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The COVID-19 pandemic has pushed the population to adopt increasingly sedentary lifestyles. Faced with this problem, remote training appears as a practical and inexpensive strategy to promote physically active lifestyles. The aim of this research was to compare the effects of remote versus in-person training on metabolic profiles and body composition of physically inactive adults. This research was conducted through a randomized, single-blind clinical trial with balanced block randomization. The sample consisted of 30 physically inactive subjects of both sexes between 18 and 30 years of age. The sample was selected using a voluntary public call. The 30 subjects were randomized into three groups of 10 people each. One group trained for 36 sessions remotely, and the other did so in person. The control group did not have a training plan. The variables evaluated pre- and post-intervention were body composition by bioimpedance, grip strength through dynamometry, primary outcome, and metabolic profile assessed from a capillary sample using the CARDIOCHEK equipment. In the remote training group, significant gains were evident in the variables of weight (p = 0.042, d = 1.119), muscle percentage (p = 0.032, d = 0.499), and fat percentage (p = 0.001, d = 1.132), visceral fat (p = 0.032, d = 0.424), total cholesterol (p = 0.001, d = 1.213), HDL (p = 0.001, d = 0.534), LDL (p = 0.001, d = 0.973), triglycerides (p = 0.001, d = 0.583), and grip strength (p = 0.001, d = 1.201). When comparing the effects between the remote and in-person training groups, it is evident that the improvements were similar in all variables, except for glucose, in which the in-person group had a greater value reduction.
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González-García, Mauricio and Luis Ernesto Téllez. Adaptation to living at high altitude in patients with COPD. Comparative study of exercise capacity and ventilatory variables between patients residing at high and low altitudes in the Andes. High Alt Med Biol. 00:000-000, 2024. Introduction: Although some variables related to oxygen transport and utilization such as ventilation, pulmonary vascular responses to hypoxia, heart rate (HR), cardiac output, hemoglobin (Hb), and oxygen saturation (SpO2) are used to compare adaptation to altitude between populations, peak oxygen consumption (VO2) constitutes an integrative measure of total oxygen transport that may reflect successful adaptation to altitude. We designed this study to make a direct comparison of VO2 in a cardiopulmonary exercise test (CPET) between chronic obstructive pulmonary disease (COPD) patients residing at high altitude (Bogotá, Colombia: 2,640 m) (COPD-HA) and those living at low altitude (Bucaramanga, Colombia: 959 m) (COPD-LA). Methods: All patients performed a CPET with measurements of VO2, minute ventilation (VE), HR, oxygen pulse (VO2/HR), ventilatory equivalents (VE/VCO2), and SpO2. Unpaired T-test or Mann-Whitney U test were used for comparisons between COPD-HA and COPD-LA. Results: We included 71 patients with COPD, 53 COPD-HA, and 18 COPD-LA. There were no differences between groups in age, sex, or forced expiratory volume in 1 second. The means ± SD of Hb, g/dl was slightly higher in COPD-HA (15.9 ± 1.9 vs. 14.7 ± 1.8, p = 0.048), without differences in VO2, % pred (71.6 ± 17.9 vs. 69.0 ± 17.0, p = 0.584), VO2/HR, % pred (92.1 ± 22.0 vs. 89.7 ± 19.8, p = 0.733) or VE/MVV, % (75.5 ± 14.1 vs. 76.5 ± 14.3, p = 0.790) at peak exercise between groups. Median (IQR) of VE/VCO2 nadir [38.0 (37.0-42.0) vs. 32.5 (31.0-39.0), p = 0.005] was significantly higher, and SpO2, % at rest [88.0 (86.0-91.0) vs. 95.0 (94.0-96.0), p < 0.001] and at peak exercise [84.0 (77.0-90.0) vs. 93.0 (92.0-95.0), p < 0.001] were significantly lower in COPD-HA. Conclusions: Despite higher desaturation at rest and during exercise in COPD-HA, there were no differences in VO2 peak between COPD-HA and COPD-LA, suggesting a potential altitude adaptation in those patients chronically exposed to hypoxia.
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Motor deficits observed in Parkinson's disease (PD) are caused by the loss of dopaminergic neurons and the subsequent dopamine depletion in different brain areas. The most common therapy to treat motor symptoms for patients with this disorder is the systemic intake of L-DOPA that increases dopamine levels in all the brain, making it difficult to discern the main locus of dopaminergic action in the alleviation of motor control. Caged compounds are molecules with the ability to release neuromodulators locally in temporary controlled conditions using light. In the present study, we measured the turning behavior of unilateral dopamine-depleted mice before and after dopamine uncaging. The optical delivery of dopamine in the striatum of lesioned mice produced contralateral turning behavior that resembled, to a lesser extent, the contralateral turning behavior evoked by a systemic injection of apomorphine. Contralateral turning behavior induced by dopamine uncaging was temporarily tied to the transient elevation of dopamine concentration and was reversed when dopamine decreased to pathological levels. Remarkably, contralateral turning behavior was tuned by changing the power and frequency of light stimulation, opening the possibility to modulate dopamine fluctuations using different light stimulation protocols. Moreover, striatal dopamine uncaging recapitulated the motor effects of a low concentration of systemic L-DOPA, but with better temporal control of dopamine levels. Finally, dopamine uncaging reduced the pathological synchronization of striatal neuronal ensembles that characterize unilateral dopamine-depleted mice. We conclude that optical delivery of dopamine in the striatum resembles the motor effects induced by systemic injection of dopaminergic agonists in unilateral dopamine-depleted mice. Future experiments using this approach could help to elucidate the role of dopamine in different brain nuclei in normal and pathological conditions.
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Dopamina , Enfermedad de Parkinson , Animales , Ratones , Enfermedad de Parkinson/tratamiento farmacológico , Levodopa/farmacología , Levodopa/uso terapéutico , Cuerpo Estriado , NeostriadoRESUMEN
Although the consumption of carbohydrates is needed for survival, their potent reinforcing properties drive obesity worldwide. In turn, sugar overconsumption reveals a major role for brain reward systems in regulating sugar intake. However, it remains elusive how different cell types within the reward circuitries control the initiation and termination of sugary meals. Here, we identified the distinct nucleus accumbens cell types that mediate the chemosensory versus postprandial properties of sweet sugars. Specifically, D1 neurons enhance sugar intake via specialized connections to taste ganglia, whereas D2 neurons mediate the termination of sugary meals via anatomical connections to circuits involved in appetite suppression. Consistently, D2, but not D1, neurons partially mediate the satiating effects of glucagon-like peptide 1 (GLP-1) agonists. Thus, these nucleus accumbens cell types function as a behavioral switch, enabling positive versus negative control over sugar intake. Our study contributes to unveiling the cellular and circuit substrates of sugar overconsumption.
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Neuronas , Núcleo Accumbens , Ratones , Animales , Núcleo Accumbens/metabolismo , Neuronas/metabolismo , Encéfalo/metabolismo , Azúcares/metabolismo , Receptores de Dopamina D1/metabolismoRESUMEN
INTRODUCTION AND IMPORTANCE: Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures. PRESENTATION OF CASE: A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present. CLINICAL DISCUSSION: The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient's outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction. CONCLUSION: In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.
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Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovial joint inflammation, progressive disability, premature immune aging, and telomere length (TL) shortening. Objectives: The objective of the study was to study TL changes in patients at early disease onset and after follow-up. Methods: Relative leukocyte TL (rLTL) was measured by quantitative polymerase chain reaction (qPCR) in 88 at-admission patients (AAP) with < 1 year of symptoms onset, self-compared after follow-up, and a reference group of sex- and age-matched healthy individuals. Correlations between rLTL percentage change after variable disease exposure time (DET) and clinical laboratory disease activity markers and treatments were assessed. Non-parametrical statistics were applied, considering < 0.05 p-value significant. Results: The median (p25, p75) rLTL was lower in patients after DET (0.61, 0.49-0.70) than in AAP (0.64, 0.50-0.77), p = 0.017. Furthermore, telomeres at early stages of RA were shorter than in the reference group (0.77, 0.59-0.92; p = 0.003). HLA-DRB1*04 allele carrier status did not significantly affect rLTL at an early stage and after follow-up. The patients' rLTL shortening was mainly associated with longer at-admission telomeres (OR 16.2, 95%CI: 3.5-74.4; p < 0.0001). Conclusions: At follow-up, RA patients showed significantly shorter rLTL than AAP, particularly in those AAP with longer telomeres, disregarding disease activity and treatments, denoting an rLTL shortening effect influenced by age, DET, and native rLTL.
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Artritis Reumatoide , Humanos , Artritis Reumatoide/genética , Estudios de Seguimiento , Telómero/genética , Acortamiento del TelómeroRESUMEN
Early life stress induced by maternal separation (MS) causes neuroendocrine, behavioral, and metabolic alterations that are related to gut dysbiosis. MS also increases microglial activation and decreases neurogenesis. Whether these long-term alterations are maintained or worsened in the absence of gut microbiota remains unknown. Hence, this study evaluated the effect of MS symptomatology after antibiotic-induced microbiota depletion (AIMD) in adult rats. Control and maternally separated (3 h per day from postnatal day one to 14, MS180) rats were subjected to AIMD for one month, then assessed for behavioral, metabolic, and neuroendocrine responses. Effects of MS180 and AIMD on gut microbiota were confirmed by qPCR. The data indicate that MS180 caused a passive coping strategy in the forced swimming test and decreased hippocampal neurogenesis. In addition, fasting glucose, cholesterol, and corticosterone levels increased, which correlated with a decrease in Lactobacillus spp counts in the caecum. AIMD also increased immobility in the forced swimming test, decreased hippocampal neurogenesis, and augmented corticosterone levels. However, it had no effects on glucose homeostasis or plasma lipid levels. Furthermore, the MS180-induced long-term effects on behavior and neurogenesis were not affected by microbiota depletion. Meanwhile, the metabolic imbalance was partially reversed in MS180 + AIMD rats. These results show that AIMD mimics the behavioral consequences of MS180 but may prevent metabolic imbalance, suggesting that gut dysbiosis could be part of the mechanisms involved in the maintenance of the long-term consequences of early life stress.
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Microbiota , Estrés Psicológico , Animales , Ratas , Antibacterianos/farmacología , Conducta Animal/fisiología , Corticosterona , Disbiosis , Glucosa/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Privación Materna , Sistema Hipófiso-Suprarrenal/metabolismoRESUMEN
ABSTRACT Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovial joint inflammation, progressive disability, premature immune aging, and telomere length (TL) shortening. Objective: The objective of the study was to study TL changes in patients at early disease onset and after follow-up. Methods: Relative leukocyte TL (rLTL) was measured by quantitative polymerase chain reaction (qPCR) in 88 at-admission patients (AAP) with < 1 year of symptoms onset, self-compared after follow-up, and a reference group of sex- and age-matched healthy individuals. Correlations between rLTL percentage change after variable disease exposure time (DET) and clinical laboratory disease activity markers and treatments were assessed. Non-parametrical statistics were applied, considering < 0.05 p-value significant. Results: The median (p25, p75) rLTL was lower in patients after DET (0.61, 0.49-0.70) than in AAP (0.64, 0.50-0.77), p = 0.017. Furthermore, telomeres at early stages of RA were shorter than in the reference group (0.77, 0.59-0.92; p = 0.003). HLA-DRB1*04 allele carrier status did not significantly affect rLTL at an early stage and after follow-up. The patients' rLTL shortening was mainly associated with longer at-admission telomeres (OR 16.2, 95%CI: 3.5-74.4; p < 0.0001). Conclusion: At follow-up, RA patients showed significantly shorter rLTL than AAP, particularly in those AAP with longer telomeres, disregarding disease activity and treatments, denoting an rLTL shortening effect influenced by age, DET, and native rLTL.
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BACKGROUND: Myelomeningocele (MMC) is the most severe and frequent type of spina bifida. Its etiology remains poorly understood. The Hedgehog (Hh), Wnt, and planar cell polarity (PCP) signaling pathways are essential for normal tube closure, needing a structural-functional cilium for its adequate function. The present study aimed to investigate the impact of different gene variants (GV) from those pathways on MMC genotype-subphenotype correlations. METHODS: The study comprised 500 MMC trios and 500 controls, from 16 Telethon centers of 16 Mexican states. Thirty-four GVs of 29 genes from cilia, Hh, PCP, and Wnt pathways, were analyzed, by an Illumina on design microarray. The total sample (T-MMC) was stratified in High-MMC (H-MMC) when thoracic and Low-MMC (L-MMC) when lumbar-sacral vertebrae affected. STATA/SE-12.1 and PLINK software were used for allelic association, TDT, and gene-gene interaction (GGI) analyses, considering p value <.01 as statistically significant differences (SSD). RESULTS: Association analysis showed SSD for COBL-rs10230120, DVL2-rs2074216, PLCB4-rs6077510 GVs in T-MMC and L-MMC, and VANGL2-rs120886448 in T-MMC and H-MMC, and INVS-rs7024375 exclusively in L-MMC. TDT assay showed SSD preferential transmissions of C2CD3-rs826058 in H-MMC, and LRP5-rs3736228, and BBS2-rs1373 in L-MMC. Statistically significant GGI was observed in four in T-MMC, four completely different in L-MMC, and one in H-MMC. Interestingly, no one repeated in subphenotypes. CONCLUSIONS: Our results support an association of GVs in Hh, Wnt, PCP, and cilia pathways, with MMC occurrence location, although further validation is needed. Furthermore, present results show a distinctive panel of gene-variants in H-MMC and LMMC subphenotypes, suggesting a feasible genotype-phenotype correlation.
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Proteínas Hedgehog , Meningomielocele , Cilios/genética , Estudios de Asociación Genética , Humanos , Meningomielocele/genética , Proteínas Asociadas a Microtúbulos , Vía de Señalización Wnt/genéticaRESUMEN
Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.
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Resumen Introducción: la neumonía adquirida en la comunidad es una infección aguda del parénquima pulmonar que corresponde a una importante causa de morbi-mortalidad en Colombia. En esta entidad, se ha asociado la pobre calidad en la atención y la mala adherencia a las guías de manejo con un impacto negativo tanto en el desenlace clínico del paciente, como en la academia y solvencia económica de un Hospital Universitario. Objetivo: describir la calidad de la atención médica y adherencia a la guía colombiana de manejo de la neumonía adquirida en la comunidad en el Hospital Universitario de Santander durante el periodo 2014-2015. Materiales y métodos: estudio descriptivo de corte transversal; se seleccionaron 121 historias clínicas con diagnóstico de Neumonía Adquirida en la Comunidad en el Hospital Universitario de Santander durante el periodo 2014-2015. A partir de estas, se recolectaron variables respecto a la aproximación diagnóstica, asignación de tratamiento y recomendaciones generales, evaluando por cada ítem individual el porcentaje de adherencia a la guía de Neumonía adquirida en la comunidad de la Asociación Colombiana de Infectología y los criterios de calidad en la atención de la Community Acquired Pneumonia Organization. Resultados: los ítems con mayor cumplimiento fueron: el hemoleucograma (100%) y la toma de radiografía de tórax (98%). Por otra parte, la clasificación CURB-65 (15%), la indicación de radiografía de tórax en el control (12%) y las recomendaciones para cese de tabaquismo y vacunación (0%) fueron los parámetros con menor rendimiento. Conclusiones: se evidenció una falencia en el proceso de clasificación clínica del paciente, condición que, asociada al escaso uso de laboratorios de diagnóstico microbiológico y el excesivo uso de estudios de imagen no indicados como la tomografía computarizada, favorece un tratamiento ineficiente y el desarrollo de resistencia farmacológica. MÉD.UIS.2019;32(2):23-30
Abstract Introduction: community-acquired pneumonia is an acute infection of lung parenchyma, being nowadays an important cause of morbidity and mortality in Colombia. In this entity, poor health care quality and poor adherence to management guidelines has been associated with a negative impact on both, the clinical outcome of the patient and the academic and financial solvency of a university hospital. Objective: to describe the quality of medical care and adherence to the Colombian community-acquired pneumonia guideline in the Hospital Universitario de Santander during the 2014-2015 period. Methods: descriptive cross-sectional study. 121 clinical records with diagnosis of community-acquired pneumonia in the Hospital Universitario de Santander were selected. Variables regarding diagnostic approach, treatment assignment and general recommendations were collected from these, evaluating for each item the proportion of adherence to the guideline as well as the quality criteria in medical care defined by the Community Acquired Pneumonia Organization. Results: items with best reported adherence were: complete blood count (100%) and chest X-ray (98%). On the other hand, CURB-65 classification (15%), chest X-ray indicated for the ambulatory control (12%), as well as recommendations for cessation of smoking and vaccination (0%), were the parameters with the lowest performance. Conclusions: there was evidence of failure in the clinical classification of the patient, which was associated with poor use of microbiological diagnostic laboratories and overuse of imaging studies such as computed tomography, thus favoring inefficient treatment and development of bacterial pharmacological resistance. MÉD.UIS.2019;32(2):23-30
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neumonía , Calidad de la Atención de Salud , Atención , Terapéutica , Tórax , Tabaquismo , Radiografía , Fumar , Tomografía Computarizada por Rayos X , Registros Médicos , Estudios Transversales , Morbilidad , Mortalidad , Vacunación , Guía de Práctica Clínica , Colombia , Atención Médica , Diagnóstico , Infectología , Tejido Parenquimatoso , Infecciones , PulmónAsunto(s)
Países en Desarrollo , Accesibilidad a los Servicios de Salud , Neumotórax/terapia , Pautas de la Práctica en Medicina , Procedimientos Quirúrgicos Torácicos/efectos adversos , Colombia , Adhesión a Directriz , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Humanos , Neumotórax/diagnóstico , Neumotórax/etiología , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Resultado del TratamientoRESUMEN
Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.
Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.
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Humanos , Costos y Análisis de Costo , Desfibriladores , Análisis de Costo-Efectividad , Inconsciencia , Reanimación Cardiopulmonar , Participación de la ComunidadRESUMEN
BACKGROUND: The combined treatment of beta-blockers with ablation and Implanted cardioverter defibrillation therapy, continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients. CASE SERIES PRESENTATION: During a period of three years, from 2015 through 2017, twenty patients (N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (beta-blockers), Implanted Cardioverter defibrillation (ICD) and ablation therapy. All twenty patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. During the month prior to bilateral VATS denervation a combined total of twenty-nine (N = 29) ICD shocks were registered in addition to six (N = 6) cases of electrical storms averaging three (N = 3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N = 18/20) total resolution of ICD registered shocks, a 100% (N = 6/6) resolution of electrical storms, and a 92% (N = 11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities. CONCLUSIONS: Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with life-threatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.
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Cardioversión Eléctrica/métodos , Electrocardiografía , Simpatectomía/métodos , Taquicardia Ventricular/cirugía , Cirugía Torácica Asistida por Video/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Resultado del TratamientoRESUMEN
Fontan-associated liver disease is a hepatic disorder arising from hemodynamic changes and systemic venous congestion following Fontan surgery. The histological changes produced in the liver are similar but not equivalent to those seen in other forms of cardiac liver disease. While the natural history of this form of liver disease is not well established, over time many Fontan patients develop portal hypertension-related complications such as ascites, variceal hemorrhage or encephalopathy. Fontan survivors also show an increased risk of hepatocellular carcinoma. Early diagnosis of advanced liver disease is mandatory for the prevention and treatment of complications such as hepatocellular carcinoma, esophageal varices and malnutrition. This review updates current knowledge of the pathophysiology and management of Fontan-associated liver disease including new diagnostic methods and treatments.
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Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Hemodinámica , Circulación Hepática , Hepatopatías/etiología , Hígado/irrigación sanguínea , Cardiopatías Congénitas/fisiopatología , Humanos , Hepatopatías/diagnóstico por imagen , Hepatopatías/fisiopatología , Hepatopatías/prevención & control , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Autonomic modulation is a valuable therapeutic option for the management of ventricular arrhythmias. Bilateral cardiac sympathetic denervation (BCSD) has shown promising results in the acute, intermediate, and long-term management of polymorphic and monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Cardiomyopathy (CM) due to Chagas disease (CD), and associated VT, is thought to be in part due to autonomic neuronal destruction and dysfunction. OBJECTIVE: The purpose of this study was to assess whether BCSD is a safe and effective treatment modality in patients with CD and VT storm or refractory VT. METHODS: A retrospective analysis of data from patients with chagasic CM who underwent BCSD between 2009 and 2015 at 2 international centers was performed. RESULTS: Of 75 patients who underwent BCSD for VT storm or refractory VT in the setting of CM, 7 (9.3%) patients had CD as the etiology of CM. All patients had monomorphic VT. Median follow-up was 7 months (range 1-46 months). All patients either underwent previous unsuccessful catheter ablation or were not candidates for ablation. The median number of implantable cardioverter-defibrillator (ICD) shocks 1 month before BCSD was 4 (range 2-30) and decreased to 0 (range 0-2) during available follow-up after BCSD. When antitachycardia pacing therapies were included in the analysis, the median number of ICD therapies (shocks + antitachycardia pacing) still decreased to 1 (range 0-3). CONCLUSION: In patients with chagasic CM presenting with refractory monomorphic VT, early evidence suggests that BCSD reduces appropriate ICD therapy and may represent a valuable treatment option.
Asunto(s)
Cardiomiopatía Chagásica , Simpatectomía , Taquicardia Ventricular/prevención & control , California/epidemiología , Cardiomiopatía Chagásica/complicaciones , Cardiomiopatía Chagásica/diagnóstico , Cardiomiopatía Chagásica/fisiopatología , Colombia/epidemiología , Femenino , Estudios de Seguimiento , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Simpatectomía/efectos adversos , Simpatectomía/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Resultado del TratamientoRESUMEN
Introducción. La hiperhidrosis primaria localizada y el rubor facial patológico son manifestaciones de hiperfunción del sistema autónomo simpático, que se presentan en casi el 3 % de la población y afectan en forma importante la vida cotidiana de muchas de estas personas. La simpatectomía videotoracoscópica es actualmente el tratamiento de elección. Materiales y métodos. Estudio descriptivo de una serie de 44 pacientes con síntomas de hiperhidrosis a quienes se les practicó simpatectomía videotoracoscópica bilateral, entre los años 2000 y 2003, para evaluar el nivel de satisfacción con los resultados clínicos. Resultados. Se pudieron localizar 18 pacientes en el 2014, con más de 10 años de evolución desde la cirugía (41 %). La satisfacción inicial, evaluada una semana después de la cirugía, fue excelente (90 %) en 42 de 44 pacientes, moderada, en uno, y solo en uno, inferior a 50 %. Diez años después de la cirugía, el promedio de satisfacción fue de 81,7 %. De 18 pacientes, 15 continuaban estando muy satisfechos o satisfechos (71-100 %) y 2 estaban insatisfechos (50 % o menos): uno por sudoración compensatoria grave y otro por recidiva de los síntomas. Conclusiones. Se encontró que la satisfacción de los pacientes con los resultados a largo plazo no parece depender de la gravedad de la hiperhidrosis compensatoria. Parece, entonces, que la hiperhidrosis compensatoria puede ser mejor tolerada con el paso del tiempo, ya que el paciente se acostumbra a esta situación y ya no lo afecta tanto en su vida cotidiana.
Introducción. La hiperhidrosis primaria localizada y el rubor facial patológico son manifestaciones de hiperfunción del sistema autónomo simpático, que se presentan en casi el 3 % de la población y afectan en forma importante la vida cotidiana de muchas de estas personas. La simpatectomía videotoracoscópica es actualmente el tratamiento de elección. Materiales y métodos. Estudio descriptivo de una serie de 44 pacientes con síntomas de hiperhidrosis a quienes se les practicó simpatectomía videotoracoscópica bilateral, entre los años 2000 y 2003, para evaluar el nivel de satisfacción con los resultados clínicos. Resultados. Se pudieron localizar 18 pacientes en el 2014, con más de 10 años de evolución desde la cirugía (41 %). La satisfacción inicial, evaluada una semana después de la cirugía, fue excelente (90 %) en 42 de 44 pacientes, moderada, en uno, y solo en uno, inferior a 50 %. Diez años después de la cirugía, el promedio de satisfacción fue de 81,7 %. De 18 pacientes, 15 continuaban estando muy satisfechos o satisfechos (71-100 %) y 2 estaban insatisfechos (50 % o menos): uno por sudoración compensatoria grave y otro por recidiva de los síntomas. Conclusiones. Se encontró que la satisfacción de los pacientes con los resultados a largo plazo no parece depender de la gravedad de la hiperhidrosis compensatoria. Parece, entonces, que la hiperhidrosis compensatoria puede ser mejor tolerada con el paso del tiempo, ya que el paciente se acostumbra a esta situación y ya no lo afecta tanto en su vida cotidiana.
Asunto(s)
Hiperhidrosis , Simpatectomía , Satisfacción del Paciente , Cirugía Asistida por VideoRESUMEN
Cervical lesions have been associated with infection by high-risk human papilloma virus (high-risk HPV). In 409 women aged >15 years high-risk HPV lesions were identified. In a cohort of this population persistent infection was compared with cytological, colposcopic, and histological lesions. Cervical scrapes were taken and DNA was isolated. HPV was detected by PCR in the E6/E7 region. Genotyping was performed by PCR nested multiple E6/E7. HPV was detected in a 37.40% (153/409), high-risk HPV in 86% (153/178), HPV18 46.64% (83/178), HPV16 34.28% (61/178). Among these 53.93% (96/178) were multiple infections, and HPV18/16 (30/96) was the most frequent 31.25%. The cytology showed changes in 15% of positive patients. A 49.67% in women positive for HPV infection showed abnormalities in the colposcopic study, a relationship that turned out to be statistically significant ( p < 0.0019 test χ(2)). Among all 85% of the women were younger than 45 years of age. Fifty-seven patients were evaluated 15 months after the base study, with initial prevalence of morbidity 49.12% (28/57) and at the end 10.53% (6/57), showing in 89.29% (25/28) negative for HR-HPV infection, 10.34% (3/28) showed persistence of infection, 17.54% (10/57) presented cytological alterations, with 80% of positivity for HPV, and a regression of 100% (10/10) of the previously identified lesions. With colposcopy, 50% (14/28) presented alterations related to HPV, of these 85.71% (12/14) showed regression of such an alteration. The cumulative incidence for HPV was 10.34% (3/29). The incidence rate was 4.23% (3/71), which is equal to 4.23 new cases of HPV infection per 100 people, per year of follow-up. In conclusion, the present work shows a high frequency of infection by high-risk HPV, with predominance of HPV18 and 16 and in general for multiple infections. Colposcopy was better predictor than the Pap smear for infection. The follow-up study revealed a low percentage of persistent infection, and a high frequency of negativity for viral infection, high regression of cytological and colposcopic lesions, a low cumulative and incidence rate similar to that reported by other Latin American countries and higher than the European countries.
RESUMEN
The rational designing of binding abilities in proteins requires an understanding of the relationship between structure and thermodynamics. However, our knowledge of the molecular origin of high-affinity binding of ligands to proteins is still limited; such is the case for l-lysine-l-arginine-l-ornithine periplasmic binding protein (LAOBP), a periplasmic binding protein from Salmonella typhimurium that binds to l-arginine, l-lysine, and l-ornithine with nanomolar affinity and to l-histidine with micromolar affinity. Structural studies indicate that ligand binding induces a large conformational change in LAOBP. In this work, we studied the thermodynamics of l-histidine and l-arginine binding to LAOBP by isothermal titration calorimetry. For both ligands, the affinity is enthalpically driven, with a binding ΔCp of ~-300 cal mol(-1) K(-1) , most of which arises from the burial of protein nonpolar surfaces that accompanies the conformational change. Osmotic stress measurements revealed that several water molecules become sequestered upon complex formation. In addition, LAOBP prefers positively charged ligands in their side chain. An energetic analysis shows that the protein acquires a thermodynamically equivalent state with both ligands. The 1000-fold higher affinity of LAOBP for l-arginine as compared with l-histidine is mainly of enthalpic origin and can be ascribed to the formation of an extra pair of hydrogen bonds. Periplasmic binding proteins have evolved diverse energetic strategies for ligand recognition. STM4351, another arginine binding protein from Salmonella, shows an entropy-driven micromolar affinity toward l-arginine. In contrast, our data show that LAOBP achieves nanomolar affinity for the same ligand through enthalpy optimization.
Asunto(s)
Arginina/metabolismo , Proteínas Bacterianas/química , Proteínas Bacterianas/metabolismo , Proteínas Portadoras/química , Proteínas Portadoras/metabolismo , Histidina/metabolismo , Salmonella typhimurium/metabolismo , Calorimetría , Cristalografía por Rayos X , Enlace de Hidrógeno , Modelos Moleculares , TermodinámicaRESUMEN
Problema de investigación: Analizar los costos y la efectividad de los desfibriladores automático y semiautomático en espacios de afluencia masiva y ambulancias básicas en Colombia. Tipo de evaluación \r\neconómica: Análisis de costo-efectividad. Población objetivo: Personas que presentan pérdida de conciencia (no tose, no se mueve, no respira, no responde) en espacios de afluencia masiva de público (aeropuertos, centros comerciales, estadios, centros de convenciones, colegios, universidades, medios masivos de trasporte público, cárceles, entre otros) y en ambulancias básicas. Intervención y comparadores: I: Desfibrilador automático/semiautomático externo, C: Reanimación cardiopulmonar (RCP).Horizonte temporal: Un año. Perspectiva Sistema: General de Seguridad Social en Salud (SGSSS). Estructura del modelo: Árbol de decisión, que incluye los eventos de sobrevida y muerte. Fuentes de datos de efectividad y seguridad: Ensayos clínicos y meta-análisis. Desenlaces y valoración: Mortalidad, Años de vida ganados. Costos incluidos: Costo del dispositivo, Costo de medicamentos, Costo de procedimientos e insumos. Fuentes de datos de costos: Consulta a proveedores, SISMED, Manual tarifario ISS 2001. Resultados del caso base: En el escenario de espacios públicos, el costo de una muerte evitada es de $87.492.099. Al expresar estas cifras en costo por año de vida ganado, el DEA sería una estrategia altamente costo-efectivo. En el caso específico de ambulancias básicas, no se dispone de información suficiente que permita extraer conclusiones sólidas. Análisis de sensibilidad: Los análisis de sensibilidad y el diagrama de tornado mostraron que las \r\nvariables con mayor impacto sobre las estimaciones de costo-efectividad en espacios públicos son la probabilidad de sobrevida al alta hospitalaria y el costo del desfibrilador externo automático (DEA). Conclusión y discusión: El uso del DEA en espacios de afluencia masiva de público es una \r\nestrategia altamente costo-efectiva en Colombia. No obstante, es necesario tener en cuenta que la implementación de un programa de desfibrilación de acceso enfrenta múltiples barreras, por lo cual es \r\nfundamental fortalecer los tres primeros eslabones de la cadena de supervivencia, entre los cuales se encuentra el uso del DEA en espacio de afluencia masiva del público y la optimización de los tiempos de respuesta.(AU)