Potenciales biomarcadores moleculares de infiltración a sistema nervioso central en leucemia linfoblástica aguda / Central nervous system potential molecular biomarkers in acute lymphoblastic leukemia

Resumen La leucemia linfoblástica aguda es el tipo de leucemia más frecuente en niños entre los 2 y 3 años. A nivel internacional la población hispana es reportada como la más prevalente. En México se carece de información reciente, sin embargo, se conoce que es uno de los cánceres más frecuentes en niños. La infiltración de células linfoblásticas a sistema nervioso central es una complicación de pronóstico ominoso que puede presentarse en los pacientes con leucemia linfoblástica aguda, actualmente el diagnóstico se establece mediante citología de líquido cefalorraquídeo, sin embargo, es una prueba operador dependiente y que es afectada por el número de punciones realizadas en la toma de líquido cefalorraquídeo, con potencial contaminación con sangre. En distintos estudios se han caracterizado 6 genes que presentan una sobreexpresión en líquido cefalorraquídeo cuando se presenta dicha infiltración, en esta revisión analizamos estos nuevos marcadores y su potencial como herramientas de diagnóstico oportuno.

Abstract Acute lymphoblastic leukemia is the most common type of leukemia in children between 2 and 3 years of age. Internationally, hispanic population is reported as the most prevalent. In Mexico there is few recent information, however, it is known that it is one of the most frequent cancers in children. Infiltration of lymphoblastic cells into the central nervous system is an ominous prognostic complication that can occur in patients with acute lymphoblastic leukemia. Currently, diagnosis is established by cerebrospinal fluid cytology, however, this technique is affected by the number of punctions done while obtaining the fluid. In several research studies, 6 genes have been identified to be overexpressed in cerebrospinal fluid when infiltration occurs. In this review we analyzed these new molecular biomarkers and their potential as tools for timely diagnosis.

Changes in Brain-Derived Neurotrophic Factor by different kind of military training / Cambios en el Factor Neurotrófico Derivado del Cerebro por diferentes tipos de entrenamiento militar

Abstract Background: Brain Derived Neurotrophic Factor (BDNF) serum levels change with age, physical exercise, and neuropsychiatric disorders such as dementia, depression, anxiety, schizophrenia, and bipolar disorder. Military personnel are physically and mental training with an increased risk of developing mental disorders. Objective: The main objective of this study was determinate the BDNF serum levels in four military samples. 132 participants, administrative personnel (control) and three different Special Operations Forces (SOF) groups participated in the study. Methods: A first group of SOFS was on a training course (SOF-TC), second group exposed to 48 hours of operational stress (SOF-48hS) and third group exposed to two-weeks of operational stress (SOF-2wS). The mini interview was conducted and CAPS, and BNF levels were determined by ELISA assays. Results: Differences in age, were evaluated by ANOVA post-hoc Tukey´s. Differences in BNDF levels are evaluated by the Kruskal-Wallis test post hoc Dunn's. Spearman's correlation was used to analyze the relationship between BDNF and age. The SOF-TC had a BDNF elevation in comparison with Control group that could be related to age differences or the physical and mental training.SOF-2wS had decreased BDNF levels in comparison to the other groups that could be related to the psychosocial stress or other mental disorders such as PTSD. That group, 2 participants showed signs of PTSD. Conclusion: BDNF levels are an accurate method for the evaluation of mental health to prevent, diagnose & treat mental disorders in military personnel exposed to operational stress.

Resumen Introducción: Los niveles séricos del factor neurotrófico derivado del cerebro (BDNF) cambian con la edad, el ejercicio físico y los trastornos neuropsiquiátricos como la demencia, la depresión, la ansiedad, la esquizofrenia y el trastorno bipolar. El personal militar está en formación física y mental con un mayor riesgo de desarrollar trastornos mentales. Objetivo: El objetivo principal de este estudio fue determinar los niveles séricos de BDNF en cuatro muestras militares. Participaron en el estudio 132 individuos entre personal administrativo (control) y tres grupos diferentes de Fuerzas de Operaciones Especiales (SOF). Métodos: Un primer grupo de SOFS estaba en un curso de capacitación (SOF-TC), el segundo grupo expuesto a 48 horas de estrés operativo (SOF-48hS) y el tercer grupo expuesto a dos semanas de estrés operativo (SOF-2wS). Se realizó la minientrevista y se determinaron los niveles de CAPS y BNF mediante ensayos ELISA. Resultados: Las diferencias en edad, se evaluaron mediante ANOVA post hoc de Tukey. Las diferencias en los niveles de BNDF se evalúan mediante la prueba de Dunn post hoc de Kruskal-Wallis. Se utilizó la correlación de Spearman para analizar la relación entre BDNF y la edad. El SOF-TC tuvo una elevación de BDNF en comparación con el grupo control que podría estar relacionado con las diferencias de edad o el entrenamiento físico y mental, tal como PTSD. En ese grupo, dos participantes mostraron signos de PTSD. Conclusión: Los niveles de BDNF son un método preciso para la evaluación de la salud mental para prevenir, diagnosticar y tratar los trastornos mentales en el personal militar expuesto al estrés operativo.

Genetic variants in Colombian patients with inherited cardiac conditions.

BACKGROUND: Clinical and molecular diagnosis of inherited cardiac conditions is key to find at-risk subjects and avoid preventable deaths. This study aimed to identify genetic variants in a sample of Colombian patients diagnosed with inherited cardiac conditions. METHODS: Next-generation sequencing (Illumina platform) using a 231 gene panel was performed in blood samples of 25 unrelated patients with age disease onset between 9 and 55 years. RESULTS: Genetic testing yield was 52%. Two novel likely pathogenic/ pathogenic variants were found: a DSP nonsense variant in a patient with arrhythmogenic cardiomyopathy and a KCNE1 frameshift variant in two patients with long QT syndrome. Younger individuals (<18 years) had the highest genetic testing yield (66.6%) compared to 50% and 20% in young adults and patients over 40 years, respectively. All subjects affected with long QT syndrome with a severe event while exercising had a positive genetic test. They also had four times more loss of consciousness events and, resuscitated sudden cardiac arrest was more representative. CONCLUSION: This study is the first one undertaken in Colombia to evaluate inherited cardiac conditions. It highlights the need to perform mutational analysis to provide adequate genetic counseling and to be able to identify patients at risk of severe events.

Expresión de miRNAs en orina como herramienta de diagnóstico y pronóstico en cáncer de próstata / Expression of urine miRNAs as a diagnostic and prognostic tool in prostate cancer

Resumen Introducción: El cáncer de próstata es la principal causa de muerte por cáncer en México, el diagnóstico inicial se hace mediante la medición del antígeno prostático específico y el tacto rectal de la próstata. Sin embargo, hay limitaciones que incluye la capacidad para distinguir con precisión los pacientes con y sin cáncer y aquellos que presentan una forma agresiva de la enfermedad. Los microRNAs se encuentran alterados en el tejido prostático canceroso, incluyendo aquellos casos fármaco resistentes. Los miRNAs son reguladores de la expresión génica y se encuentran involucrados en diversos procesos patológicos. Se ha demostrado que estas moléculas son detectables en orina. Objetivo: Esta revisión presenta la información sobre cuáles son los miRNAs reportados en orina como posibles marcadores para el diagnóstico, pronóstico y respuesta a la terapia en cáncer de próstata. Resultados: De la búsqueda realizada en la bibliografía, se encontraron 13 miRNAs en los diferentes estudios, miR-19a, miR-19b, miR-21, miR-148a, miR-375, miR-125b-5p, miR-151-5p, miR-141, miR-200b, miR-221, miR-107, miR-26b-5p, miR-205-5p. Teniendo algunos miRNAs como miR-375, miR-21, miR-141 encontrados en varios estudios. Limitaciones del estudio o implicaciones: Se puede concluir es factible obtener la medición por métodos no invasivos de miRNAs en pacientes con cáncer de próstata. Originalidad o valor: Es un estudio de revisión respecto a los miRNAs obtenidos en muestras de orina en pacientes con cáncer de próstata.

Abstract Introduction: Prostate cancer is the leading cause of cancer death in Mexico, the initial diagnosis is made by measuring the Prostate Specific Antigen and the digital rectal examination of the prostate. However, there are limitations including the ability to accurately distinguish patients with and without cancer and those with an aggressive form of the disease. MicroRNAs are altered in cancerous prostate tissue, including drug-resistant cases. MiRNAs are regulators of gene expression and are involved in various pathological processes. These molecules have been shown to be detectable in urine. Objective: This review presents the information on which are the miRNAs reported in urine as possible markers for the diagnosis, prognosis and response to therapy in prostate cancer. Results: From the literature search, 13 miRNAs were found in the different studies, miR-19a, miR-19b, miR-21, miR-148a, miR-375, miR-125b-5p, miR-151-5p , miR-141, miR-200b, miR-221, miR-107, miR-26b-5p, miR-205-5p. Having some miRNAs like miR-375, miR-21, miR-141 found in various studies. Limitations of the study or implications: It can be concluded that it is feasible to obtain the measurement of miRNAs by non-invasive methods in patients with prostate cancer. Originality or value: It is a review study regarding miRNAs obtained in urine samples in patients with prostate cancer.

Relación de la expresión génica de IP-10 con la actividad del lupus eritematoso sistémico / Relationship of IP-10 gene expression to systemic lupus erythematosus activity

Objetivo: Evaluar la expresión génica del gen IP-10 en pacientes con lupus eritematoso sistémico (LES) y su posible relación con la actividad de la enfermedad. Pacientes y métodos: El estudio incluyó 120 pacientes diagnosticados con LES y 30 controles sanos. Se investigó la expresión génica relativa de IP-10 con el método fold change, la cual fue correlacionada con el nivel de actividad lúpica evaluado con el instrumento SLEDAI 2-K. Resultados: Se encontraron diferentes niveles en la expresión génica de IP-10 relacionada con la actividad lúpica (p =<0,001). Estos fueron mayores en los pacientes con actividad grave respecto a aquellos sin actividad, baja y moderada. El incremento en la expresión génica del grupo con actividad grave fue significativo con un fold change de tres. Conclusión: El incremento significativo en la expresión génica relativa IP-10 puede ser un marcador de actividad lúpica grave.(AU)

Objectives: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. Patients and methods: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. Results: Different levels of gene expression were found according to the SLE activity (p =<0.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3. Conclusion: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.(AU)

Relationship of IP-10 gene expression to systemic lupus erythematosus activity.

OBJECTIVES: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. PATIENTS AND METHODS: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. RESULTS: Different levels of gene expression were found according to the SLE activity (P = <.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3 CONCLUSION: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.

Serum miRNA profile as a potential tool for non-invasive gastric cancer diagnosis in Mexican patients.

INTRODUCTION: Gastric cancer (GC) is the third leading cause of cancer death and a major public health-care problem worldwide. At present, methods for plasma detection of cancer are limited. MicroRNAs (miRNAs) have recently been proposed as genetic regulators, which are deregulated in different types of cancer. The miRNAs are stable in serum/plasma and can be detected. Circulating miRNAs in plasma have been proposed as potential diagnostic biomarkers in GC. MATERIALS AND METHODS: After reviewing the relevant literature, the expression levels of seven miRNAs (miR-16, miR-21, miR-25, miR-26a, miR-92, miR-218, miR-223, and miR-451) were assessed by quantitative reverse transcription polymerase chain reaction using TaqMan microRNA Assays (Applied Biosystems) in plasma samples from GC patients (n = 80) and healthy controls (n = 80). RESULTS: Our results demonstrated that the expression levels of miR-21 and miR-25 were significantly upregulated in GC patients compared to healthy controls with a Fold Change of 11.551 and 60.129, respectively, while miR-223 showed downregulation in GC patients compared to healthy controls with a Fold Change of -247.281. The absolute value of Fold Change > 2 was consider significant, p < 0.05. CONCLUSIONS: Our results indicated that miR-21, miR-25, and miR-223 in plasma samples can be served as a potential noninvasive tool in detection of GC.

INTRODUCCIÓN: El cáncer gástrico (CG) es la tercera causa de muerte por cáncer y un importante problema de salud pública. Actualmente, los métodos para la detección de CG en plasma son limitados. Recientemente se han propuesto los microARNs (miARN) como reguladores genéticos en diferentes tipos de cáncer. Los miARN son estables en plasma, lo que permite una fácil detección, pudiendo usarse como biomarcadores en CG. MATERIALES Y MÉTODOS: Los niveles de expresión de siete miARN seleccionados (miR-16, miR-21, miR-25, miR-26a, miR-92, miR218, miR-223, miR-451) fueron evaluados mediante qRT-PCR mediante análisis con microARN TaqMan (Applied Biosystems) en muestras de plasma de pacientes con CG (n = 80) y controles sanos (n = 80). RESULTADOS: Se observo que los niveles de expresión de miR-21 y miR-25 estaban significativamente regulados al alza en los pacientes con CG en comparación con los controles con un Fold Change de 11.551 y 60.129 respectivamente, mientras que miR-223 mostró una regulación negativa con un cambio de -247,281. El valor absoluto de Fold Change >2 se consideró estadísticamente significativo, P <0,05. CONCLUSIONES: Nuestros resultados indicaron que miR 21, miR 25 y miR-223 en plasma pueden servir como una potencial herramienta no invasiva en la detección de CG.

Relationship of IP-10 gene expression to systemic lupus erythematosus activity. / Relación de la expresión génica de IP-10 con la actividad del lupus eritematoso sistémico.

OBJECTIVES: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. PATIENTS AND METHODS: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. RESULTS: Different levels of gene expression were found according to the SLE activity (p =<0.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3. CONCLUSION: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.

Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy.

Chagas cardiomyopathy is a parasitic infection caused by Trypanosoma cruzi. Structural and functional abnormalities are the result of direct myocardial damage by the parasite, immunological reactions, dysautonomia, and microvascular alterations. Chronic Chagas cardiomyopathy (CCC) is the most serious and important manifestation of the disease, affecting up to 30% of patients in the chronic phase. It results in heart failure, arrhythmias, thromboembolism, and sudden cardiac death. As in other cardiomyopathies, scar-related reentry frequently results in ventricular tachycardia (VT). The scars typically are located in the inferior and lateral aspects of the left ventricle close to the mitral annulus extending from endocardium to epicardium. The scars may be more prominent in the epicardium than in the endocardium, so epicardial mapping and ablation frequently are required. Identification of late potentials during sinus rhythm and mid-diastolic potentials during hemodynamically tolerated VT are the main targets for ablation. High-density mapping during sinus rhythm can identify late isochronal regions that are then targeted for ablation. Preablation cardiac magnetic resonance imaging with late enhancement can identify potentials areas of arrhythmogenesis. Therapeutic alternatives for VT management include antiarrhythmic drugs and modulation of the cardiac autonomic nervous system.

Preliminary Aquatic Physical Therapy Core Sets for Children and Youth With Neurological Disorders: A Consensus Process.

PURPOSE: To report on the preliminary aquatic physical therapy core sets for children and youth with neurological disorders using the International Classification of Functioning, Disability and Health-children and youth version. METHODS: A formal and structured consensus process was developed, integrating the findings of preparatory studies: a systematic literature review, expert survey with 69 participants, and a qualitative study with 43 participants. RESULTS: Five preliminary aquatic physical therapy core sets were described: a Comprehensive Core Set (64 categories); a Common Brief (13 categories); and 3 age-specific Core Sets: infant (below 6 years, 18 categories), school-age (from 6 to <14 years, 22 categories), and youth (from 14 to 18 years, 19 categories). CONCLUSIONS: Consensus among aquatic physical therapists' expert opinions identified the relevant intervention categories available when treating children and youth with neurological disorders. This list of intervention categories can be used in practice, research, education, and health administration.

Terapia de la resincronización cardiaca transvenosa en la población pediátrica / Transvenous cardiac resynchronization therapy in pediatric population

Resumen La disfunción ventricular izquierda y la cardiopatía dilatada (CD), debidas a la estimulación crónica ventricular derecha son complicaciones reconocidas en adultos y niños. La terapia de la resincronización cardiaca (TRC), ha demostrado beneficios en los adultos con disfunción ventricular izquierda (FEVI < 35%), deterioro de la clase funcional y bloqueo de la rama izquierda (intrínseco o inducido por estimulación). En los niños la incidencia de cardiomiopatía dilatada es desconocida y no existen guías o grandes estudios sobre la resincronización cardiaca, por lo que no es posible extrapolar las recomendaciones de los pacientes adultos. Se presenta la experiencia en una paciente con bloqueo A-V completo postquirúrgico tras corrección de cardiopatía congénita, portadora de un marcapaso quien desarrolló la falla cardiaca, esta fue tratada exitosamente mediante la resincronización biventricular en dos oportunidades, con recuperación de la clase funcional y los parámetros hemodinámicos.

Abstract Left ventricular dysfunction and dilated cardiomyopathy (DC) caused by right ventricular chronic stimulation are recognised complications in adults and children. Cardiac resynchronization therapy (CRT) has shown benefits in adults with left ventricular dysfunction (LVEF < 35%), deterioration of functional class and left bundle-branch block (instrinsic or induced by stimulation). Incidence of dilated cardiomyopathy in children is unknown, and there are no guides or big studies about cardiac resynchronization therapy, so recommendations for adult patients cannot be extrapolated. The experience of a female patient with a pacemaker and postoperative complete AV block after correction of a congenital heart disease is presented; she developed heart failure that was successfully treated with biventricular resynchronization in two opportunities, with recovery of functional class and hemodynamic parametres.

Controversias en el manejo actual de la coartación de la aorta / Controversies in current management of the aortic coarctation

La coartación de la aorta fue descrita clásicamente como una simple estrechez del istmo aórtico que podría ser "curada" por medio de cirugía. En la actualidad se sabe que es la manifestación clínica de una vasculopatía arterial más amplia, en donde la afección del arco aórtico puede ser variable. La corrección quirúrgica ha demostrado ser un tratamiento efectivo para el manejo de la coartación aórtica nativa y permanece como el de elección en neonatos. De otra parte, la angioplastia con balón es el tratamiento de elección en niños con recoartación, cuyos resultados en la reducción aguda del gradiente aórtico posterior al manejo de la coartación nativa, son similares a los obtenidos con cirugía. La implantación de prótesis endovasculares (stents) ha mostrado excelentes resultados a corto plazo tanto en niños mayores como en adultos con coartación nativa. En pacientes con coartación recurrente considerados de alto riesgo quirúrgico, la angioplastia con balón y la implantación de stent ofrecen una estrategia de manejo menos invasiva e igual de efectiva. Se prefiere el uso de stents sobre la angioplastia con balón en adultos y niños mayores con coartación recurrente, ya que el riesgo de recoartación y formación de aneurismas parece ser menor. No se cuenta con suficiente información acerca de los desenlaces a largo plazo posteriores al tratamiento percutáneo de la coartación aórtica. Este artículo revisa las controversias existentes en cuanto al manejo actual de esta condición.

Coarctation of the aorta was once viewed as a simple discrete narrowing of the aortic isthmus that could be 'cured' by surgical intervention. It is now clear that this condition represents a wider vasculopathy that could affect the aortic arch in a highly variable manner. Surgery has proven to be an effective treatment for the management of native aortic coarctation, and remains the treatment of choice in neonates. Balloon angioplasty is the treatment of choice in children with re-coarctation, and currently available immediate results in native coarctation are similar with regards to gradient reduction as compared with surgery. Stent implantation has shown excellent short-term results in both children beyond infancy and in adults with native coarctation. In patients with recurrent coarctation who are at high surgical risk, balloon angioplasty and stent repair offer a less invasive and equally effective method. Stent repair is preferred over balloon angioplasty in adults and outgrown children with a recurrent coarctation, as the risk for re-coarctation and aneurysm formation seems to be lower. Data with regard to long-term outcome after percutaneous treatment strategies are scarce. This review outlines the controversies in the treatment of this disease.

Trombosis de vena cava superior asociada a catéter en paciente crítico: reporte de un caso y breve revisión de la literatura / Superior vena cava thrombosis associated with catheter in critical patients: a case report and brief literature review

Los fenómenos de hipercoagulabilidad son comunes en los pacientes politraumatizados críticamente enfermos. Los principales factores de riesgo para esta complicación son la cirugía, las invasiones vasculares, la inmovilidad y los procesos inflamatorios. Los catéteres intravasculares proveen un acceso necesario para la administración de terapia intravenosa, toma de muestras sanguíneas y monitorización. Sin embargo, su uso se asocia frecuentemente con complicaciones locales y sistémicas serias incluyendo infecciones diseminadas, tromboflebitis séptica y endocarditis. En este contexto, debe sospecharse de tromboflebitis séptica de la vena cava superior en el paciente con bacteriemia persistente después de 72 horas de terapia antimicrobiana apropiada. La base del tratamiento incluye: remoción del foco infeccioso, administración temprana de antibióticos intravenosos y anticoagulación. Así mismo, debe considerarse el tratamiento quirúrgico en aquellos con evolución inadecuada.

Hypercoagulability phenomena are common in critically ill polytraumatized patients. The main risk factors for this complication are surgery, vascular invasions, immobility and inflammatory processes. Intravascular catheters provide a necessary access for the administration of intravenous therapy, blood sampling and monitoring. However, their use is frequently associated with serious local and systemic complications including disseminated infections, septic thrombophlebitis and endocarditis. In this context, septic thrombophlebitis of the superior vena cava should be suspected in patients with persistent bacteremia after 72 hours of appropriate antimicrobial therapy. The mainstay of treatment includes the removal of the source of infection, early administration of intravenous antibiotics and anticoagulation. Also, surgical treatment should be considered in those with inadequate clinical evolution.

Pericarditis tuberculosa: presentación de un caso y revisión de la literatura / Tuberculous pericarditis: a case report and review of the literature

La pericarditis constrictiva crónica es un síndrome clínico causado por la compresión cardíaca ejercida por un pericardio engrosado o rígido. La tuberculosis es una causa rara de pericarditis constrictiva en los países desarrollados. Sin embargo, ésta es una importante condición a considerar en países en desarrollo y en pacientes con infección por VIH. La pericarditis tuberculosa es una forma de tuberculosis extra-pulmonar que puede conducir a la muerte. La dificultad en su diagnóstico y las serias consecuencias de la infección no tratada hacen de esta condición un importante problema de salud tanto en países industrializados como en aquellos en vía de desarrollo. Ayudas diagnósticas como la ecocardiografía son esenciales en el diagnóstico, y ante la sospecha de afección tuberculosa del pericardio se indica la realización de estudios del líquido o del tejido pericárdico. El tratamiento antituberculoso se realiza durante seis meses y se considera la pericardiectomía en pacientes con pericarditis constrictiva calcificada o en quienes la constricción empeora después de seis a ocho semanas de tratamiento.

Constrictive pericarditis is a clinical syndrome caused by the cardiac compression of a thickened or rigid pericardium. Tuberculosis is a rare cause of constrictive pericarditis in developed countries. However, this is an important condition to consider in developing countries and in patients with HVI infection. Tuberculous pericarditis is a form of extra-pulmonary tuberculosis that may lead to death. The difficulty in its diagnosis and the serious consequences of this non-treated infection make this condition an important health problem both in industrialized and developing countries. Diagnostic aids such as echography are essential in the diagnosis, and in front of the suspicion of tuberculous infection of the pericardium, the performance of pericardial fluid or pericardial tissue studies is indicated. Anti TB treatment is carried out for six months and pericardiectomy is considered in patients with calcified constrictive pericarditis or in those in whom the constriction worsens after six to eight weeks of treatment.