[Peripartum cardiomyopathy with biventricular failure plus pulmonary thromboembolism and atrial septal defect]. / Miocardiopatía periparto con fallo biventricular más tromboembolismo pulmonar y comunicación interauricular.

This case report examines peripartum cardiomyopathy (PPCM), a rare variant of heart failure with reduced ejection fraction, which manifests at the end of labor or puerperium. The frequency of this pathology varies globally, and its association with risk factors such as genetic disorders, autoimmune diseases, viral infections, suggests a multifactorial etiology. Diagnostic criteria include: Heart failure secondary to left ventricular systolic dysfunction, manifested in the puerperium or at the end of pregnancy and lack of other identifiable causes of heart failure. The case presents a patient with no significant personal pathological history, who, 17 days post cesarean section developed acute symptoms, including abdominal pain, dry cough and dyspnea. Clinical findings revealed hypoxemia, alterations in blood tests and an echocardiogram that confirmed an atrial septal defect. Multidisciplinary management resulted in successful treatment and the patient was discharged without complications. This case highlights the importance of MCPP, a disease with high maternal mortality. The connection between atrial septal defect and PPCM, as well as the involvement of pulmonary thromboembolism.

Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model.

OBJECTIVES: . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN: . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS: . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION: . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.

Nutritional and non-nutritional agents that stimulate white adipose tissue browning.

Obesity is a public health problem present in both developed and developing countries. The white adipose tissue (WAT) is the main deposit of lipids when there is an excess of energy. Its pathological growth is directly linked to the development of obesity and to a wide number of comorbidities, such as insulin-resistance, cardiovascular disease, among others. In this scenario, it becomes imperative to develop new approaches to the treatment and prevention of obesity and its comorbidities. It has been documented that the browning of WAT could be a suitable strategy to tackle the obesity epidemic that is developing worldwide. Currently there is an intense search for bioactive compounds with anti-obesity properties, which present the particular ability to generate thermogenesis in the brown adipose tissue (BAT) or beige. The present study provide recent information of the bioactive nutritional compounds capable of inducing thermogenesis and therefore capable of generate positive effects on health.

Mannose-Binding Lectin-Deficient Donors Increase the Risk of Bacterial Infection and Bacterial Infection-Related Mortality After Liver Transplantation.

Mannose-binding lectin (MBL) is synthesized by the liver and binds to microbes. MBL2 gene polymorphisms produce intermediate/low/null or normal MBL serum levels (MBL-deficient or MBL-sufficient phenotypes, respectively). We aimed to evaluate the incidence and severity of infection, rejection, and survival within 1 year after liver transplantation (LT) according to donor and recipient MBL2 gene polymorphisms. A repeated-event analysis for infection episodes (negative binomial regression, Andersen-Gill model) was performed in 240 LTs. Four hundred twenty-eight infectious episodes (310 bacterial, 15 fungal, 65 cytomegalovirus [CMV]-related, and 38 viral non-CMV-related episodes) and 48 rejection episodes were recorded. The main bacterial infections were urinary (n = 82, 26%) and pneumonia (n = 69, 22%). LT recipients of MBL-deficient livers had a higher risk of bacterial infection (incidence rate ratio [IRR] 1.48 [95% confidence interval 1.04-2.09], p = 0.028), pneumonia (IRR 2.4 [95% confidence interval 1.33-4.33], p = 0.013), and septic shock (IRR 5.62 [95% confidence interval 1.92-16.4], p = 0.002) compared with recipients of MBL-deficient livers. The 1-year bacterial infection-related mortality was higher in recipients of MBL-deficient versus MBL-sufficient livers (65.8% vs. 56.1%, respectively; p = 0.0097). The incidence of rejection, viral, or fungal infection was similar in both groups. Recipient MBL2 genotype did not significantly increase the risk of bacterial infection. LT recipients of MBL-deficient livers have a higher risk of bacterial infection, pneumonia, septic shock, and 1-year bacterial infection-related mortality after LT.

Prognostic Value of Brain Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy: A Meta-analysis.

OBJECTIVE: To quantify the prognostic value of neonatal brain magnetic resonance imaging (MRI) in neonatal hypoxic-ischemic encephalopathy. METHODS: Meta-analysis of studies with ≥35-week neonates with hypoxic-ischemic encephalopathy who underwent brain MRI within age 4 weeks and had neurodevelopmental follow-up for at least 12 months. RESULTS: An abnormal neonatal brain MRI was more frequent among patients with unfavorable neurodevelopmental outcome: odds ratio = 18.2 (95% confidence interval: 9.4-34.9), P <.0001. The prognostic value of neonatal brain MRI in moderate hypoxic-ischemic encephalopathy had an odds ratio of 17.7 (95% confidence interval: 5.3-59.3) and in severe hypoxic-ischemic encephalopathy, the odds ratio was 125.0 (95% confidence interval: 2.0-7917.1). Therapeutic hypothermia did not change the prognostic value of neonatal brain MRI (odds ratio for hypothermia, 14.0 [95% confidence interval: 3.1-63.6], vs no hypothermia, 18.1 [95% confidence interval: 10.0-33.1], P = .7525). CONCLUSION: Neonatal brain MRI provides prognostic information on outcome beyond early infancy in hypoxic-ischemic encephalopathy and therapeutic hypothermia does not change its prognostic value.

Lesiones y variantes normales de la rodilla pediátrica / Injuries and normal variants of paediatric knee

Abstract. Knee pathology is a reason for consultation and prevalent condition in children, making it important to know the normal variants as well as the most frequent pathologies. This review includes a brief description of the main pathologies and normal variants that affect the knee in children, with their main clinical features, as well as the findings described in the various, most-used, imaging techniques (X-ray, ultrasound, computed tomography, and magnetic resonance (MR).

Resumen. La patología de rodilla es un motivo de consulta y una entidad prevalente en la edad pediátrica, razón por la cual es importante conocer tanto las variantes normales como las patologías más frecuentes. En esta revisión se realiza una breve descripción de las principales patologías y variantes normales que afectan a la rodilla en la edad pediátrica, tanto de sus características clínicas principales como de los hallazgos descritos en las distintas modalidades de imagen más utilizadas (radiografía, ecografía, tomografía computarizada y resonancia magnética (RM).

Biological markers in noninvasive brain stimulation trials in major depressive disorder: a systematic review.

OBJECTIVES: The therapeutic effects of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation in patients with major depression have shown promising results; however, there is a lack of mechanistic studies using biological markers (BMs) as an outcome. Therefore, our aim was to review noninvasive brain stimulation trials in depression using BMs. METHODS: The following databases were used for our systematic review: MEDLINE, Web of Science, Cochrane, and SCIELO. We examined articles published before November 2012 that used TMS and transcranial direct current stimulation as an intervention for depression and had BM as an outcome measure. The search was limited to human studies written in English. RESULTS: Of 1234 potential articles, 52 articles were included. Only studies using TMS were found. Biological markers included immune and endocrine serum markers, neuroimaging techniques, and electrophysiological outcomes. In 12 articles (21.4%), end point BM measurements were not significantly associated with clinical outcomes. All studies reached significant results in the main clinical rating scales. Biological marker outcomes were used as predictors of response, to understand mechanisms of TMS, and as a surrogate of safety. CONCLUSIONS: Functional magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, magnetic resonance spectroscopy, cortical excitability, and brain-derived neurotrophic factor consistently showed positive results. Brain-derived neurotrophic factor was the best predictor of patients' likeliness to respond. These initial results are promising; however, all studies investigating BMs are small, used heterogeneous samples, and did not take into account confounders such as age, sex, or family history. Based on our findings, we recommend further studies to validate BMs in noninvasive brain stimulation trials in MDD.

Evaluation of six risk factors for the development of bacteremia in children with cancer and febrile neutropenia.

Febrile neutropenia is a well-known entity in children with cancer, being responsible for the high risk for infection that characterizes this population. For this reason, cancer patients are hospitalized so that they can receive prophylactic care. Risk factors have been used to classify patients at a high risk for developing bacteremia. The present study evaluates whether those risk factors (C-reactive protein, hypotension, leukemia as the cancer type, thrombocytopenia, recent chemotherapy, and acute malnutrition) apply to patients at the Unidad Nacional de Oncología Pediátrica. We evaluated 102 episodes in 88 patients, in whom risk factors and blood cultures were tested. We observed no statistical relationship between the six risk factors and bacteremia. There was also no relationship between bacteremia and the simultaneous presence of two, three, or more risk factors. A significant relationship of C-reactive protein and platelet count with other outcome factors was observed.

Signo del yin-yang: la dualidad del pseudoaneurisma / Yin-yang sign: the duality of the pseudoaneurysm

Pseudoaneurysm is a collection of blood adjacent to a punctured blood vessel, connected with it and characterized by an inner bidirectional flow in relation with systole and diastole. This diagnosis is usually based on color Doppler examination findings, among which we can highlight the visualization of a collection with a two-way flow pattern, with a red and a blue component, which resembles the Chinese Yin Yang symbol. The increase in the number of angiographic procedures and arterial catheterization requires from radiologists the ability to properly diagnose the complications these procedures may entail.

El pseudoaneurisma corresponde a una colección adyacente a un vaso arterial puncionado, conectada con éste y con flujo bidireccional en su interior, en relación con el sístole y el diastole. Habitualmente este diagnóstico se basa en los hallazgos al estudio Doppler color, entre los cuales destaca la visualización de una colección que presenta flujo en dos direcciones, que se representa en dos colores y se asemeja al signo oriental del Yin Yang. El aumento en el número de procedimientos angiográficos y cateterizaciones arteriales requiere que los radiólogos diagnostiquen adecuadamente las complicaciones que estos procedimientos pueden presentar.

Microinjerto in vitro de vid (Vitis vinifera) / In vitro micrograft of vine (Vitis viniferous)

Se implementó la técnica de microinjerto in vitro de meristemos apicales de dos variedades productoras de vid, además trata de la importancia del cultivo de la vid en Bolivia tomando en cuenta la calidad de los viñedos.

Psychology over the Internet: On-Line Experiences.

The "International Symposium on Psychology over the Internet: On-Line Experiences" was held in Lima, Peru, July 2003, at the 29th InterAmerican Congress of Psychology. The main topic was the advantages and disadvantages of using this technology in the applied field of psychology. The Internet has been considered a new alternative for teaching-learning processes (virtual classroom); vocational assessment; counseling and orientation (virtual psychological consultation); and intervention focused on specific health-related problems. These experiences of on-line psychological services and their conclusions are briefly described herein.

Anencefalia: presentación de un caso clínico / Anencephaly: a clinical case

La anencefalia es una malformación del sistema nervioso, causado por la falla del cierre del neuroporo anterior durante la embriogénesis. Su incidencia es de 1 en 1.000 embarazos en Estados Unidos. Los recién nacidos con anencefalia generalmente sobreviven sólo pocas horas o días, y excepcionalmente se han descrito casos de sobrevida de algunas semanas. Existen numeroso estudios que sugieren la existencia de factores genéticos y ambientales en la génesis de este trastorno, por ejemplo, mutaciones en el gen que codifica la enzima metilentetrahidrofolato reductasa, elevados niveles plasmáticos de homocisteína y bajos de folato en madres de niños con defectos del tubo neural y factores ambientales diversos. La mayoria de los casos son diagnosticados mediante ultrasonografía precozmente durante el embarazo (antes de las 20 semanas). Se presenta un caso clínico de recién nacido con anencefalia, en el Hospital de Salamanca, que tuvo una sobrevida excepcionalmente prolongada y se revisa el tema

Evaluación de la respuesta de la Begonia Rex a la variación de medios y reguladores de crecimiento en técnicas de cultivo de hojas in vitro / Evaluation of the answer of the Begonia Rex to the variation of half irregular of growth in technical of cultivation of leaf in vitro

El presente trabajo comprendió la estandarización de tratamientos de desinfección, medios y reguladores de crecimiento, en el proceso de micropropagación de Begonia rex, especie con valor ornamental y de reproducción agámica, a partir de la técnica de cultivo in vitro de hojas y peciolos. Durante la etapa de desinfección, se probó los siguientes tratamientos con hipoclorito de sodio (obtenida a partir de lejía comercial): 1 por ciento de NaClO durante 10 min (para peciolo), 1,5 por ciento durante 20 min, 0.5 por ciento durante 45 min, 0.5 por ciento durante 10 min (para peciolos y hojas), 2 por ciento durante 15 min+0.5 por ciento durante 15 min y 0.5 por ciento durante 90 min (para hojas). Los resultados mostraron que, el tratamiento 0.5 por ciento de NaClO durante 45 min, es el más recomendado para la desinfección de hojas, y el tratamiento 1.5 por ciento durante 20 min para peciolos. Una vez establecido un método de desinfección, para hojas y peciolos, se procedió a evaluar los efectos de los medios de cultivo sobre los diferentes explantes (limbos foliares y peciolos). Se evaluaron los siguientes medios: (M1) MS sin reguladores de crecimiento; (M2) MS+0.1 mg/1 de ANA+0.4 mg/1 de BAP; (M3) MS+00.1 mg/1 de ANA+0.1 mg/1 de Kin (M4) MS+1 mg/1 de ANA+0.3 mg/1 de BAP; (M5) MS+0.5 mg/1 de AIB, resultando el más adecuado el M5 para peciolos y hojas, que indujo a la formación de mayor número de brotes en menor tiempo

Evaluación de la respuesta de dos ecotipos de ajo (Allium sativum L) a la variación de medios y reguladores de crecimiento, en el proceso de microbulbificación in vitro / Evaluation of the answer of two ecotypes of garlic to the variation of middles and regulating of growth en the process of microbulbificacion in vitro

En la actualidad el cultivo de ajo, va tomando importancia en el país, debido al estímulo de su exportación. En este trabajo, se logró la obtención de microbulbillos de dos de los ecotipos de mayor producción en Bolivia, Rosado de Italia y Colorado de Mendoza. La producción de éstos ecotipos en la actualidad está destinada a la exportación. En la etapa de establecimiento, se estudió el comportamiento de los dos ecotipos, en tres medios basales Murashige & Skoog (MS), Gamborg (B5) y nutrientes MS con vitaminas B5 (MS + B5) con dos variaciones de los reguladores de crecimiento ácido indolacético (AIA) y kinetina (Kin), (0.1 mg/1 de AIA + 0.1 mg/1 de Kin y 0.1 mg/1 de AIA + 0.15 mg/1 de Kin). El ecotipo Rosado de Italia mostró mejor desarrollo de sus explantes, alcanzando alturas promedio de 95.1 mm al cabo de 42 días (P=0.0001). La mejor combinación para esta etapa fue el uso del medio MS+B5 con 0.1 mg/1 de AIA + 0.1 mg/1 de Kin (P=0.0098). En la etapa de multiplicación, se estudió el comportamiento de los dos ecotipos, utilizando solo el medio basal MS + B5, con cuatro variaciones de los regulares de crecimiento; dimetil alilaminopurina (2ip), ácido naftalenacético (ANA) y ácido jasmónico (JA); (1 mg/1 de 2ip + 0.1 mg/1 de ANA, 3 mg/1 de 2ip + 0.3 mg/1 de ANA, 1 mg/1 de 2ip + 1 mg/1de JA y 1 mg/1 de 2ip + 2 mg/1 de JA). Los medios que promovieron un mayor número de brotes a partir de cada explante, fueron los que contenían JA (P=0.0001). El ecotipo que desarrolló mayor número de brotes fue el Colorado de Mendoza con un promedio de 6.18, en comparación al promedio de 3.75 brotes del Rosado de Italia (P=0.0001). En la etapa de microbulbificación, se estudió el comportamiento de los dos ecotipos, en el medio basal MS+B5 al que se añadió sacarosa con una concentración de 50 g/1, con tres concentraciones diferentes de ácido jasmónico (0 mg/1, 1 mg/1 y 2 mg/1). En ésta etapa el ecotipo Rosado de Italia, desarrolló microbulbillos de diámetros mayores (5.75 mm) que el ecotipo Colorado de Mendoza (4.56 mm) P=0.0003. No hubo diferencias significativas (P>0.05) entre las diferentes concentraciones de reguladores de crecimiento. Por lo tanto, para producir una bulbificación in vitro, es necesario inducir un estrés fisiológico, mediante un estrés hídrico producido por el aumento del potencial osmótico al aumentar la concentración de sacarosa

Fibromialgia: revisión y actualización / Fibromyalgia: review and update

Se presenta una revisión bibliográfica de la fibromialgia, síndrome reumatológico doloroso crónico, sin etiología precisa y con una fisiopatología actualmente en estudio. Se revisan los tratamientos tanto farmacológicos como no farmacológicos actualmente disponibles para el manejo de la enfermedad con recomendaciones respecto de aquellos que han demostrado buenos resultados en estudios casos comparativos y de controles

Blastomycosis presenting as multiple splenic masses.

Blastomyces dermatitidis is a fungus that causes a wide spectrum of disease in humans. The clinical and pathological entity of splenic abscess due to blastomycosis is extremely rare. A case of splenic blastomycosis is reported, and its cytopathological and radiological features are described.

A comparison of lateral versus anterior-posterior spine dual energy x-ray absorptiometry for the diagnosis of osteopenia.

Because bone mineral density (BMD) measurements at various sites differ in the relative amounts of cortical and trabecular bone that they assess, they also differ in their sensitivity for detecting osteopenia. Lateral spine dual energy x-ray absorptiometry (DXA) allows measurement of BMD of the vertebral bodies, which contain mainly trabecular bone, without contribution from the posterior vertebral elements, which are rich in cortical bone. Thus, we hypothesized that lateral spine DXA would detect osteopenia more frequently than anterior-posterior (AP) spine DXA. To assess the ability of DXA to estimate trabecular bone mass, we compared AP and lateral DXA spine measurements with trabecular bone measurements by quantitative computed tomography (QCT) in 58 patients. We then compared AP vs. lateral spine DXA measurements in 1) 300 women referred for routine bone densitometry, 2) 30 glucocorticoid-treated women, and 3) 44 women with vertebral compression fractures. To compare short term reproducibility, we performed repeat AP and lateral DXA scans in 50 women. The association between QCT and DXA measurements was stronger when DXA measurements were made in the lateral (r = 0.784) or midlateral (r = 0.823) projection than in the AP (r = 0.571) projection. The association of BMD with age was stronger when DXA measurements were made in the lateral (r = 0.536) or midlateral (r = 0.536) projection than in the AP (r = 0.382) projection. The declines in BMD with age for AP, lateral, and midlateral DXA measurements were 0.48%, 0.60%, and 0.88%/yr, respectively. In the women referred for routine densitometry, lateral DXA measurements were significantly (P < 0.05) more abnormal than AP measurements compared with those in young women. This was also true in the women treated with glucocorticoids and women with vertebral compression fractures. Lateral DXA often detected osteopenia in patients whose AP DXA was normal. The 95% confidence limits for changes in BMD attributable to measurement error for AP, lateral, and midlateral DXA were 0.027, 0.038, and 0.057 g/cm2, respectively. These results indicate that lateral DXA measurements identify patients with osteopenia more often than AP DXA measurements, probably because lateral DXA more accurately estimates trabecular bone mass. Short term reproducibility of lateral DXA is nearly as good as that for AP DXA.