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BACKGROUND: Toxoplasmosis is potentially avoidable, treatable, and curable by simple and direct preventive measures. Knowledge, attitudes, and practices (KAP) assessments concerning gestational toxoplasmosis were evaluated in a cohort of pregnant women from Armenia-Quindío (Colombia, South America). METHODS: This cross-sectional descriptive KAP-type study was performed with informed consent between October 2021 and March 2022. The intervention involved a ten-minute talk administered by prenatal clinic nurses to pregnant women. This took place in the public health clinic RedSalud and the private clinic Happy Maternity with a post-KAP survey after pregnancy. RESULTS: The findings of the initial KAP survey revealed that approximately 42.8 % of the 250 mothers surveyed had IgG anti-T. gondii antibodies present. A strong correlation was observed between a lower frequency of antibodies and a higher level of education. Following an educational intervention, 73 seronegative women demonstrated a significant improvement in their knowledge and behavior. Among the 111 mothers who received the intervention, 42 (37 %) were followed until delivery. Unfortunately, their level of compliance with prenatal serological follow-up was lower compared to previous historical records of cohort of mothers in the same health center during pre-pandemic periods. No seroconversion occurred, although the small number of cases makes the outcome inconclusive with respect to statistical significance. CONCLUSIONS: Education plays a crucial role in imparting valuable knowledge and fostering effective practices. It holds significant potential to prevent toxoplasmosis in pregnant seronegative mothers. Prenatal check-ups have proven to be a critical determinant in leveraging the benefits of education for seronegative mothers. Reporting and observed behaviors differed, identifying areas for improvement.
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Conocimientos, Actitudes y Práctica en Salud , Toxoplasmosis , Humanos , Femenino , Embarazo , Estudios Transversales , Adulto , Toxoplasmosis/prevención & control , Adulto Joven , Colombia , Anticuerpos Antiprotozoarios/sangre , Toxoplasma/inmunología , Encuestas y Cuestionarios , Complicaciones Parasitarias del Embarazo/prevención & control , Mujeres Embarazadas/psicología , Atención Prenatal , Inmunoglobulina G/sangre , AdolescenteRESUMEN
Resumen El uso de dispositivos cardiacos implantables ha aumentado en los últimos años, lo que ha generado un aumento en el número de procedimientos de extracción de electrodos a medida que se intervienen pacientes con un mayor número de comorbilidades. En la actualidad, la técnica percutánea de extracción es de elección en la mayoría de los pacientes debido a los excelentes resultados alcanzados y a una morbi-mortalidad asociada inferior a la de la extracción quirúrgica. No obstante, algunos pacientes pueden presentar retos que aumentan el grado de dificultad técnica del procedimiento, entre los que se encuentran variantes anatómicas, calcificaciones extensas o la necesidad de extraer electrodos de fijación pasiva. Se expone el caso de la extracción de un electrodo disfuncionante en una paciente portadora de marcapasos por bloqueo auriculoventricular completo, con estimulación diafragmática por electrodo ventricular de fijación pasiva implantado a través de una vena cava superior izquierda persistente en una vena posterolateral del seno coronario.
Abstract The use of cardiac electronic devices has increased over the last decades, which has generated an increase in the number of electrode extraction procedures, as a greater number of patients with multiple comorbidities undergo cardiac electronic device implantation. Currently, the percutaneous technique is preferable in most patients, given its excellent clinical results and lower morbidity and mortality compared to surgical extraction. Nonetheless, some clinical scenarios increase procedural difficulty, including anatomical variants, or the need to extract passive fixation leads. We present a case of a patient with pacemaker due to complete atrioventricular block, with diaphragmatic stimulation caused by a passive fixation ventricular electrode that was implanted in a posterolateral vein of the coronary sinus through a persistent left superior vena cava, who underwent successful transvenous lead extraction.
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Toxoplasmosis is the most prevalent parasitic zoonosis worldwide, causing ocular and neurological diseases. No vaccine has been approved for human use. We evaluated the response of peripheral blood mononuclear cells (PBMCs) to a novel construct of Toxoplasma gondii total antigen in maltodextrin nanoparticles (NP/TE) in individuals with varying infectious statuses (uninfected, chronic asymptomatic, or ocular toxoplasmosis). We analyzed the concentration of IFN-γ after NP/TE ex vivo stimulation using ELISA and the immunophenotypes of CD4+ and CD8+ cell populations using flow cytometry. In addition, serotyping of individuals with toxoplasmosis was performed by ELISA using GRA6-derived polypeptides. Low doses of NP/TE stimulation (0.9 µg NP/0.3 µg TE) achieved IFN-γ-specific production in previously exposed human PBMCs without significant differences in the infecting serotype. Increased IFN-γ expression in CD4+ effector memory cell subsets was found in patients with ocular toxoplasmosis with NP/TE but not with TE alone. This is the first study to show how T-cell subsets respond to ex vivo stimulation with a vaccine candidate for human toxoplasmosis, providing crucial insights for future clinical trials.
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Antígenos de Protozoos , Interferón gamma , Activación de Linfocitos , Nanopartículas , Polisacáridos , Toxoplasma , Toxoplasmosis , Humanos , Nanopartículas/química , Polisacáridos/inmunología , Toxoplasma/inmunología , Antígenos de Protozoos/inmunología , Toxoplasmosis/inmunología , Interferón gamma/metabolismo , Interferón gamma/inmunología , Activación de Linfocitos/inmunología , Femenino , Adulto , Leucocitos Mononucleares/inmunología , Leucocitos Mononucleares/metabolismo , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/metabolismo , Masculino , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/metabolismo , Linfocitos T/inmunología , Linfocitos T/metabolismo , Persona de Mediana EdadRESUMEN
ABSTRACT Introduction: Metastatic disease of the thyroid corresponds to 2% of thyroid malignancies in autopsy series. Up to 50% of metastases are due to renal cell carcinoma (Ree). These can occur several years after diagnosis or nephrectomy. An isolated presence in the thyroid gland is rare. Clinical case presentation: We present the case of a 68-year-old woman with a history of Ree managed with nephrectomy and retroperitoneal lymphadenectomy. After 7 years free of symptoms, she noticed a mass over the thyroid region. Ultrasonography reported bilateral thyroid nodules. Due to the oncologic history and the affirmation of symptoms during swallowing, a full thyroidectomy was performed. The histopathological report was compatible with Ree metastasis. Discussion: The literature shows that the median time for thyroid metastasis in patients with Ree is 92 months. Most patients are asymptomatic, and a full thyroidectomy is recommended to prevent disease progression with a favorable impact on Survival. Conclusion: In patients with thyroid nodules and a history of Ree, metastasis should be suspected.
RESUMEN Introducción: La enfermedad metastásica a tiroides corresponde a 2% de las malignidades tiroideas en series de autopsias. Hasta el 50% de las metástasis se deben a carcinoma de células renales (Ree). Estas pueden ocurrir varios años después del diagnóstico o la nefrectomía. La presentación aislada en la glándula tiroides es rara. Presentación caso clínico: Presentamos el caso de una mujer de 68 años con historia de Ree manejada con nefrectomía y linfadenectomía retroperitoneal. Tras 7 años libre de síntomas notó la aparición de una masa sobre la región tiroidea. La ultrasonografía reportó nódulos tiroideos bilaterales. Por el antecedente oncológico y la afirmación de síntomas durante la deglución se le realizó tiroidectomía total. El reporte histopatológico fue compatible con metástasis de Ree. Discusión: La literatura muestra que el tiempo medio de metástasis a tiroides en pacientes con Ree es 92 meses. La mayoría de los pacientes son asintomáticos. Se recomienda la tiroidectomía total para prevenir progresión de la enfermedad con impacto favorable en la supervivencia. Conclusión: En los pacientes con nódulos tiroideos y antecedente de Ree se debe sospechar enfermedad metastásica.
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BACKGROUND: Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative pacing strategy to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). We aimed to assess the impact of LBBAP vs. BIVP on all-cause mortality and heart failure (HF)-related hospitalization in patients undergoing CRT. METHODS: Studies comparing LBBAP and BIVP for CRT in patients with HF with reduced left ventricular ejection fraction (LVEF) were included. The coprimary outcomes were all-cause mortality and HF-related hospitalization. Secondary outcomes included procedural and fluoroscopy time, change in QRS duration, and change in LVEF. RESULTS: Thirteen studies (12 observational and 1 RCT, n = 3239; LBBAP = 1338 and BIVP = 1901) with a mean follow-up duration of 25.8 months were included. Compared to BIVP, LBBAP was associated with a significant absolute risk reduction of 3.2% in all-cause mortality (9.3% vs 12.5%, RR 0.7, 95% CI 0.57-0.86, p < 0.001) and an 8.2% reduction in HF-related hospitalization (11.3% vs 19.5%, RR 0.6, 95% CI 0.5-0.71, p < 0.00001). LBBAP also resulted in reductions in procedural time (mean weighted difference- 23.2 min, 95% CI - 42.9 to - 3.6, p = 0.02) and fluoroscopy time (- 8.6 min, 95% CI - 12.5 to - 4.7, p < 0.001) as well as a significant reduction in QRS duration (mean weighted difference:- 25.3 ms, 95% CI - 30.9 to - 19.8, p < 0.00001) and a greater improvement in LVEF of 5.1% (95% CI 4.4-5.8, p < 0.001) compared to BIVP in the studies that reported these outcomes. CONCLUSION: In this meta-analysis, LBBAP was associated with a significant reduction in all-cause mortality as well as HF-related hospitalization when compared to BIVP. Additional data from large RCTs is warranted to corroborate these promising findings.
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Terapia de Resincronización Cardíaca , Causas de Muerte , Insuficiencia Cardíaca , Humanos , Bloqueo de Rama/terapia , Bloqueo de Rama/mortalidad , Terapia de Resincronización Cardíaca/métodos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Hospitalización/estadística & datos numéricos , Medición de Riesgo , Volumen Sistólico/fisiología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Left atrial appendage occlusion (LAAO) is a suitable alternative to oral anticoagulant therapy to prevent stroke in patients with AF. Most procedures are performed under transoesophageal echocardiography (TOE) guidance, which facilitates transseptal puncture, reduces the risk of procedurerelated complications and provides an additional method for device selection and real-time monitoring during device deployment. However, TOE has significant shortcomings, including the need for general anaesthesia/deep sedation as well as a significant risk of procedure-related adverse events. More recently, intracardiac echocardiography has been proposed as an alternative to TOE guidance during LAAO procedures. In this review, we summarise the available evidence as well as providing a step-by-step approach for intracardiac echocardiography-guided LAAO.
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Las infecciones perinatales son una causa de morbilidad, tanto fetal como neonatal, y que compromete la salud de la mujer embarazada, por lo que su diagnóstico, tratamiento, e intento de eliminación son una prioridad en América Latina y el Caribe. Este documento representa la segunda entrega realizada por expertos en la región dentro de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE), brindando una mirada actualizada en el manejo de las infecciones congénitas y entrega herramientas para detectar posibles momentos estratégicos de intervención y cambio en el manejo de las infecciones congénitas.
Perinatal infections are a major cause of morbidity and mortality in the fetus, neonate, and the health of the pregnant woman. Diagnosis, treatment, and the search for elimination of these diseases are a priority in Latin America and the Caribbean. This document represents the second delivery by a group of experts in the region inside the Latin-American Society of Pediatric Infectious Diseases (SLIPE), presenting a up-to-date look into the management of congenital infectious diseases and give a tool to detect possible strategic sceneries and a change in the management of congenital infections in our region.
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Humanos , Femenino , Embarazo , Recién Nacido , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Infecciones por Arbovirus/congénito , Infecciones por Arbovirus/diagnóstico , Infecciones por Arbovirus/terapia , Toxoplasmosis/diagnóstico , Toxoplasmosis/terapia , Toxoplasmosis Congénita , Enfermedades Transmisibles , Infecciones por Citomegalovirus , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/terapia , Dengue , Infección por el Virus Zika , COVID-19 , Herpes Simple/congénito , Herpes Simple/diagnóstico , Herpes Simple/terapiaRESUMEN
BACKGROUND: Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE). The objective of this study is to evaluate the impact of ICE versus TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. METHODS: All studies comparing ICE-guided versus TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. RESULTS: Twelve studies (n = 5637) were included. There were no differences in procedural success (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p = .27; I2 = 0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p = .25; I2 = 0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-min reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p = 0.64); however, an increased prevalence of residual IASD was observed with ICE-guided versus TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p = 0.04). CONCLUSION: ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.
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Apéndice Atrial , Fibrilación Atrial , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ecocardiografía Transesofágica , Resultado del TratamientoRESUMEN
BACKGROUND: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined. OBJECTIVES: The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT. METHODS: In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters. RESULTS: A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP. CONCLUSIONS: In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.
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Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Humanos , Terapia de Resincronización Cardíaca/efectos adversos , Estudios Prospectivos , Sistema de Conducción Cardíaco , Ventrículos Cardíacos , ElectrocardiografíaRESUMEN
Resumen Introducida inicialmente en la década de los cincuenta para la evaluación de las presiones de la aurícula izquierda y posteriormente para la realización de valvuloplastia mitral, la punción transeptal es, con frecuencia, la vía de acceso para efectuar procedimientos que involucren las cavidades izquierdas. En la actualidad, se usa comúnmente en los laboratorios de electrofisiología, tanto para la ablación de arritmias en cavidades izquierdas como para los procedimientos de cierre percutáneo de orejuela. No obstante, con la llegada de diversas técnicas para el manejo percutáneo de la válvula mitral, se espera un aumento progresivo de su uso por parte de cardiólogos intervencionistas. En este artículo, se revisa la técnica para hacer una punción transeptal segura y se dan recomendaciones y estrategias para el manejo de la punción transeptal difícil.
Abstract Initially described in 1959 as a technique to measure left atrial pressures, and later used during balloon mitral valvuloplasty, transeptal puncture (TSP) is frequently the access route for procedures involving the left heart chambers. Currently, it is mostly used in electrophysiology laboratories for arrhythmia ablation and during left atrial appendage occlusion procedures. However, with the ongoing development of percutaneous mitral valve interventions, it is expected that a greater number of interventional cardiologists will be using this technique in the near future. In this article, we review the technique to perform TSP safely, and we provide recommendations and different strategies to deal with difficult TSPs.
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Ocular toxoplasmosis (OT) is characterized by inflammation within the eye and is the most recognized clinical manifestation of toxoplasmosis. The objective of this study was to identify new single-nucleotide polymorphisms (SNPs) in the P2RX7 gene that may have significance in the immune response to OT in Colombian patients. A case-control study was conducted to investigate the associations between SNPs (rs1718119 and rs2230912) in the P2RX7 gene and OT in 64 Colombian patients with OT and 64 controls. Capillary electrophoresis was used to analyze the amplification products, and in silico algorithms were employed to predict deleterious SNPs. Stability analysis of amino acid changes indicated that both mutations could lead to decreased protein structure stability. A nonsynonymous SNP, Gln460Arg, located in the long cytoplasmic tail of the receptor, showed a significant association with OT (Bonferroni correction (BONF) = 0.029; odds ratio OR = 3.46; confidence interval CI: 1.05 to 11.39), while no significant association between rs1718119 and OT risk was observed. Based on the 3D structure analysis of the P2RX7 protein trimer, it is hypothesized that an increase in the flexibility of the cytoplasmic domain of this receptor could alter its function. This SNP could potentially serve as a biomarker for identifying Colombian patients at risk of OT.
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Resumen El cierre percutáneo de orejuela se ha posicionado como una estrategia eficaz en la prevención de embolia en pacientes con fibrilación auricular. La mayoría de los procedimientos en el mundo se realizan mediante ecocardiografía transesofágica, que implica, en la mayoría de los casos, el uso de sedación profunda guiada por anestesiología o incluso anestesia general, lo que conlleva tiempos de sala y de procedimiento prolongados, potenciales retardos en la programación del procedimiento (por baja disponibilidad de servicios de anestesiología y de ecocardiografía) y exposición a los riesgos propios de la sedación profunda y la anestesia general. Adicionalmente, el mayor número de personas requeridos en sala para el cierre percutáneo de orejuela guiado por ecacardiografía transesofágica aumenta la cantidad de personas expuestas a radiación ionizante, particularmente el ecocardiografista, que se ubica próximo al angiógrafo y con frecuencia debe introducir sus manos en el campo de fluoroscopia. En los últimos años, la ecocardiografía intracardíaca ha cobrado importancia para guiar los procedimientos de cierre percutáneo de orejuela debido a su amplia disponibilidad en los laboratorios de electrofisiología, y a la posibilidad de realizar procedimientos con menor tiempo de uso de sala y de recuperación, ya que evita el uso de anestesia general y a que facilita los procedimientos con alta el mismo día, lo que se podría asociar a una disminución global de los costos de procedimientos. En este artículo se discute la evidencia actual que avala el uso de ecocardiografía intracardiaca en el cierre percutáneo de orejuela.
Abstract Left atrial appendage occlusion has proven to be an effective strategy in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation. Worldwide, most left atrial appendage occlusions are performed using transesophageal echocardiography, which requires the use of monitored anesthesia care or general anesthesia, resulting in prolonged in-room and procedural times, delays in procedural scheduling (due to a low availability of anesthetic and echocardiography services) and the risks associated with anesthesia per se. Moreover, the additional personnel required to perform left atrial appendage occlusion guided by transesophageal echocardiography increases the number of people exposed to ionizing radiation, which is particularly high for the transesophageal echocardiography operator, who stands beside the fluoroscopy tube and frequently introduces his/her hands in the fluoroscopy field. Intracardiac echocardiography has gained acceptance to guide left atrial appendage occlusion in recent years, given its high availability in electrophysiology labs, as well as its potential to reduce in-room and procedural times, reduce the need for extensive recovery times, avoid the use of general anesthesia and facilitating same-day discharge, all of which could result in a reduction of total procedure-related costs. In this article, we discuss the evidence supporting the use of intracardiac echocardiography guidance during left atrial appendage occlusion.
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Purpose: The purpose of this study is to perform a systematic review of the scientific literature to compare single and double row techniques for rotator cuff tears in terms of functional, pain improvement and structural healing of the tendon. Methods: In order to carry out the research, a systematic selection of scientific articles has been made by consulting PubMed and The Cochrane Library databases. The articles included in the present study compare the single-row and double-row techniques, with publication date between 2016 and 2021. Results: Diverse results are observed in the UCLA, SST, Constant and ASES assessment scales and in the range of mobility, therefore, the superiority of one technique in terms of functional results is not established. The double row technique may show superiority in the strength variable, although there is a methodological variability in its measurement. The double-row technique may be related to more intense postoperative pain, while the single-row technique to residual shoulder pain. However, the variables strength and pain show non-homogeneous or coincident data. The superiority of the double row repair in the structural healing of the tendon and a lower re-tear rate than the single row technique is established with statistically significant results, being the most homogeneous and coincident studies.
Objetivos: El propósito de este estudio es realizar una revisión sistemática de la literatura científica para comparar las técnicas de hilera simple y doble para los desgarros del manguito de los rotadores en términos de curación funcional, del dolor y estructural del tendón. Métodos: Para llevar a cabo la investigación se ha realizado una selección sistemática de artículos científicos consultando las bases de datos PubMed y The Cochrane Library. Los artículos incluidos en el presente estudio comparan las técnicas de una y dos hileras, con fecha de publicación entre 2016 y 2021. Resultados: Se observan diversos resultados en las escalas de valoración UCLA, SST, Constant y ASES y en el rango de movilidad, por lo que no se establece la superioridad de una técnica en cuanto a resultados funcionales. La técnica de doble hilera puede mostrar superioridad en la variable fuerza, aunque existe una variabilidad metodológica en su medición. La técnica de doble hilera puede estar relacionada con un dolor postoperatorio más intenso, mientras que la técnica de hilera simple con dolor residual en el hombro. Sin embargo, las variables fuerza y ââdolor muestran datos no homogéneos o coincidentes. Se establece con resultados estadísticamente significativos, siendo los estudios más homogéneos y coincidentes, la superioridad de la reparación en doble hilera en la cicatrización estructural del tendón y una menor tasa de re-desgarro que la técnica de hilera simple.
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Lesiones del Manguito de los Rotadores , Hombro , Humanos , Estudios RetrospectivosRESUMEN
This work analyzed exhaustion markers in CD8+ T-cell subpopulations in 21 samples of peripheral blood mononuclear cells (PBMCs) from individuals with ocular toxoplasmosis (n = 9), chronic asymptomatic toxoplasmosis (n = 7), and non-infected people (n = 5) by using RT-qPCR and flow cytometry techniques. The study found that gene expression of PD-1 and CD244, but not LAG-3, was higher in individuals with ocular toxoplasmosis versus individuals with asymptomatic infection or uninfected. Expression of PD1 in CD8+ central memory (CM) cells was higher in nine individuals with toxoplasmosis versus five uninfected individuals (p = .003). After ex vivo stimulation, an inverse correlation was found between the exhaustion markers and quantitative clinical characteristics (lesion size, recurrence index, and number of lesions). A total exhaustion phenotype was found in 55.5% (5/9) of individuals with ocular toxoplasmosis. Our results suggest that the CD8+ exhaustion phenotype is involved in the pathogenesis of ocular toxoplasmosis.
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BACKGROUND: Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES: The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS: In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS: A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS: LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.
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Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Humanos , Terapia de Resincronización Cardíaca/efectos adversos , Terapia de Resincronización Cardíaca/métodos , Volumen Sistólico , Estudios Prospectivos , Función Ventricular Izquierda , Resultado del Tratamiento , Insuficiencia Cardíaca/terapiaRESUMEN
Resumen Introducción: el parto pretérmino es una importante causa de morbimortalidad perinatal; entre las principales etiologías está la infección inflamación intraamniótica que se asocia a resultados perinatales adversos. El objetivo del presente estudio fue evaluar la asociación de la antibioticoterapia con los desenlaces maternos, fetales y perinatales en gestantes con sospecha de infección intraamniótica en un centro de alta complejidad obstétrica. Métodos: estudio analítico de cohortes ambispectivo en gestantes con embarazo simple con edad gestacional ≥ 24 semanas atendidas en la Clínica Universitaria Bolivariana (CUB) con sospecha diagnóstica de infección/inflamación intramniótica subclínica desde enero del 2011 a diciembre del 2021. Se evaluó la asociación entre el uso de antimicrobianos y los desenlaces clínicos materno y perinatales. Resultados: entre los hallazgos clínicos, ecográficos y paraclínicos se destacó el dolor abdominal, sangrado y la presencia de sludge en la cervicometría. La prevalencia del uso de antimicrobianos entre quienes tenían sludge fue 1,88 veces comparado con quienes no tenían este hallazgo ecográfico, (IC95% 1,23- 2,88), p 0,0009; mientras que la de la dinámica uterina fue 1,43 veces (IC95% 1,06- 1,94), p 0,050. La diferencia de medianas de los leucocitos en líquido amniótico reportó un exceso del número de leucocitos por campo entre las que recibieron antimicrobianos, diferencia de 9 (IC95% 5- 25), p <0,0001. El parto pretérmino fue más frecuente en las pacientes que tenían indicación clínica de uso de antimicrobianos (RR 1,58 IC95% 0,96- 2,61), tras de ajustar el análisis por tiempo de latencia entre la sospecha de infección y el parto se observó que el uso de antimicrobianos reduce en un 46% el riesgo de parto pretérmino, RR 0,54 (IC95% 0,35- 0,83). En las pacientes con cultivo positivo de líquido amniótico la mediana de latencia hasta el parto fue de 4 semanas (RIQ 0- 9) y de 11 (RIQ 8- 15) en las que no se obtuvo aislamiento, con una diferencia de medianas de 6 semanas (IC95% 1- 10). Conclusiones: en las pacientes con sospecha de infección inflamación intraamniótica la terapia antibiótica se relacionó con un menor riesgo de parto pretérmino, y el cultivo positivo en líquido amniótico con una menor latencia de la gestación.
Abstract Introduction: preterm birth is an important underlying cause of perinatal morbidity and mortality; one of the primary etiologies is intra-amniotic inflammation/infection, which are associated with adverse perinatal outcomes. The purpose of this study was to assess the relationship between antimicrobial treatment and maternal, fetal, and perinatal clinical outcomes in pregnant patients with suspected intra-amniotic inflammation/infection seen at a nationally- and internationally- recognized university hospital for high-risk obstetric cases in Medellín, Colombia. Methods: the researchers conducted an ambispective cohort study of singleton pregnancies with gestational ages > 24 weeks seen at the Clínica Universitaria Bolivariana (CUB) with suspected subclinical intra-amniotic inflammation/infection between January 2011 and December 2021 (n=75). The relationship between the use of antimicrobial treatment and maternal and perinatal clinical outcomes. Results: after conducting an analysis of clinical, para-clinical and laboratory evidence, the most statistically significant findings included abdominal pain, acute vaginal bleeding, and the presence of amniotic fluid "sludge" found during ultrasound cervicometry. The use of antimicrobial therapy was 1.88 times more common among patients with amniotic fluid "sludge" when compared to those without the presence of this clinical finding (CI 95% 1.23 to 2.88), p=0.0009; it was 1.43 times more common among patients experiencing uterine dynamics (CI 95% 1.06 to 1.94), p=0.050. The median difference of leukocytes in amniotic fluid showed an excess of leukocytes per field in patients who received antimicrobials, a difference of 9 leukocytes (CI 95% 5 to 25), p <0.0001. Preterm labor was more frequent in patients in whom there was a clinical indication for the use of antimicrobials (RR 1,58 IC95% 0,96- 2,61). After adjusting the analysis by time of latency between the suspicion of infection and labor, it was observed that the use of antimicrobials reduced the rish of preterm labor by 46% RR 0,54 (IC95% 0,35- 0,83). In culture-positive patients, the median latency period until birth was 4 (IQR 0-9 weeks) and 11 (IQR 8-15 weeks) in culture-negative patients, with a median difference of 6 weeks (CI 95% 1 to 10). Conclusion: among patients with suspected intra-amniotic inflammation/infection, antimicrobial therapy is associated with a lower risk for preterm birth, and lower latency period among culture-positive patients.
RESUMEN
Strong evidence exists based on metanalysis of the relationship between toxoplasmosis and many psychiatric diseases: schizophrenia, bipolar disorder, and suicidal behavior. Herein, we estimate the number of cases based on the attributable fraction due to toxoplasmosis on these diseases. The population attributable fraction of mental disease associated with toxoplasmosis was 20,4% for schizophrenia; 27,3% for bipolar disorder; and 0,29% for suicidal behavior (self-harm). The lower and upper estimated number of people with mental disease associated with toxoplasmosis was 4'816.491 and 5'564.407 for schizophrenia; 6'348.946 and 7'510.118,82 for bipolar disorder; and 24.310 and 28.151 for self-harm; for a global total lower estimated number of 11'189.748 and global total upper estimated number of 13'102.678 people with mental disease associated with toxoplasmosis for the year 2019. According to the prediction through the Bayesian model of risk factors for toxoplasmosis associated with mental disease, these varied in importance geographically; thus, in Africa, the most important risk factor was water contamination and in the European region, the cooking conditions of meats. Toxoplasmosis and mental health should be a research priority given the enormous potential impact of reducing this parasite in the general population.
Asunto(s)
Trastornos Mentales , Toxoplasma , Toxoplasmosis , Humanos , Teorema de Bayes , Trastornos Mentales/epidemiología , Trastornos Mentales/complicaciones , Toxoplasmosis/complicaciones , Toxoplasmosis/epidemiología , Toxoplasmosis/parasitología , Factores de RiesgoRESUMEN
INTRODUCTION: Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time-consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) lavage in lieu of capsulectomy for the treatment of CIED infections. METHODS: This retrospective study included patients who underwent TLE for CIED-related infections in two institutions in Colombia. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, exhaustive lavage of the generator pocket with 20 cc of CHG at 2% followed by irrigation with approximately 500 cc of normal saline (0.9% sodium chloride) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included the occurrence of any adverse reaction to chlorhexidine, the need for reintervention, infection-related mortality, and total procedural time. RESULTS: A total of 102 patients (mean age 67.2 ± 13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n = 54) or CHG (n = 48) lavage. Hematoma formation was significantly higher in the capsulectomy group versus the CHG group (13% vs. 0%, p = .014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7 ± 78.5 vs. 89.9 ± 51.8 min, p = .002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: three in the capsulectomy group and one in the CHG group (p = .346). CONCLUSIONS: In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.
Asunto(s)
Cardiopatías , Marcapaso Artificial , Humanos , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Clorhexidina , Marcapaso Artificial/efectos adversos , Estudios Retrospectivos , Irrigación Terapéutica , Reinfección/etiología , Cardiopatías/etiologíaRESUMEN
BACKGROUND: Patients with cardiac implantable electronic devices (CIEDs) living in rural areas have difficulty obtaining follow-up visits for device interrogation and programming in specialized healthcare facilities. OBJECTIVE: To describe the use of an assisted reality device designed to provide front-line workers with real-time online support from a remotely located specialist (Realwear HTM-1; Realwear) during CIED assistance in distant rural areas. METHODS: This is a prospective study of patients requiring CIED interrogation using the Realwear HMT-1 in a remote rural population in Colombia between April 2021 and June 2022. CIED interrogation and device programming were performed by a general practitioner and guided by a cardiac electrophysiologist. Non-CIED-related medical interventions were allowed and analyzed. The primary objective was to determine the incidence of clinically significant CIED alerts. Secondary objectives were the changes medical interventions used to treat the events found in the device interrogations regarding non-CIED related conditions. RESULTS: A total of 205 CIED interrogations were performed on 139 patients (age 69 ± 14 years; 54% female). Clinically significant CIED alerts were reported in 42% of CIED interrogations, consisting of the detection of significant arrhythmias (35%), lead malfunction (3%), and device in elective replacement interval (3.9%). Oral anticoagulation was initiated in 8% of patients and general medical/cardiac interventions unrelated to the CIED were performed in 52% of CIED encounters. CONCLUSION: Remote assistance using a commercially available assisted reality device has the potential to provide specialized healthcare to patients in difficult-to-reach areas, overcoming current difficulties associated with RM, including the inability to change device programming. Additionally, these interactions provided care beyond CIED-related interventions, thus delivering significant social and clinical impact to remote rural populations.
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Desfibriladores Implantables , Marcapaso Artificial , Humanos , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Estudios Prospectivos , Arritmias Cardíacas/terapiaRESUMEN
BACKGROUND: A new point of care test (POC) was developed that is promising as a tool to enhance impact of prenatal care programs for toxoplasmosis, however, no reports exist about its use or acceptability for healthcare personnel and mothers in Colombia. METHODS: This was a translational research - phase III study of the acceptability of a new POC test (Toxoplasma ICT IgG-IgM, LDBio) for qualitative diagnosis of toxoplasmosis in 783 pregnant women and 30 health personnel in primary health care sites in the city of Armenia, Quindío (Colombia). Along with collection of the results of diagnostic POC and confirmatory test and demographic information, we evaluated acceptability through measure of the willingness, credibility, and satisfaction by using questionnaires with a Likert scale during routine prenatal care visits. RESULTS: POC positivity was 46.5% among pregnant participants and was significantly related to socioeconomic factors, including education level (p = 0.00000000) and insurance status (p = 0.00000015). A total of 93-97% of healthcare personnel indicated agreement to positive statements regarding total satisfaction and total credibility of the LDBio test, but qualitative questions identified "Difficulty in the test procedure" as the most common response about barriers to apply the test. Greater than 90% of pregnant participants agree that POC test should be routine for all pregnant woman and permanently implemented. CONCLUSIONS: The test had near complete acceptability. In future studies it is necessary to examine the effect of non-differentiation between IgG and IgM isotypes.