RESUMO
Resumen La presente investigación tuvo como objetivo identificar y describir los niveles de desarrollo de la noción de "mitad" en un grupo de niños de dos comunidades indígenas pertenecientes al pueblo shipibo-konibo de la región Ucayali, en la Amazonía del Perú. Se trabajó con 14 estudiantes de edades entre 7 y 13 años, seis de ellos pertenecientes a la comunidad de Bethel y ocho a la comunidad de Bena Jema. Todos fueron evaluados utilizando el método clínico-crítico de Jean Piaget. Los estudiantes de la comunidad de Bethel fueron evaluados con una tarea centrada en cantidades discretas y los de la comunidad de Bena Jema, con la misma tarea y con otra centrada en cantidades continuas. Los desempeños de los participantes evidenciaron cuatro niveles de desarrollo en cada una de las tareas. Sus respuestas fueron consistentes con otras investigaciones que evaluaron la misma noción en contextos occidentales. Los resultados apoyan la universalidad en la construcción de la noción de "mitad", pero evidencian un retraso en la adquisición de los niveles por parte de los niños evaluados, si se toma como referencia los currículos nacionales. Se discuten los hallazgos resaltando la universalidad de las estructuras lógico-matemáticas y la necesidad de repensar el momento y la forma en que la noción de "mitad" aparece en el currículo.
Abstract This research aims to identify and describe developmental levels of the notion of "half" in a group of children from two Shipibo-Konibo native communities of the Ucayali region, in the Peruvian Amazon rainforest. Fourteen students aged between 7 and 16 participated, six from Bethel community and eight from Bena Jema community. The community of Bethel is located approximately 6 hours by river from the city of Pucallpa, while Bena Jema is located within Pucallpa's boundaries, in the Yarinacocha district. All participants were assessed using Jean Piaget's clinical-critical method, with two tasks. In the first task, focusing on discrete quantities: different sets of cards with the picture of a fish were presented sequentially, some with an even number of units and some with an odd number. Participants were asked to choose and present back half of each set. In the second task, focusing on continuous quantities: participants were asked to choose and present half of a single raw spaghetti, which they needed to break with their hands. If the resulting pieces were unequal, they were asked to break them again and redistribute the results. Students from Bena Jema community were assessed with both tasks, while students from Bethel community were assessed only with the discrete quantities task. The results showed four developmental levels in the discrete quantities task. In the first level, participants took any one of two parts of the set to be "half", without checking if they were equal or whether putting them back together reconstituted the original whole. In the second level, participants took any one of two equal parts to be "half", but were inconsistent and accepted the possibility of the parts being unequal. In the third level, participants only took any one of two equal parts to be "half" but had difficulties splitting odd-numbered sets, including sets with fewer elements than the even-numbered ones they had previously split correctly. In the fourth level, the task was solved successfully with both even-numbered and odd-numbered sets. For the continuous quantities task, three levels were found. In the first level, any one of two raw spaghetti pieces was taken to be "half", without checking their evenness. In the second level, participants took any two equal pieces of the raw spaghetti to be "half", but without checking whether putting them back together reconstituted the original whole, with no extra parts remaining. In the third level, participants took any one of two equal pieces to be "half", checking whether putting them back together reconstituted the original whole. These results are consistent with reports from previous research assessing the notion of "half" in Western contexts. Results support universality in the development of the notion of "half", but show a delay in the participants' level of acquisition, taking Peru's national curriculum as reference. This study is a contribution to the understanding of the development of the notion of "half" in indigenous children living in Amazonian native communities, and shows the relevance of the Piagetian clinical-critical interview in these sociocultural contexts. The implications of these findings are discussed in relation to the universality of logical-mathematical knowledge, as well as the need to rethink the timing and manner in which the notion of "half" appears in the curriculum.
RESUMO
Wegener's granulomatosis is an autoimmune disease where autoantibodies target human autoantigen PR3, a serine protease locates on the neutrophil membrane. This disease affects blood small vessels and could be deadly. The origin of these autoantibodies is unknown, but infections have been implicated with autoimmune disease. In this study, we explored potential molecular mimicry between human PR3 and homologous pathogens through in silico analysis. Thirteen serine proteases from human pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Salmonella sp., Streptococcus suis, Vibrio parahaemolyticus, Bacteroides fragilis, Enterobacter ludwigii, Vibrio alginolyticus, Staphylococcus haemolyticus, Enterobacter cloacae, Escherichia coli and Pseudomonas aeruginosa) shared structural homology and amino acid sequence identity with human PR3. Epitope prediction found an only conserved epitope IVGG, located between residues 59-74. However, multiple alignments showed conserved regions that could be involved in cross-reactivity between human and pathogens serine proteases (90-98, 101-108, 162-169, 267 and 262 residues positions). In conclusion, this is the first report providing in silico evidence about the existence of molecular mimicry between human and pathogens serine proteases, that could explain the origins of autoantibodies found in patients suffering from Wegener's granulomatosis.
RESUMO
Se evaluaron la cinética de fermentación, pruebas de crecimiento y efecto de inhibición de Lactobacillus gasseri sobre Yersinia pseudotuberculosis. Se determinó susceptibilidad de L. gasseri y Y. pseudotuberculosis a los antibióticos gentamicina, penicilina, ciprofloxacina, dicloxacilina y cefalotina; además, el efecto de inhibición de L. gasseri y su sobrenadante en Y. pseudotuberculosis y el crecimiento de L. gasseri a diferentes concentraciones de sales biliares, bilis bovina y temperatura. Se evaluó la cinética de crecimiento de la cepa láctica (UFC/ml, pH, azúcar, acidez y proteína) y se determinaron péptidos en el sobrenadante mediante HPLC. Las variables pH y UFC/ml se evaluaron mediante un diseño de medidas repetidas en el tiempo. Se encontró resistencia de L. gasseri y Y. pseudotuberculosis a la dicloxacilina, además de cefalotina para la primera. La cepa láctica y su sobrenadante inhibieron a la cepa patógena. Se obtuvieron crecimientos entre 3 x 10(8) y 1,7 x 10(13) UFC/150 pl en sales biliares, entre 3 x 10(8) y 3 x 10(12) UFC/150 pl en bilis bovina y entre 4,3 x 10(8) y 3 x 10(13) UFC/150 pl a diferentes temperaturas. La fase exponencial se observó a las 16 h con un valor de 3 x 10(12) UFC/150 pl, pH de 4,56, azúcar de 1,79 mg/l, acidez de 0,925 y proteína de 0,16 mg/l. Se encontró el péptido VAL-TIR-VAL en el sobrenadante de L. gasseri. Los resultados indican que L. gasseri puede ser importante como cepa probiótica en condiciones in vitro.
Fermentation kinetics, growth tests and inhibition effect of Lactobacillus gasseri on Yersinia pseudotuberculosis was evaluated. Susceptibility to gentamicin, penicillin, ciprofloxacin, and cephalothin, dicloxacillin antibiotics, and the inhibition effect of L. gasseri and supernatant on Y. pseudotuberculosis was determined. Additionally, the growth of L. gasseri to different concentrations of bile salts, bovine bile and temperature. Growth kinetics of lactic strain (CFU/ml, pH, sugar, acidity and protein) was evaluated and peptide in the supernatant was determined by HPLC. The pH and CFU/ml variables were evaluated using a repeated measures time design. L. gasseri and Y. pseudotuberculosis resistance to dicloxacillin was found in addition to the first cephalothin. Lactic strain and its supernatant inhibited the pathogenic strain, 3 x 10(8) at 1.7 x 1013 CFU/150 pl in bile salts, 3 x 10(8) at 3 x 10(12) CFU/150 pl in bovine bile and 4.3 x 10(8) to 3 x 10(13) CFU/150 pl to different temperatures. Exponential phase was observed at 16 h with a value of 3 x 10(12) CFU/150 pl , pH 4.56, sugar 1.79 mg/l, acidity 0.925 and protein 0.16 mg/l, the TIR-VAL VAL-peptide was found in the supernatant of L. gasseri. The results indicate that L. gasseri can be important as probiotic strain in vitro conditions.
RESUMO
UNLABELLED: Marfan syndrome is an inherited disorder of connective tissue with manifestations in various organ-systems including cardiovascular system. The aim of this study was to characterize and determine the frequency of cardiovascular alterations by echocardiography in 2 age cohorts of Mexican patients with Marfan syndrome and their comparisons with control groups. MATERIAL AND METHODS: Sixty six with Marfan syndrome and 33 control patients were evaluated by echocardiography. Segments of the aorta and pulmonary artery were measured at different levels, cardiac valves were examined for prolapse and the interatrial septum was assessed for septal aneurysm. Numeric values were corrected for the body surface area and compared with the control group. RESULTS: Mean significant values between group I (children) and Group II (adults) were as follows: aortic annulus 16.62 +/- 4.57 mm/m2 vs 12.81 +/- 1.95 (p < 0.001), aortic root 23.30 +/- 7.49 mm/m2 vs 18.36 +/- 2.97 (p < 0.001), sinuses of Valsalva 24.14 +/- 7.29 mm/m2 vs 19.84 +/- 3.59 (p < 0.001), ascending aorta 18.43 +/- 5.90 mm/m2 vs 17.02 +/- 4.79 (p < 0.001), aortic arch 16.12 +/- 4.73 mm/m2 vs 14.20 +/- 2.68 (p < 0.001). Pulmonary valve prolapse was seen in 10/22 (45.5%) vs 7/44 (15.9%), p < or = 0.03. Interatrial septal aneurysm was found in 3/22 (13.6%) vs 20/44 (45.5%), p < or = 0.03. There was a significative diference in the presence of atrial septal aneurysm between the adult group and control group (p < 0.001). CONCLUSIONS: The incidence of cardiovascular abnormalities in our series is similar to that in the literature with the exception of the very high incidence of pulmonary valve prolapse vs control groups, then it suggests that the clinical manifestations of MFS are strikingly severe in the Mexican population. Also a high incidence of interatrial septal aneurysm (34.9%) in comparison to control groups (18.2%) was found.
Assuntos
Ecocardiografia Doppler em Cores , Síndrome de Marfan/diagnóstico por imagem , Adolescente , Adulto , Anormalidades Cardiovasculares/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Coortes , Ecocardiografia Transesofagiana , Feminino , Valvas Cardíacas/anormalidades , Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Marfan syndrome is an inherited disorder of connective tissue with manifestations in various organ-systems including cardiovascular system. The aim of this study was to characterize and determine the frequency of cardiovascular alterations by echocardiography in 2 age cohorts of Mexican patients with Marfan syndrome and their comparisons with control groups. Material and methods: Sixty six with Marfan syndrome and 33 control patients were evaluated by echocardiography. Segments of the aorta and pulmonary artery were measured at different levels, cardiac valves were examined for prolapse and the interatrial septum was assessed for septal aneurysm. Numeric values were corrected forthe body surface area and compared with the control group. Results: Mean significant values between group I (children) and Group II (adults) were as follows: aortic annulus 16.62 ± 4.57 mm/m² vs 12.81 ± 1.95 (p< 0.001), aortic root 23.30 ±7.49 mm/m²vs 18.36 ± 2.97 (p < 0.001), sinuses of Valsalva 24.14 ± 7.29 mm/m² vs 19.84 ± 3.59 (p < 0.001), ascending aorta 18.43 ± 5.90 mm/m² vs 17.02 ± 4.79 (p < 0.001), aortic arch 16.12 ± 4.73 mm/m² vs 14.20 ± 2.68 (p < 0.001). Pulmonary valve prolapse was seen in 10/22 (45.5%) vs 7/44 (15.9%), p < 0.03. Interatrial septal aneurysm was found in 3/22 (13.6%) vs 20/44 (45.5%), p < 0.03. There was a significative diference in the presence of atrial septal aneurysm between the adult group and control group (p < 0.001). Conclusions: The incidence of cardiovascular abnormalities in our series is similar to that in the literature with the exception of the very high incidence of pulmonary valve prolapse vs control groups, then it suggests that the clinical manifestations of MFS are strikingly severe in the Mexican population. Also a high incidence of interatrial septal aneurysm (34.9%) in comparison to control groups (18.2%) was found.
El síndrome de Marfán es una enfermedad hereditaria del tejido conectivo con manifestaciones en varios órganos incluyendo el sistema cardiovascular. El objetivo del estudio fue caracterizar y determinar la frecuencia de las alteraciones cardiovasculares mediante ecocardiografía en 2 grupos de pacientes mexicanos con síndrome de Marfán en comparación con los grupos controles. Material y métodos: Se estudiaron mediante ecocardiografía a 66 pacientes con síndrome de Marfán y 33 pacientes del grupo control. Se midieron los segmentos de la aorta y de la arteria pulmonar a diferentes niveles, se valoró prolapso valvular y presencia de aneurisma del septum interatrial. Los valores numéricos fueron corregidos por área de superficie corporal y comparados con el grupo control. Resultados: Los variables con valor significativo entre el grupo I (niños) y el grupo II (adultos) fueron: Anillo aórtico: 16.62 ± 4.57 mm/m² vs 12.81 ± 1.95 (p< 0.001), raíz aórtica 23.30 ±7.49 mm/m²vs 18.36 ± 2.97 (p < 0.001), senos de Valsalva 24.14 ± 7.29 mm/m² vs 19.84 ± 3.59 (p < 0.001), aorta ascendente 18.43 ± 5.90 mm/m² vs 17.02 ± 4.79 (p < 0.001), arco aórtico 16.12 ± 4.73 mm/m² vs 14.20 ± 2.68 (p < 0.001). Se encontró prolapso valvular pulmonar en 10/22 (45.5%) vs 7/44 (15.9%), p < 0.03. Aneurisma del septum interatrial en 3/22 (13.6%) vs 20/44 (45.5%), p < 0.03. Hubo diferencia significativa para la presencia de aneurisma del septum interatrial entre el grupo de adultos y el grupo control (p < 0.001). Conclusiones: La incidencia de anormalidades cardiovasculares en nuestra serie es similar a la reportada en la literatura excepto la alta incidencia de prolapso valvular pulmonar en relación al grupo control, lo que sugiere que las manifestaciones clínicas cardiovasculares del síndrome de Marfán son más severas en la población mexicana. Se encontró también una alta incidencia de aneurisma del septum interatrial (34.9%) en comparación al grupo control (18.2%). (Arch Cardiol Mex 2005; 75: 133-140).
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ecocardiografia Doppler em Cores , Síndrome de Marfan , Estudos de Coortes , Anormalidades Cardiovasculares , Ecocardiografia Transesofagiana , Valvas Cardíacas/anormalidades , Valvas CardíacasRESUMO
Suicidal ingestions of fireworks containing yellow phosphorus occur often during holidays. A case is reported of a 17 year old woman who intentionally ingested an estimated amount of 5.5 mg of yellow phosphorus, presenting with upper abdominal pain as the only complaint, a physical examination was normal. Blood tests showed a considerable decrease in the granulocyte count; the bone marrow biopsy revealed a decreased cellular mass with degenerative changes. Spontaneous remission was observed during the next 48 hours, with no further complaints.
Assuntos
Doenças da Medula Óssea/induzido quimicamente , Fósforo/intoxicação , Tentativa de Suicídio , Adulto , Doenças da Medula Óssea/fisiopatologia , Feminino , Humanos , Remissão EspontâneaRESUMO
Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease, characterized by asymmetric hypertrophy of the left and/or right ventricle with disarray of myocardial fibers. In order to know its clinical and electrocardiographic manifestation in the pediatric age group, we made a retrospective study of 24 cases from 1986 to 1995. There were: 15 girls and 9 boys, with a mean age of 6 years (age range: 1 month to 17 years). Clinical manifestations were dyspnea (71%), syncope (42%) and palpitations (42%). Physical examination disclosed an aortic systolic murmur in all patients, a mitral regurgitation in 42% and physical signs of congestive heart failure in 54% of patients. Chest X rays showed cardiac enlargement in 71% and pulmonary capillary hypertension in 42%. The most frequent ECG abnormalities were: a prolonged time in the intrinsecoid deflection onset on leads corresponding to the affected region, more or less deep and clean Q waves on leads aVF, aVL, V5 and V6, as well as supraventricular and ventricular rhythm disturbances in 11 patients (46%) with and without congestive heart failure. Bidimensional echocardiography confirmed antero-septal hypertrophy in all patients. The mortality rate was 17%. HCM is rare disease in the pediatric age group. Mortality increases when congestive heart failure and arrhythmias are present. Treatment must be individualized in all cases.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Adolescente , Cardiomiopatia Hipertrófica/complicações , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Lactente , Masculino , Estudos RetrospectivosRESUMO
La miocardiopatía hipertrófica (MCH) es una alteración heterogénea de causas múltiples, caracterizada por hipertrofia asimétrica del ventrículo izquierdo y/o derecho e histopatológicamente por desorganización de las fibras miocárdicas. Con la finalidad de conocer sus características electrocardiográficas y ecocardiográficas en pacientes en edad pediátrica, se realizó un estudio retrolectivo de 1986 a 1995. Se encontraron 24 casos con MCH: 15 fueron del sexo femenino y 8 del masculino con edad promedio de 6 años (1 mes a 17 años). En 6 casos había antecedentes familiares de MCH. Las manifestaciones clínicas fueron: disnea (71 por ciento); síncope (42 por ciento) y palpitaciones (42 por ciento). A la exploración física, en todos los pacientes existió soplo aórtico de tipo expulsivo, soplo regurgitante mitral en 42 por ciento y signos de insuficiencia cardiaca global en 54 por ciento. La radiografía de tórax evidenció cardiomegalia en 71 por ciento e hipertensión venocapilar en 42 por ciento. Las alteraciones electrocardiográficas más frecuentes fueron: prolongación del tiempo de inicio de la deflexión intrinsicoide en las derivaciones correspondientes a la región afectada, Q limpias y más o menos profundas en aVF, aVL, V5 y V6 y trastornos del ritmo de tipo supraventricular en 11 enfermos (46 por ciento) con y sin insuficiencia cardiaca. Por ecocardiograma bidimensional, se confirmó la existencia de hipertrofia anteroseptal en los 24 pacientes. El tratamiento fue médico en el 83 por ciento y quirúrgico en los restantes. Se observó una mortalidad del 17 por ciento. La MCH es un padecimiento raro en la edad pediátrica, la mortalidad se incrementa con la presencia de insuficiencia cardiaca y trastornos del ritmo. El tratamiento debe individualizarse.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Cardiomiopatia Hipertrófica/diagnóstico , Criança , Ecocardiografia , Eletrocardiografia/métodos , Hipertrofia Ventricular Esquerda , Hipertrofia Ventricular Direita , Insuficiência Cardíaca/diagnósticoAssuntos
Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Humanos , Feminino , Adulto , Lúpus Eritematoso Sistêmico/complicações , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/fisiopatologia , Anticorpos Antifosfolipídeos/efeitos adversos , Lúpus Eritematoso Sistêmico/fisiopatologia , Meningites Bacterianas/complicaçõesAssuntos
Humanos , Feminino , Adulto , Lúpus Eritematoso Sistêmico/complicações , Trombose dos Seios Intracranianos/diagnóstico , Anticorpos Antifosfolipídeos/efeitos adversos , Lúpus Eritematoso Sistêmico/fisiopatologia , Meningites Bacterianas/complicações , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/fisiopatologiaRESUMO
Entre abril de 1992 y junio de 1994, se realizó ablación con radiofrecuencia de vías anómalas en 250 pacientes con taquicardias supraventriculares por reentrada auriculoventricular, la cual fue exitosa en 232 pacientes (93 por ciento). De esta población, estudiamos 102 pacientes con preexitación manifiesta en el electrocardiograma basal. Ninguno de ellos tenía cardiopatías congénitas o adquiridas que pudieran afectar la morfología del complejo QRS. Analizamos unicamente la polaridad del complejo QRS en las derivaciones DIII, V1 y V2, y con esto logramos elaborar un algoritmo para localizar la inserción de la vía accesoria en cinco sitios con un 88 por ciento de probabilidad de éxito. Este análisis electrocardiográfico en pacientes con síndrome de Wolff-Parkinson-White facilita el diagnóstico topográfico de la zona de preexitación y mejora los resultados de la ablación transcatéter con radiofrecuencia
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Ablação por Cateter/métodos , Ablação por Cateter , Eletrocardiografia/métodos , Eletrocardiografia , Eletrofisiologia/instrumentação , Eletrofisiologia/métodos , Síndrome de Lown-Ganong-Levine/diagnóstico , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
From 250 consecutive patients who underwent radiofrequency ablation of accessory pathways, we studied 102 patients with successful ablation of a single overt accessory pathway. All patients had manifested preexcitation on a baseline 12 lead electrocardiogram. None of this patients had additional congenital or acquired cardiac abnormalities which could have affected the QRS morphology. A new algorithm for localizing the AP site was developed, based only on the polarity of the QRS complexes in DIII, V1 and V2, without analysis of the delta wave. We could localize the accessory pathway in five sites with 88% of probability of success. This simplify the electrocardiographic analysis of Wolff Parkinson White and improvement the results of radiofrequency ablation.
Assuntos
Algoritmos , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/anormalidades , Adolescente , Adulto , Idoso , Teorema de Bayes , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Criança , Pré-Escolar , Eletrocardiografia/estatística & dados numéricos , Eletrofisiologia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia , Síndrome de Wolff-Parkinson-White/cirurgiaRESUMO
En una serie consecutiva de 222 pacientes con infarto agudo del miocardio, se realizó seguimiento durante un año. Se valoró en ellos la utilidad de los potenciales ventriculares tardíos, el espectroanálisis, la variabilidad de la frecuencia cardíaca, el estado de la arteria responsable del infarto, la fracción de expulsión del ventrículo izquierdo, la presencia de arritmias complejas en el monitoreo Holter de 24 horas y otras variables clínicas como marcadores de riesgo para desarrollar arritmias ventriculares graves y/o muerte súbita. Durante el seguimiento, 24 pacientes (11 por ciento) tuvieron eventos arrítmicos malignos: 7 con muerte súbita, 15 con taquicardia ventricular sostenida documentada y 2 con síncope de causa desconocida: La prueba que mostró mayor sensibilidad (94 por ciento) correspondió a los potenciales ventriculares tardíos, con un alto valor predictivo negativo (99 por ciento), seguidos por el estado de la arteria responsable del infarto (sensibilidad de 75 por ciento y valor predictivo negativo de 96 por ciento). La prueba con más especificidad (92 por ciento) era representada por las arritmias complejas en el monitoreo Holter. La combinación de los potenciales tardíos, ya fuera con el estado de la arteria responsable del infarto o con la fracción de expulsión, mostró tanto una sensibilidad como un valor predictivo negativo de 100 por ciento. En el análisis multivariado, de las dieciseis variables estudiadas, cinco tuvieron un valor independiente y significativo como predictores de eventos arrítmicos malignos. Estas fueron, de acuerdo con la magnitud de riesgo relativo: la presencia de potenciales tardíos (20.2), la fracción de expulsión menor o igual a 40 por ciento (12.1), las arritmias complejas en el Holter (7.5), la arteria responsable del infarto ocluido (6.4) y la localización anterior del infarto agudo del miocardio (4.5). Con una combinación de métodos relativamente sencillos se puede seleccionar a un sub-grupo de pacientes, sobrevivientes a la fase aguda de un infarto del miocardio, que tienen una alta probabilidad de presentar arritmias ventriculares graves y/o muerte súbita. Se puede también identificar, incluso con mayor precisión, aquellos pacientes con bajo riesgo de desarrollar dichas complicaciones.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Arritmias Cardíacas/etiologia , Neoplasias Cardíacas/diagnóstico , Infarto do Miocárdio/complicaçõesRESUMO
Two hundred twenty two consecutive patients with acute myocardial infarction were followed for one year. We evaluated the usefulness of late potentials, the spectral analysis, heart rate variability, infarct-related coronary artery, ejection fraction, arrhythmias during Holter monitoring and other clinical variables as risk markers for developing of ventricular arrhythmias and/or sudden death. Twenty four patients (10.8%) had late arrhythmic events: sudden death in 7, sustained ventricular tachycardia in 15 and unexplained syncope in 2. Late potentials had high sensitivity (94%) and negative predictive value (99%), followed by an occluded related-infarct coronary artery (75% sensitivity and 96% negative predictive value). Complex ventricular arrhythmias during Holter monitoring was the test with the highest specificity (92%). A combination of late potentials plus an occluded infarct-related coronary artery or late potentials plus ejection fraction showed 100% sensitivity with 100% negative predictive value. Of the 16 studied variables, 5 had independent and significative value as a predictor of arrhythmic events, these are, according to the relative risk: late potentials (20.2), ejection fraction less than 40% (12.1), complex arrhythmias during Holter monitoring (7.5), the presence of an occluded infarct-related coronary artery (6.4) and anterior myocardial infarction localization (4.5). We consider, that with a combination of simple methods of assessment, we can select a subgroup of survivors of an acute myocardial infarction at high risk of developing ventricular arrhythmias and sudden death, which also identifies patients with low risk for these complications.
Assuntos
Arritmias Cardíacas/diagnóstico , Infarto do Miocárdio/complicações , Idoso , Arritmias Cardíacas/etiologia , Morte Súbita/etiologia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Feminino , Testes de Função Cardíaca , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The most common cause of sudden death is malignant ventricular arrhytHmia. In order to identify the predictive value of the vectospatial evaluation in the surface electrocardiogram during a monomorphic ventricular tachycardia (MVT), and the equilibrium state of AutonomOus Nervous System (ANS), 89 patients of both sexes were studied with mean age of 47 +/- 16.2 years. They were grouped as follows: Group I included 43 patients (P), with a coronary heart disease; Group II (n = 24P) with a noncoronary myocardiopathy and Group III (n = 22P) with unknown origin MVT (Cryptogenic). Relationship between QRS configuration in the frontal plane (QRSf) during MVT episode with transverse plane, cardiac position in the chest X-rays, presence and duration of late potentials (LPs) in their two types of analysis (time domain and spectral mapping by high-resolution electrocardiogram), heart rate variability and ejection fraction by echocardiography were determined in all patients. The QRSf configuration with left bundle-branch block (LBBB) was the most common in group I, the sustained MVT (SMVT) + LBBB was associated with both prevalence and duration of late potentials (p = 0.005), low-rate heart variability and ejection fraction < 40%. SMVT + LBBB was the most common type in group III and if it has shown and inferior axis, an elevated rate of LPs (+) was seen. Situation that oriented to an arrhythmogenic right ventricular dysplasia. Low amplitude signals with short duration in the time domain were seen in group I with LBBB; and with SMVT + RBBB in group II. We suggest that vectospatial evaluation of QRSf during a MVT is a greater importance in the risk stratification for sudden death and it can guide to anatomic origin and the diagnosis-therapeutic approach.
Assuntos
Eletrocardiografia/métodos , Taquicardia Ventricular/diagnóstico , Nervo Vago/fisiopatologia , Vetorcardiografia , Adulto , Idoso , Análise de Variância , Cardiomiopatias/diagnóstico , Cardiomiopatias/epidemiologia , Cardiomiopatias/fisiopatologia , Morte Súbita , Eletrocardiografia/estatística & dados numéricos , Feminino , Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Potenciais da Membrana , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/fisiopatologiaRESUMO
The Pelger-Huet anomaly is a benign disorder which affects the morphology of the granulocytes and is namely inherited as an autosomic dominant trait. The frequency of this anomaly varies from country to country and in México this constitutes the sixth family reported. This is a case of a 21-month-old boy whose anomaly was detected during the study of his ferropenic anemia with which he arrived at the hospital. During the study of his nine family members, the anomaly was found to have also been present in his father. An electron microscopy study of the subject, his father's and a normal control's neutrophils was conducted. The patient's and his father's leucocyte granules were found to be normal but decreased in number. This work includes some discussion on inherited traits, their presentation, morphology, differential diagnosis and emphasizes the importance in recognizing this anomaly and the promotion of genetic counselling.
Assuntos
Anomalia de Pelger-Huët/diagnóstico , Adulto , Núcleo Celular/ultraestrutura , Grânulos Citoplasmáticos/ultraestrutura , Diagnóstico Diferencial , Humanos , Lactente , Masculino , México , Microscopia Eletrônica , Neutrófilos/ultraestrutura , Linhagem , Anomalia de Pelger-Huët/sangue , Anomalia de Pelger-Huët/genéticaRESUMO
Los objetivos de este trabajo fueron aislar e identificar las levaduras asociadas a la nata de la madre del vinagre que se utiliza en México, y realizar con ella pruebas de alimentación con aves y conejos para observar su efecto en el peso de los animales, con el fin de buscar fuentes alternativas de alimento no convencional, barato y de fácil producción, para animales domésticos. Con respecto a las levaduras estudiadas, se presenta la descripción de Zygosaccharomyces bailii, registrada por primera vez para la madre del vinagre, y de Pichia membranaefaciens, especie que frecuentemente ha sido aislada de múltiples sustratos, incluyendo bebidas fermentadas indígenas de México. En relación al empleo de la nata de la madre del vinagre como componente de diversas dietas con las que se alimentaron aves (pollos de engorda, gallinas ponedoras y codornices) y conejos se comunican los efectos sobre el peso de los animales y, para el caso de las gallinas, también sobre la postura de huevos. Con las proporciones de nata utilizada, los pollos que comieron alimentos balanceados más nata alcanzaron pesos promedio similares a los de los pollos que comieron sólo alimento balanceado, pero con las gallina no fue así, pues su peso y la postula de huevos sí se vieron afectados negativamente. Por otro lado, las codornices que comieron alimento balanceado más nata llegaron a pesar más que las que comieron sólo alimento balanceado. En el caso de los conejos se observó una mayor longitud, aunque no un mayor peso, en los animales que comieron alimento convencional más nata. En este trabajo también se compara la madre del vinagre con los tibicos (otro tipo de macrocolonias constituidas por bacterias y levaduras en simbiosis), tanto en lo que se refiere a su composición química y microbiana como a las pruebas de alimentación hechas con aves y roedores