insuficiencia mitral. Un caso de válvula mitral asimétrica en paracaídas-like.

Introducción: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo las pruebas de imagen cardiaca son el procedimiento de elección tanto para el diagnóstico anatómico como para realizar la valoración funcional de este tipo de anomalía estructural. Caso Clínico: Paciente con cuadro de descompensación hemodinámica en el cual se diagnóstica de manera incidental de una valvulopatía mitral en forma de paracaídas-like. Los hallazgos de imagen por ecocardiografía transtorácica y resonancia magnética ponen de manifiesto la presencia de 2 músculos papilares, ambos con inserción en segmento lateral apical confirmando una válvula mitral asimétrica con similitud a su morfología en paracaídas. Discusión: La válvula mitral en paracaídas es una anomalía congénita poco común constituyente en la presencia de dos músculos papilares siendo uno de ellos más elongado y adherido al velo mitral de forma contigua, mostrándose en algunos casos pequeñas cuerdas tendinosas asociadas. Puede presentar una evolución benigna siendo un hallazgo casual o asociarse a repercusión hemodinámica valvular como el caso presentado. Conclusión: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo su evolución muy variable, pudiendo pasar desapercibida o afectando de forma significativa a la mecánica valvular.

Introducción: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo las pruebas de imagen cardiaca son el procedimiento de elección tanto para el diagnóstico anatómico como para realizar la valoración funcional de este tipo de anomalía estructural. Caso Clínico: Paciente con cuadro de descompensación hemodinámica en el cual se diagnóstica de manera incidental de una valvulopatía mitral en forma de paracaídas-like. Los hallazgos de imagen por ecocardiografía transtorácica y resonancia magnética ponen de manifiesto la presencia de 2 músculos papilares, ambos con inserción en segmento lateral apical confirmando una válvula mitral asimétrica con similitud a su morfología en paracaídas. Discusión: La válvula mitral en paracaídas es una anomalía congénita poco común constituyente en la presencia de dos músculos papilares siendo uno de ellos más elongado y adherido al velo mitral de forma contigua, mostrándose en algunos casos pequeñas cuerdas tendinosas asociadas. Puede presentar una evolución benigna siendo un hallazgo casual o asociarse a repercusión hemodinámica valvular como el caso presentado. Conclusión: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo su evolución muy variable, pudiendo pasar desapercibida o afectando de forma significativa a la mecánica valvular.

Cardiac Transthyretin Amyloidosis: A Nuclear Medicine Leading Role. Situation in a Spanish Center and "State of the Art" in Nuclear Medicine.

PURPOSE: Amyloidosis is a heterogeneous group of diseases caused by abnormal extracellular deposition of insoluble proteins and can involve myocardium. One of the causes of myocardial involvement is TTR amyloidosis. Our objective has been to evaluate the situation of cardiac amyloidosis (CA) in our center and the role of nuclear medicine, and to review the state of the art of nuclear medicine in this entity. PATIENTS AND METHODS: We have evaluated retrospectively 186 patients with clinical suspicion of CA and analyzed the clinical characteristics, free light chains and immunofixation in serum and/or urine, and the most relevant biomarkers associated with transthyretin CA (C-ATTR) of these patients and compared them with the results of the 99mTc-DPD scintigraphy. RESULTS: We have verified the growing bibliographic evidence concerning C-ATTR. A total of 51 scintigraphies (27.4%) were positive, 2 (1.1%) indeterminate and 133 (71.5%) negative according to the Perugini score. ATTR was diagnosed in 22 (11.8%; 77.3% males; mean age, 79.4 years). Of these, 12 (75% men; 82.3 years) were ATTRwt (wild-type or age-associated) patients, 2 (50% men; 52 years) experienced ATTRv (variant or hereditary), and 8 (87.5% men; 82.3 years) were not classified because of the absence genetic test. The origin of amyloidosis could not be determined in 31 (16.7%; 80.7% males; 84.5 years). In 29 of them (93.6%), it was because there was no study of free light chains or immunofixation. CONCLUSIONS: Nuclear medicine is playing an increasing role in the diagnosis and classification of CA. However, the monitoring of these is still patchy.

Satisfacción laboral y condiciones laborales en odontólogos de Cartagena de Indias-Colombia / Labor satisfaction and labor conditions in dentists of Cartagena de Indias-Colombia

Objetivo: relacionar satisfacción laboral con la condición laboral de odontólogos de Cartagena, Colombia. Materiales y métodos: estudio descriptivo transversal en una muestra no probabilística de 107 odontólogos generales que laboraban de manera independiente en centros odontológicos en el año 2016. Se diseña y aplica cuestionario para indagar satisfacción laboral, variables sociodemográficas y condiciones laborales. Resultados: 55,1 % de los odontólogos se sentían satisfechos laboralmente; de estos 62,6 % refirieren sentirse insatisfechos con la remuneración obtenida y así mismo 75,7 % insatisfechos con las condiciones del mercado laboral. Se hallan relaciones con significancia estadística entre satisfacción laboral y tener menos de 44 años (p =0,003), sexo masculino (p= 0,007) y estar casado (p= 0,038); igualmente entre condiciones laborales y duración de jornada laboral (p= 0,016), remuneración recibida (p=0,000), competencia laboral (p=0,001) y haber estado alguna vez desempleado (p=0,034). Conclusión: la satisfacción de los odontólogos, las condiciones laborales y el cumplimiento de expectativas se relaciona con factores que generan resultados de percepción negativa indicando que la situación de la odontología no es la mejor en la actualidad. Estudios más a fondo se recomiendan para determinar las raíces del problema y tomar decisiones gubernamentales respecto al futuro..Au

Objective: to relate job satisfaction with the working condition of dentists in Cartagena-Colombia. Materials and methods: cross-sectional descriptive study in a non-probabilistic sample of 107 general dentists who work in dental centers in 2016. A questionnaire was designed and applied to investigate job satisfaction, sociodemographic variables and working conditions. A descriptive statistic and a test with 95% confidence were performed for the significance of the relationships. Results: 55.1% of dentists felt satisfied at work; Of these, 62.6% reported dissatisfaction with remuneration and 75.7% dissatisfied with labor market conditions. The relationships with statistical significance between job satisfaction and having less than 44 years (p = 0.003), male sex (p = 0.007) and being married (p = 0.038); just like relate working conditions with the duration of the working day (p = 0.016), remuneration received (p = 0.000), labor competence (p = 0.001) and having been unemployed at some time (p = 0.034). Conclusion: the satisfaction of dentists, working conditions and the fulfillment of expectations are related to factors, which generate negative perception results indicating that the dentistry situation is not the best at present. Further studies are recommended to determine the roots of the problem and make government decisions regarding the future..Au

Immunohistochemical Demonstration of Parvovirus B19 Viral Protein 2 in Periflexural Exanthema in an Adult, Supporting Antibody-Dependent Enhancement as Means of Endothelial Uptake of the Virus.

Human parvovirus B19 (B19V) causes a number of skin exanthemas and has been related to both cutaneous and systemic diseases. Tropism of the virus for the rapidly proliferating erythroid progenitor cells in the bone marrow and fetal liver explains the pathogenesis of anemia and fetal hydrops. The cutaneous lesions of erythema infectiosum and other B19V-related exanthemas have been attributed to the deposition of immune complexes in the skin. We report on the immunohistochemical detection of B19V protein in the cytoplasm of dermal endothelial cells in a case of periflexural exanthema in a 28-year-old woman. An antibody-dependent enhancement mechanism of entry has been suggested for B19V in myocardial endothelial cells and could also be involved in B19V-related exanthemas.

Índice de diversidad biológica urbana de la ciudad de la antigua Guatemala / Index of urban biological diversity in the city of la antigua Guatemala L

La urbanización es un fenómeno global cuyo pronóstico prevé que para el 2050 hasta el 70% de la poblaciónmundial vivirá en ciudades. Esto tendrá un impacto sobre la diversidad biológica, lo que podría generar pérdidade especies y de los servicios ecosistémicos relacionados. Las administraciones municipales deben contemplareste componente para la planificación y desempeño ambiental de sus ciudades y áreas urbanas. El Convenio sobrela Diversidad Biológica (CDB) ha planteado una nueva herramienta para estimar la diversidad biológica enciudades: el índice de diversidad biológica urbana. En este proyecto se evaluó este índice para la ciudad de LaAntigua Guatemala. De un máximo de 72 puntos, el resultado para la ciudad de La Antigua Guatemala fue de33 puntos. Se midieron 18 indicadores de tres componentes: (1) biodiversidad urbana con un desempeño alto,(2) servicios ecosistémicos con un desempeño bajo y (3) gobernanza y manejo de la diversidad biológica con undesempeño medio. Los registros para la línea base de la biodiversidad son: 99 especies de aves, 148 especies deplantas vasculares, 46 especies de mariposas y 11 especies de murciélagos. Se recomienda a las autoridades dela ciudad de La Antigua Guatemala y actores involucrados, elaborar de urgencia la estrategia local de diversidadbiológica y su plan de acción.

The global process of urbanization predicts a 70% of all world citizens living in cities by the year 2050. Theresult will be a high impact on biological diversity like species loss and degradation of ecosystem services.Local governments have to introduce this component in the environmental planning and performance of their cities.The UN Convention on Biological Diversity (CBD) has proposed a new tool to evaluate the biological diversityin cities: The City Biodiversity Index (CBI). In this project the CBI for the city of La Antigua Guatemala wasassessed. The city scores 33 points out of 72. The indicators measured were related to three main components: (1)biological diversity with high value, (2) ecosystem services with low value and (3) governance and managementof biological diversity with medium value. Biodiversity base line records were: 99 bird species, 148 plant species,46 butterfly species and 11 bat species. The project recommends the urgent elaboration of Antigua Guatemala’sCity Local Biodiversity Strategy and Action Plan (LBSAP).

Brain natriuretic peptide levels variation after left atrial appendage occlusion.

OBJECTIVE: To explore the variations of brain natriuretic peptide (BNP) secretion after left atrial appendage occlusion. BACKGROUND: Left atrial appendage occlusion has been increasingly performed in the last few years, however little is known about the physiological consequences of left atrial appendage occlusion. Left atrial appendage regulates partially intravascular volume via release of brain natriuretic peptide. Brain natriuretic peptide levels have been related to increased risk of stroke in atrial fibrillation patients. METHODS: Venous blood samples were obtained in consecutive patients undergoing left atrial appendage occlusion before, 24 hr after device implantation and at the first visit after discharge (45-60 days) for BNP measurement. RESULTS: Left atrial appendage occlusion was performed in 34 patients with non-valvular atrial fibrillation and contraindication to long-term oral anticoagulation or at high-risk of bleeding. There were no differences in BNP levels between baseline and 24 hr after device implantation. However left atrial appendage closure resulted in a significant decrease in BNP levels at the first follow-up visit (45-60 days) compared to baseline measurements (759.90 pg ml(-1) vs. 636.90 pg ml(-1) , P = 0.013). CONCLUSIONS: Left atrial appendage occlusion modifies BNP levels. These levels decrease after left atrial appendage occlusion. The clinical consequences of these findings need to be evaluated in further studies. © 2015 Wiley Periodicals, Inc.

Aspectos neuropsiquiátricos de la parálisis supranuclear progresiva: análisis de un caso / Neuropsychiatric aspects of progressive supranuclear palsy: Case report

La parálisis supranuclear progresiva (PSP) es una enfermedad neurodegenerativa de etiología desconocida descrita por primera vez en 1964 por Steele, Richardson y Olszewsy. Cursa con inestabilidad postural prominente como síntoma de comienzo, seguida posteriormente de parálisis supranuclear de la mirada vertical y sintomatología parkinsoniana como bradicinesia y rigidez. Incluye deterioro cognitivo y trastornos neuropsiquiátricos. En este trabajo se describe el caso de una paciente que tras ser vista por varios especialistas es derivada a Salud Mental por síndrome depresivo, siendo finalmente diagnosticada como PSP. A pesar de la importancia de los aspectos neuropsiquiátricos en el cuadro clínico de la PSP, estos han sido descritos de forma menos detallada en la literatura que los síntomas neurológicos. Cabe recordar que los ganglios basales desarrollan un papel muy importante en la regulación de las emociones, el ánimo, la motivación y la cognición, además del conocido respecto al control motor. El diagnóstico temprano de la PSP es difícil, las quejas iniciales suelen ser vagas, inespecíficas e inducen a error, es muy frecuente que estos pacientes sean diagnosticados erróneamente como depresivos. Un mayor conocimiento de la enfermedad que permita realizar un diagnóstico temprano puede prevenir tratamientos con medicaciones inútiles y llevar a cabo las intervenciones necesarias. Revisaremos los aspectos diferenciales psicopatológicos y cognoscitivos de la PSP en relación con otras enfermedades neurodegenerativas, prestando especial atención a la apatía como síntoma y su diferenciación con lo depresivo (AU)

Progressive supranuclear palsy (PSP) is a neurodegenerative disease of unknown etiology, first described in 1964 by Steele, Richardson and Olszewsy. It presents with prominent postural instability as an onset symptom, followed by vertical supranuclear gaze palsy and Parkinsonian symptomatology, such as bradykinesia and rigidity. It also includes cognitive impairment and neuropsychiatric disorders. This paper describes the case of a patient, who after being evaluated by several specialists was referred due to a depressive syndrome to our mental health service, and was finally diagnosed with PSP. Despite the importance of neuropsychiatric aspects in the clinical manifestation of PSP, these have been less described in the literature than the neurological symptoms. Basal ganglia have an important role in the regulation of emotions, mood, motivation, and cognition, as well as in motor control. Early diagnosis of PSP is difficult, and as initial complaints are often vague, unspecific and misleading, it is common for these patients to be misdiagnosed as depression. Increased awareness of the disease to enable an early diagnosis to be made can prevent unnecessary treatment with medications and lead to appropriate interventions. The differential psychopathological and cognitive aspects of the PSP in relation to other neurodegenerative diseases will be reviewed, with special attention to apathy as symptom and its differentiation with depression (AU)