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We report the complete genome assembly of Pediococcus acidilactici A40, a bacterium with biocontrol and plant growth-promoting properties, obtained from Colombia.

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Resumen Objetivo: Identificar en qué medida la salud mental y bienestar subjetivo son predichas por el endeudamiento por motivos de estudio en estudiantes universitarios de la ciudad de Temuco, Chile. Método: Una muestra no probabilística de 151 estudiantes universitarios de quinto año o superior de su respectiva carrera universitaria respondió a medidas de salud mental (DASS-21), de bienestar subjetivo (satisfacción con la vida y felicidad subjetiva), y del nivel de endeudamiento asumido para financiar sus estudios universitarios. Los análisis incluyeron regresiones lineales múltiples jerárquicas donde se incluyeron como variables independientes la variable género en un primer paso y el endeudamiento por créditos universitarios en el segundo paso. En cada regresión se incluyó un factor de salud mental y de bienestar subjetivo como variable dependiente. Resultados: Resultados indican que el endeudamiento por motivos de estudio predice significativa- mente satisfacción con la vida (F(2, 148) = 5,95, p = 0,003, R2Adjusted = 0,06; β =-0,16, p = 0,049), pero no predice felicidad subjetiva (p = n.s.) (factores de bienestar subjetivo), sintomatología depresiva (p = n.s.), ansiosa (p = n.s.), ni estrés (p = n.s.) (factores de salud mental). Conclusión: Resultados del estudio sugieren que los estudiantes universitarios pudieran percibir el endeudamiento estudiantil como una inversión hacia el futuro lo que pudiera operar como un factor protector de su salud mental y bienestar subjetivo.

Abstract Objective: To evaluate if debt due to university loans predicts mental health and subjective well-being in university students of Temuco, Chile. Method: A non-probabilistic sample of 151 last-year university students completed measures of mental health (DASS-21), of subjective well-being (satisfaction with life, and subjective happiness), and debt levels due to student loans. Analyses included hierarchical multiple linear regressions where gender was entered in a first step and debt due to university loans on a second step as independent variables. Each regression considered a factor of mental health or a factor of subjective well-being as the dependent variable. Results: Results show that debt due to university loans predict predicts satisfaction with life (F(2, 148) = 5,95, p = 0,003, R2Adjusted = 0,06; β =-0,16, p = 0,049), but not subjective happiness (p = n.s.) (factors of subjective well-being), nor symptoms of depression (p = n.s.), anxiety (p = n.s.), or stress (p = n.s.) (factors of mental health). Conclusion: Results of this study suggest that university students may perceive student debt as an investment which may act as a protective factor of their mental health and subjective well-being.

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Cattle productivity depends on our ability to fully understand and manipulate the fermentation process of plant material that occurs in the bovine rumen, which ultimately leads to the improvement of animal health and increased productivity with a reduction in environmental impact. An essential step in this direction is the phylogenetic and functional characterization of the microbial species composing the ruminal microbiota. To address this challenge, we separated a ruminal fluid sample by size and density using a sucrose density gradient. We used the full sample and the smallest fraction (5%), allowing the enrichment of bacteria, to assemble metagenome-assembled genomes (MAGs). We obtained a total of 16 bacterial genomes, 15 of these enriched in the smallest fraction of the gradient. According to the recently proposed Genome Taxonomy Database (GTDB) taxonomy, these MAGs belong to Bacteroidota, Firmicutes_A, Firmicutes, Proteobacteria, and Spirochaetota phyla. Fifteen MAGs were novel at the species level and four at the genus level. The functional characterization of these MAGs suggests differences from what is currently known from the genomic potential of well-characterized members from this complex environment. Species of the phyla Bacteroidota and Spirochaetota show the potential for hydrolysis of complex polysaccharides in the plant cell wall and toward the production of B-complex vitamins and protein degradation in the rumen. Conversely, the MAGs belonging to Firmicutes and Alphaproteobacteria showed a reduction in several metabolic pathways; however, they have genes for lactate fermentation and the presence of hydrolases and esterases related to chitin degradation. Our results demonstrate that the separation of the rumen microbial community by size and density reduced the complexity of the ruminal fluid sample and enriched some poorly characterized ruminal bacteria allowing exploration of their genomic potential and their functional role in the rumen ecosystem.

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The use of bacterial inoculants for ensiling based on lactic acid bacteria (LAB) to obtain conserved forages has become an alternative for the improvement of milk and meat productivity in cattle, specifically by optimizing the nutritional and microbial quality of animal feed. LAB inoculant production involves microbial and technological aspects such as biomass obtention, the use of cocultures, the inclusion of probiotics, the production of antimicrobial peptides, operational methods used in bioreactors, and the formulation of the end product to be commercialized to farmers. This review explores the technical aspects of the manufacture of bacterial inoculants, from the main features desired in LAB for ensiling purposes to the alternatives of the bioprocess involved.

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The American tropics are hotspots of wild and domesticated plant biodiversity, which is still underutilized by breeding programs despite being conserved at regional gene banks. The improvement of those programs depends on long-term public funds and the maintenance of specialized staff. Unfortunately, financial ups and downs complicate staff connectivity and their research impact. Between 2000 and 2010, Agrosavia (Corporación Colombiana de Investigación Agropecuaria) dramatically decreased its public financial support. In 2017, we surveyed all 52 researchers from Agrosavia involved in plant breeding and plant genetic resource programs to examine the effect of decimating funds in the last ten years. We hypothesized that the staff dedicated to plant breeding still suffer a strong fragmentation and low connectivity. As we expected, the social network among researchers is weak. The top ten central leaders are predominantly males with an M.Sc. degree but have significant experience in the area. The staff has experience in 31 tropical crops, and 17 are on the list of underutilized species. Moreover, although 26 of these crops are in the national germplasm bank, this has not been the primary source for their breeding programs. We proposed five principles to improve connectivity among teams and research impact: (1) The promotion of internal discussion about gender gaps and generation shifts to design indicators to monitor and decrease this disparity over time. (2) The construction of long-term initiatives and synergies with the Colombian government to support the local production of food security crops independent of market trends. (3) Better collaboration between the National Plant Germplasm Bank and plant breeding researchers. (4) A concerted priority list of species (especially those neglected or underutilized) and external institutions to better focus the collaborative efforts in research using public funds. (5) Better spaces for the design of projects among researchers and training programs in new technologies. These principles could also apply in other tropical countries with public plant breeding research programs facing similar challenges.

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The ruminal microbial community is an important element in health, nutrition, livestock productivity, and climate impact. Despite the historic and current efforts to characterize this microbial diversity, many of its members remain unidentified, making it challenging to associate microbial groups with functions. Here we present a low-cost methodology for rumen sample treatment that separates the microbial community based on cell size, allowing for the identification of subtle compositional changes. In brief, the sample is centrifuged through a series of sucrose density gradients, and cells migrate to their corresponding density fraction. From each fraction, DNA is extracted and 16S rRNA gene amplicons are sequenced. We tested our methodology on four animals under two different conditions, fasting, and post-feeding. Each fraction was examined by confocal microscopy showing that the same sucrose fraction consistently separated similar cell-sized microorganisms independent of the animal or treatment. Microbial composition analysis using metabarcoding showed that our methodology detected low abundance bacterial families and population changes between fasting and post-feeding treatments that could not be observed by bulk DNA analysis. In conclusion, the sucrose-based method is a powerful low-cost approximation to untwine, enrich, and potentially isolate uncharacterized members of the ruminal microbiome.

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Resumen Introducción y objetivo: Comunicar el primer informe del del registro nacional de dispositivos de estimulación cardíaca de agosto 2019 a agosto 2020, registro prospectivo de participación voluntaria. Métodos: Se analiza la información registrada, en forma voluntaria, por los centros implantadores con respecto a la población de pacientes a quienes se implantó un marcapaso, un desfibrilador o un resincronizador entre el 22 de agosto de 2019 hasta setiembre de 2020. Resultados: Se registraron un total de 317 procedimientos de marcapasos, por 10 centros implantadores, lo que corresponde a una participación en el registro de un 40%. La tasa de uso de marcapasos de 6,27 x 100 mil habitantes. Un 83% de los marcapasos fueron implantados en centros públicos, un 70% correspondió a dispositivos bicamerales. La edad media de la población fue de 73,7 años. La indicación más frecuente fue el trastorno de conducción AV (70,3%). Los electrodos de fijación activa fueron los más utilizados (97,8%). Un 83,3% de los sistemas implantados tuvieron compatibilidad con resonancia magnética. El uso de marcapasos unicamerales fue más frecuente en pacientes con 80 o más años. Con respecto a la terapia DAI se registraron un total de 63 procedimientos, por 5 centros implantadores, con una participación del 41%. La tasa total de implantes durante el período fue de 1,25 x 100 mil habitantes. La cardiomiopatía dilatada no isquémica fue la cardiopatía más frecuente en la población registrada. Conclusiones: El registro permite conocer la dinámica de procedimientos e indicaciones más usuales para el uso de dispositivos electrónicos cardíacos así como establecer la tasa de uso de las terapias en nuestro país. El porcentaje de participación en el registro puede mejorar. La implantación de dispositivos de estimulación cardíaca es financiada predominantemente por el sistema de seguridad social. La tasa de implantación es baja con respecto a otras regiones.

Abstract Costa Rican Registry of Resynchronizers, Automatic Defibrillators and Endovascular Pacemakers (RECORDAME). I Official Report of the Electrophysiology Commission of the Costa Rican Cardiology Association (2019-2020) Introduction and objective: To communicate the results of the first national registry of cardiac stimulation devices from August 2019 to August 2020. Methods: We analyze the information recorded prospectively, on a voluntary basis, by the implant centers with respect to the population of patients who were implanted with a pacemaker, a defibrillator or a resynchronizer between August 22, 2019 and September 2020. Results: A total of 317 pacemaker procedures were registered from 10 centers participated. Participation was 40% of total procedures reported by companies. The pacemaker implantation rate was 6.27 per hundred thousand. A 83% of pacemakers were implanted in public centers, 70% corresponded to dual chamber devices. Mean age of the population was 73.7 years. Most frequent indication was AV conduction disorder (70.3%). Active fixation electrodes were the most used (97.8%). A 83.3% were MRI conditional. Use of single chamber pacemakers was more frequent in patients aged 80 years or older. Regarding ICD therapy, a total of 63 procedures were registered. from 5 centers, with a participation of 41%. Rate of ICD use was 1.25 per hundred thousand. Non-ischemic dilated cardiomyopathy was the most common heart disease in the recorded population. Conclusions: The registry allowed to know the frequency of procedures and more usual indications as well as to establish the rate of use of therapies in our country. The percentage of participation in the registration can be improved. The implementation of cardiac stimulation devices is predominantly financed by the social security system. The implantation rate is low compared to other regions.

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Traditionally, starting inoculants have been applied to improve ensiling of forage used for livestock feed. Here, we aimed to build up a bioinoculant composed of lactic acid-producing and lignocellulolytic bacteria (LB) derived from the Megathyrsus maximus (guinea grass) phyllosphere. For this, the dilution-to-stimulation approach was used, including a sequential modification of the starting culture medium [Man, Rogosa, and Sharpe (MRS) broth] by addition of plant biomass (PB) and elimination of labile carbon sources. Along 10 growth-dilution steps (T1-T10), slight differences were observed in terms of bacterial diversity and composition. After the sixth subculture, the consortium started to degrade PB, decreasing its growth rate. The co-existence of Enterobacteriales (fast growers and highly abundance), Actinomycetales, Bacillales, and Lactobacillales species was observed at the end of the selection process. However, a significant structural change was noticed when the mixed consortium was cultivated in higher volume (500ml) for 8days, mainly increasing the proportion of Paenibacillaceae populations. Interestingly, Actinomycetales, Bacillales, and Lactobacillales respond positively to a pH decrease (4-5), suggesting a relevant role within a further silage process. Moreover, gene-centric metagenomic analysis showed an increase of (hemi)cellulose-degrading enzymes (HDEs) during the enrichment strategy. Reconstruction of metagenome-assembled genomes (MAGs) revealed that Paenibacillus, Cellulosimicrobium, and Sphingomonas appear as key (hemi)cellulolytic members (harboring endo-glucanases/xylanases, arabinofuranosidases, and esterases), whereas Enterococcus and Cellulosimicrobium have the potential to degrade oligosaccharides, metabolize xylose and might produce lactic acid through the phosphoketolase (PK) pathway. Based on this evidence, we conclude that our innovative top-down strategy enriched a unique bacterial consortium that could be useful in biotechnological applications, including the development/design of a synthetic bioinoculant to improve silage processes.

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Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.

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Introducción. La estimulación apical del ventrículo derecho (VD) produce un patrón de activación similar al bloqueo de rama izquierda, el cual retrasa la activación de la pared lateral del ventrículo izquierdo. El "índice de disincronía" (ID) correlaciona las derivadas DII y V6 como marcadores de la despolarización septal y lateral; en el presente reporte, se utilizó el ID para el implante del electrodo ventricular en la región "parahisiana". Métodos. Se incluyeron 6 pacientes a quienes se realizó un implante electivo de marcapasos bicameral, bajo indicaciones convencionales. En cada paciente se registró un electrocardiograma de 12 derivaciones en reposo, bajo estimulación apical en el (VD) y bajo estimulación septal "parahisiana"; en cada uno se obtuvo el ID. Resultados. Se analizaron 18 electrocardiogramas de 6 pacientes, edad promedio 72±16.7 años (48-91) 2 mujeres; en 4, la indicación del implante fue bloqueo atrioventricular completo y en 2, enfermedad del nodo sinusal. En todos los pacientes se observó mejoría del ID con estimulación parahisiana, con respecto al ápex del VD y en la mayoría también con respecto al ritmo de base. No se observó correlación entre la duración del complejo QRS y el ID. Conclusión. El uso del ID utilizando las derivaciones II/V6 permite valorar la disincronía eléctrica, en forma sencilla, no invasiva y en tiempo real.

Introduction. Right ventricle (RV) apical stimulation produces an activation pattern similar to the left bundle Branch block, which delays the lateral wall of the left ventricle activation. The "dyssynchrony index" (ID) correlates DII and V6 leads as surrogate markers of septal and lateral depolarization; in this report, the ID for the ventricular electrode implantin the "parahisian" region was used. Methods. Six patients were included who underwent an elective dual chamber pacemaker implant, under conventional indications. In each patient, a 12-lead electrocardiogram was recorded at rest, under RV apical stimulation and under "parahisian" septal stimulation; in each one, the ID was obtained. Results. Eighteen electrocardiograms of 6 patients were analysed, average age 72 ± 16.7 years (48-91) 2 women; in 4, the indication of the implant was complete atrioventricular block and in 2, sinus node disease. In all patients, improvement of the ID with parahisian stimulation was observed, with respect to the RV apex, and in most of them, also with respect to the base rhythm. No correlation was observed between the QRS complex duration and the ID. Conclusión The use of the ID using leads II/V6 allows the evaluation of electrical dyssynchrony, in a simple, non-invasive way and in real time.

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Resumen Se presenta el caso de una paciente portadora de una miocardiopatía dilatada y marcapasos epicárdico unicameral im plantado por bloqueo atrioventricular completo, quien respondió favorablemente a la terapia de resincronización cardia ca; durante el seguimiento, requirió el implante de un nuevo electrodo del ventrículo izquierdo, el cual fue implantado a través de una vena posterior.

Abstract Dysautonomia and Chagas disease We present the case of a patient with a congenital dilated myocardiopathy and a single-chamber epicardic pacemaker, implanted by a complete atrioventricular block, who had a favorable response to cardiac resinchronisation therapy; during follow-up, she required a new left ventricle electrode which was implanted through a left posterior vein.

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Resumen La terapia de ablación con catéter de arritmias cardiacas ha revolucionado el manejo de estos padecimientos en las úl timas décadas. La fibrilación atrial, que es una de las arritmias más frecuentes también ha sido susceptible a este tipo de abordaje. La complejidad de sus mecanismos y diferentes formas de manifestación ha hecho que las técnicas para realizar la ablación hayan requerido de un perfeccionamiento progresivo. También la selección de los pacientes que ten drán mayor beneficio del procedimiento lo tenemos más claro hoy en día. En el presente artículo se hace una revisión de estos aspectos y los resultados de los últimos estudios que sustentan las guías actuales para su manejo con esta forma de tratamiento.

Abstract Clinical application of catheter ablation for the treatment of Atrial Fibrillation Cardiac catheter ablation therapy has revolutionized the management of these conditions in the latest decades. Atrial fibrillation, which is one of the most frequent arrhythmias, has also been susceptible to this type of approach. The complexity of its mechanisms and different forms of manifestation has made the techniques to perform the ablation necessary for a progressive improvement. Also the selection of the patients that will have greater benefit of the procedure it is clearer nowadays. In this article we present a review of these aspects and the results of the latest studies that support the current guidelines for their management with this form of treatment.

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Propósito: a la fecha sigue sin haber pruebas en cuanto a los resultados del uso de dispositivos para arritmias ventriculares en pacientes añosos, y menos aun para indicaciones de prevención primaria. La finalidad del estudio fue describir la evolución en términos de la eficacia y seguridad de la terapia con cardiodesfibriladores implantables (CDI) en una gran cohorte de pacientes añosos. Métodos y resultados: estudio multicéntrico retrospectivo realizado en 15 hospitales españoles. Se incluyeron pacientes consecutivos referidos para implante de CDI antes de 2011. Se consideró que 162 de los 1.174 pacientes (13,8%) con 75 años o más eran “añosos”. Comparado con aquellos pacientes <75 años, este subgrupo presentaba más comorbilidades como hipertensión, enfermedad pulmonar obstructiva crónica y falla renal, y más internaciones previas debido a insuficiencia cardíaca (IC). A lo largo de una media de seguimiento de 104,4 ± 3,3 meses, fallecieron 162 pacientes (14%), 120 de los más jóvenes (12,4%) y 42 (24,4%) de los añosos. El análisis de Kaplan-Meier mostró un aumento de la probabilidad de morir con el aumento de la edad (17, 24, 28, y 69% a los 12, 24, 48, y 60 meses de seguimiento en el grupo de pacientes añosos). No hubo diferencias entre la tasa de intervenciones con CDI apropiadas o inapropiadas. Conclusión: en el mundo real, los pacientes añosos constituyen ~15% de los implantes de CDI para prevención primaria de la muerte súbita cardíaca (MSC). Si bien la tasa de terapias apropiadas es similar en los diferentes grupos, el beneficio de CDI se ve atenuado por un mayor aumento del riesgo de mortalidad entre los pacientes que son mayores de 75 años al momento del implante.

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INTRODUCTION: Little is known about the prevalence of electrical storm, baseline characteristics and mortality implications of patients with implantable cardioverter defibrillator in primary prevention versus those patients without electrical storm. We sought to assess the prevalence, baseline risk profile and survival significance of electrical storm in patients with implantable defibrillator for primary prevention. METHODS: Retrospective multicenter study performed in 15 Spanish hospitals. Consecutives patients referred for desfibrillator implantation, with or without left ventricular lead (at least those performed in 2010 and 2011), were included. RESULTS: Over all 1,174 patients, 34 (2,9%) presented an electrical storm, mainly due to ventricular tachycardia (82.4%). There were no significant baseline differences between groups, with similar punctuation in the mortality risk scores (SHOCKED, MADIT and FADES). A clear trigger was identified in 47% of the events. During the study period (38±21 months), long-term total mortality (58.8% versus 14.4%, p<0.001) and cardiac mortality (52.9% versus 8.6%, p<0.001) were both increased among electrical storm patients. Rate of inappropriate desfibrillator intervention was also higher (14.7 versus 8.6%, p<0.001). CONCLUSIONS: In the present study of patients with desfibrillator implantation for primary prevention, prevalence of electrical storm was 2.9%. There were no baseline differences in the cardiovascular risk profile versus those without electrical storm. However, all cause mortality and cardiovascular mortality was increased in these patients versus control desfibrillator patients without electrical storm, as was the rate of inappropriate desfibrillator intervention.

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Hasta los años 70 la obstrucción biliar fue tratada con derivaciones biliodigestivas. El abordaje percutáneo se ha venido utilizando con fi nes diagnósticos y terapéuticos cada vez más prometedores. Los métodos combinados que utilizan endoscopia (Rendezvous) pueden realizarse vía transparietohepática, eco endoscópica, laparoscopica o transKehr. Objetivo: Evaluar el abordaje de la vía biliar a través de la combinación de la técnica endoscópica y transkehr (Rendezvous). Métodos: Se evaluaron pacientes entre enero 2004 y febrero 2012 a quienes se les realizó colecistectomía más coledocotomía y colocación de tubo de Kehr, y con deformidad postquirúrgica, canulación difícil y dificultad del paso del contraste a duodeno vía transkehr que imposibilitan la colangiografía retrógrada endoscópica. Resultados: De 1146 colangiografías retrógrada endoscópicas, 12 (1.04%) fueron realizadas en pacientes que cumplían los criterios de inclusión. 75% del sexo femenino. La etiología más frecuente fue la colédocolitiasis (83.3%) y 16.7% estenosis de papila. En todos los pacientes el drenaje biliar fue exitoso. No hubo complicaciones ni mortalidad asociada al procedimiento. Conclusiones: El procedimiento combinado endoscópico-transKehr es efectivo, sencillo y seguro en el abordaje biliar alternativo cuando fracasa o no es posible la técnica convencional, asociado a menor trauma papilar y menos incidencia de pancreatitis.

Until the 1970s, biliary obstruction was resolved surgically. Percutaneous approach has been used for diagnostic and therapeutic purposes with more and more promising results. Combined methods using endoscopy (Rendezvous) can be made via transparietohepatic, endoscopic ultrasound, laparoscopic, or transKehr. Objective: Evaluate the approach of the biliary tract through the combination of the endoscopic technique and transkehr (Rendezvous). Methods: Evaluated patients between January 2004 and February 2012 those who underwent both cholecystectomy more coledocotomy combined with Kehr tube placement, because of postoperative deformity, difficult cannulation or difficulty of the passage from the contrast to duodenum through transkehr tube, that therefore preclude cholangiography retrograde endoscopic. Results: from 1146 retrograde cholangiography endoscopic, 12 (1.04%) were performed in patients who fulfilled the inclusion criteria. 75% were female. The most frequent etiology was choledocholithiasis (83.3%) and stenosis of duodenal papilla 16.7%. Biliary drainage was successful in all patients. There were no complications or mortality associated with the procedure. Conclusions: The combined procedure endoscopic-transKehr is effective, simple and secure alternative biliary approach when it fails or is not possible the conventional technique, associated with minor trauma papillary and less incidence of pancreatitis.

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Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales características epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital "Dr. Rafael Angel Calderón Guardia" entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 a 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes). Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 +0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes), de las cuales 94 fueron apropiadas (en 5 pacientes) y 7 inapropiadas (en 3 pacientes); dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia...

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The present document reviews various aspects of the current status of cardiac resynchronization therapy: mechanisms of action, current indications and implantation technique.

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Se revisa el estado actual de la terapia de resincronización cardiaca en sus diferentes aspectos: mecanismos de acción, indicaciones actuales y técnica de implante.

The present document reviews various aspects of the current status of cardiac resynchronization therapy: mechanisms of action, current indications and implantation technique.

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Introducción. Las estenosis benignas de las anastomosis posteriores a la cirugía colorectal se presentan en un 8 a 30% de los casos. La dilatación con balón es hoy en día el tratamiento de elección por ser eficaz y seguro. Diversas técnicas de dilatación están disponibles actualmente, presentamos aquí nuestra experiencia con balón de dilatación hidrostático TTS de 20 mm y su seguimiento a corto y largo plazo. Pacientes y métodos. Siete pacientes que se presentaron con obstrucción intestinal (total o parcial) por estenosis benigna de la anastomosis colorectal fueron seleccionados y se les realizó protocolo de dilatación con balón hidrostático TTS de 20 mm (90 psi/6 Atm). A todos se les realizó una sesión de dilatación y seguimiento clínico (hasta 67 meses). Resultados. La dilatación fue exitosa en todos los pacientes, encontrándose asintomáticos en el seguimiento a corto y largo plazo. Uno de los pacientes presentó fuga de la anastomosis temprana y requirió dos sesiones de dilatación con balón hidrostático, posteriormente una sesión de dilatación con balón neumático por presentar reestenosis. No se observaron complicaciones en la muestra estudiada. Conclusiones. La dilatación con balón hidrostático TTS es segura y efectiva en el tratamiento de las estenosis benignas de las anastomosis colorectales.

Background. Benign stenosis of the posterior anastomoses after colorectal surgery appears in 8 to 30% of the cases. Balloon dilatation is the current standard of treatment given it effectiveness and safety. Several dilatation techniques are available at the moment; we present here our experience with TTS hydrostatic dilatation balloon of 20 mm. and its short and long term follow up. Patients and Methods. Seven patients who presented with intestinal obstruction (total or partial) by benign stenosis of the colorectal anastomoses were selected and dilatation with of 20 mm hydrostatic TTS balloon under our protocol was performed. (90 PSI/6 ATM). All received one session and follow up was made to them (up to 67 months). Results. Balloon dilatation was successful in all the patients, remaining asymptomatic in short and long term follow up. One of the patients in whom an anastomotic leak appeared early after the surgery required two sessions of hydrostatic balloon dilatation and one session of pneumatic balloon dilatation because of recurrent stenosis. No complications were observed in the studied sample. Conclusions. TTS hydrostatic balloon dilatation is safe and effective in the treatment of benign stenosis of the anastomoses after colorectal surgery.