RESUMO

BACKGROUND: The aging population prompts studying risk factors and markers to predict healthy aging. Telomere length is a promising candidate for assessing various age-related traits. AIM OF THE STUDY: To investigate the association between physical performance and telomere length. METHODS: We enrolled 323 older Mexican adults from the "Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults" affiliated with the Instituto Mexicano del Seguro Social and assessed their physical performance using the Short Physical Performance Battery, dividing participants into low (≤7) and high (>7) groups. Absolute telomere length was determined by qPCR, and individuals were classified into short (≤4.22 kb) and long (>4.22 kb) groups. We calculated the mean and adjusted mean, considering sex and age, among others, with 95% CI. We estimated the effect size between physical performance and telomere length using Cohen's d for unequal group sizes and calculated the odds ratio for physical performance based on telomere length. RESULTS: Participants with low physical performance had significantly shorter telomeres (mean 4.14.44.7 kb, adjusted mean 3.54.04.5 kb, p <0.001), while those with high physical performance exhibited longer telomeres (mean 5.55.75.9 kb, adjusted mean 4.75.35.8 kb, p <0.001), with a medium-to-high telomere length effect size (d = 0.762). The odds of low physical activity increased 2.13.66.1-fold per kb of telomere attrition (adjOR 1.73.36.3, p <0.001). CONCLUSION: Decreased physical function is associated with shorter telomere length. Absolute telomere length presents a promising biomarker for distinguishing between healthy and unhealthy aging, warranting further investigation.

Assuntos

RESUMO

BACKGROUND: Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. METHODS: We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. RESULTS: We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. CONCLUSIONS: Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.

The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health ­ schizophrenia, bipolar disorder, and major depressive disorder ­ by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.

RESUMO

PURPOSE: The management of depressed skull fractures in infants can be either conservative or surgical. This study aimed to examine the outcomes of management with a negative-pressure vacuum device on depressed skull fractures in newborns. METHODS: Twenty-eight patients (aged 1-6 days) with simple depressed skull fractures underwent skull elevation using negative-pressure vacuum devices. A protocol for nonsurgical management was adopted for infants with such fractures between 2010 and 2023. All patients were initially evaluated with neurological examination and complementary assessments-hematological and coagulation studies, transfontanel transcranial ultrasound, skull radiography, and computed tomography scanning with three-dimensional reconstruction-according to availability and clinical needs. Gentle (negative) extraction pressure was applied with one of several devices (according to institutional availability) for a maximum duration of 60 s; this was performed as soon as possible after diagnosis, preferably within 72 h. Follow-up data, available in the clinical records, were reported. RESULTS: All patients exhibited satisfactory elevation of the depressed bone without associated injuries, except one patient who presented with an associated cephalohematoma which prevented optimal device coupling to generate sufficient vacuum pressure for correction. Neither neurological deficits nor development of epilepsy was noted; normal neurological assessment and oral alimentation tolerance were confirmed within 24 h post procedure. CONCLUSIONS: According to our data, ping-pong skull fracture elevation using the vacuum method is a safe and satisfactory treatment in the neonatal period. Early treatment allows for quick resolution, and in our opinion is the strategy of choice for depressed skull fractures in newborns.

Assuntos

RESUMO

Bipolar Disorder (BD) is a severe and chronic disorder characterized by recurrent episodes of depression, mania, and/or hypomania. Most BD patients initially present with depressive symptoms, resulting in a delayed diagnosis of BD and poor clinical outcomes. This study leverages electronic health record (EHR) data from the Clínica San Juan de Dios Manizales in Colombia to identify features predictive of the transition from Major Depressive Disorder (MDD) to BD. Analyzing EHR data from 13,607 patients diagnosed with MDD over 15 years, we identified 1,610 cases of conversion to BD. Using a multivariate Cox regression model, we identified severity of the initial MDD episode, the presence of psychosis and hospitalization at first episode, family history of mood or psychotic disorders, female gender to be predictive of the conversion to BD. Additionally, we observed associations with medication classes (prescriptions of mood stabilizers, antipsychotics, and antidepressants) and clinical features (delusions, suicide attempt, suicidal ideation, use of marijuana and alcohol use/abuse) derived from natural language processing (NLP) of clinical notes. Together, these risk factors predicted BD conversion within five years of the initial MDD diagnosis, with a recall of 72% and a precision of 38%. Our study confirms many previously identified risk factors identified through registry-based studies (such as female gender and psychotic depression at the index MDD episode), and identifies novel ones (specifically, suicidal ideation and suicide attempt extracted from clinical notes). These results simultaneously demonstrate the validity of using EHR data for predicting BD conversion as well as underscore its potential for the identification of novel risk factors and improving early diagnosis.

RESUMO

This study aimed to determine the possible association between disc displacement (DD) disorders and malocclusion complexity. This cross-sectional study was carried out using a case-control design. The Research Diagnosis Criteria for Temporomandibular Disorders were used to identify cases and controls. The Index of Complexity, Outcome, and Need (ICON) was used to quantify malocclusion complexity as easy, mild, moderate, difficult, or very difficult. A total of 310 subjects were included: 130 cases and 180 controls. A binary logistic regression (p < 0.05) was used to identify associations. The odds ratio (OR) was also calculated. DD was associated with sex, age, and malocclusion complexity (p < 0.05). The malocclusion complexity comparison showed that 89.3% of the controls fell within the easy-moderate levels of the ICON, whereas 85.4% of the cases were in the moderate-very difficult levels (p ≤ 0.001). Difficult and very difficult malocclusions had high ORs (9.801 and 9.689, respectively) compared to the easy cases. In conclusion, patients with malocclusion complexity levels classified as difficult or very difficult have greater odds of presenting DD.

RESUMO

Hereditary spastic paraplegias (HSPs) are a group of neurodegenerative disorders characterized by progressive dysfunction of corticospinal motor neurons. Mutations in Atlastin1/Spg3, a small GTPase required for membrane fusion in the endoplasmic reticulum, are responsible for 10% of HSPs. Patients with the same Atlastin1/Spg3 mutation present high variability in age at onset and severity, suggesting a fundamental role of the environment and genetic background. Here, we used a Drosophila model of HSPs to identify genetic modifiers of decreased locomotion associated with atlastin knockdown in motor neurons. First, we screened for genomic regions that modify the climbing performance or viability of flies expressing atl RNAi in motor neurons. We tested 364 deficiencies spanning chromosomes two and three and found 35 enhancer and four suppressor regions of the climbing phenotype. We found that candidate genomic regions can also rescue atlastin effects at synapse morphology, suggesting a role in developing or maintaining the neuromuscular junction. Motor neuron-specific knockdown of 84 genes spanning candidate regions of the second chromosome identified 48 genes required for climbing behavior in motor neurons and 7 for viability, mapping to 11 modifier regions. We found that atl interacts genetically with Su(z)2, a component of the Polycomb repressive complex 1, suggesting that epigenetic regulation plays a role in the variability of HSP-like phenotypes caused by atl alleles. Our results identify new candidate genes and epigenetic regulation as a mechanism modifying neuronal atl pathogenic phenotypes, providing new targets for clinical studies.

Assuntos

RESUMO

BACKGROUND: Fibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. OBJECTIVE: To evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. PATIENTS AND METHODS: All adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: "I am going to take your blood pressure; tell me if the cuff's pressure causes pain". Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated "did it hurt much or little". Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. RESULTS: Four hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having "much" local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. CONCLUSIONS: Inquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.

Assuntos

RESUMO

The objective of this study was to determine the experience of tooth loss and associated factors in older adults and elderly residing in nursing homes. A cross-sectional study was conducted in Mexican older adults and elderly aged ≥60 years living in four nursing homes (two in Mexico City, Mexico: one in Cuernavaca, Morelos, and one in Oaxaca, Oaxaca). The data were collected at the facility (home nursing) by two dentists in 2019. To determine the number of tooth loss and DMFT, a clinical oral examination was performed. In addition, a questionnaire was applied to determine diverse independent variables (demographic, socioeconomic, and behavioral). The analysis was performed using nonparametric tests and negative binomial regression (p < 0.05). 257 subjects were included. The mean age was 81.25 ± 9.02 years, and 60.7% were women. The mean number of lost teeth was 18.78 ± 9.05 (women = 19.43 ± 8.59 and men = 17.77 ± 9.68; p > 0.05). In the multivariate negative binomial regression model, it was found that, for each one-year increase in age, the mean tooth loss increased 0.92% (p < 0.05). In current smokers (p < 0.01) and in those who brush their teeth < 2 times a day (p < 0.01), the average of tooth loss increased 22.04% and 61.46%, respectively. The experience of tooth loss in Mexican older adults and elderly was high. Demographic (age) and habit of behavior (tobacco use and less frequent tooth brushing) were associated with increased tooth loss. It is important to promote oral health programs for institutionalized older adults.

Assuntos

RESUMO

OBJECTIVE: To describe trends in cases and prevalence at birth rates of cleft lip and/or palate (CL/P) in Mexico between 2003 and 2019. DESIGN: Ecological study. SETTING: Multiple data sources systematically collected into a national epidemiological surveillance data warehouse. PARTICIPANTS: National Live Birth Information System. MAIN OUTCOME MEASURE(S): Both cases and prevalence at birth rates of CL/P in Mexico within a 17-year period were used as dependent variables. RESULTS: At the national level there were 23 184 new cases of CL/P (average of 1364 per year) in the 32 states of Mexico, with an average prevalence at birth rate of 0.53 per 1000 live births. The states with the highest prevalence at birth rates of CL/P during the period were Hidalgo (1.59) and Jalisco (1.32), while the states with the lowest rates were Nayarit (0.22) and Durango (0.29). A slight decrease in both cases (z = -2.41, P = .016) and prevalence at birth rates (z = -2.58, P = .010) of CL/P was observed at the national level. States such as Durango, Puebla, Chiapas, Guerrero, Oaxaca, Mexico City, State of Mexico, Coahuila and Jalisco showed a clear downward trend (P < .05) in their prevalence at birth of CL/P between 2003 and 2019, while in Hidalgo its trend was upward (P = .05). Significant differences by sex and region were observed (P < .05). CONCLUSION: Some states consistently had the highest or lowest prevalence of CL/P. Decreasing trends in the overall prevalence at birth rates were observed. More detailed, epidemiological studies are necessary to adequately characterize CL/P in the Mexican population.

Assuntos

RESUMO

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.

Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal

Assuntos

RESUMO

We report a new surgical method in 10 patients who underwent hybrid laparo-endoscopic resection (HLER) of submucosal tumors with the combination of flexible articulated laparoscopic instruments (FALI). We have assessed technical reproducibility, safety, and morbidity. Resection was completed in all cases. Mean surgical time was 60 min (30-85). Median tumor size was 16 mm (12-30). The more frequent location was the gastroesophageal junction. No complications were observed during the procedure. Length of stay was 1 day in all cases. We have found HLER to be a safe procedure allowing margin resection and organ preservation. The addition of FALI added ease of performance in hard-to-reach tumor locations.

Assuntos

RESUMO

Resumen La obesidad ha aumentado en proporciones epidémicas en el mundo y cada vez es mayor su asociación con otras condiciones como la hipertensión, la apnea obstructiva del sueño y la diabetes mellitus. De acuerdo con los efectos adversos que tiene la obesidad sobre la estructura, función y hemodinámica cardiovascular, no es sorprendente que en el contexto de obesidad, la mayoría de enfermedades cardiovasculares aumenten su frecuencia, incluida la hipertensión, la enfermedad coronaria y la insuficiencia cardíaca, adicional al incremento significativo del riesgo de presentar fibrilación auricular de novo y su recurrencia. Factores cardíacos estructurales y, probablemente, cardiometabólicos explican gran parte de este efecto. Se realizó una búsqueda de artículos y estudios científicos en bases de datos (PubMed, Medline, EMBASE), y concluyó que la obesidad contribuye en gran parte al riesgo de fibrilación auricular. La literatura proporciona evidencia sólida a favor de incorporar el ejercicio como una estrategia complementaria para el manejo de la fibrilación auricular, demostrando que niveles más altos de actividad física dentro del rango óptimo pueden ser beneficiosos.

Abstract Obesity has increased in epidemic proportions worldwide and is increasingly associated with other conditions such as hypertension, obstructive sleep apnea and diabetes. Considering the adverse effects that obesity has on cardiovascular hemodynamicsm structure and function, it is not surprising that in the context of obesity most cardiovascular diseases increase in frequency, including hypertension, coronary artery disease and heart failure, in addition to the significant increase in the risk of de novo atrial fibrillation and its recurrence. Structural cardiac factors, and probably cardiometabolic factors, account for much of this effect. A search for articles and scientific studies in databases (PubMed, Medline, EMBASE) was carried out, concluding that obesity contributes significantly to the risk of atrial fibrillation. The literature provides solid evidence in favor of incorporating exercise as a complementary strategy for atrial fibrillation management, demonstrating that higher levels of physical activity within the optimal range can be beneficial.

RESUMO

This study's objective was to compare the total and outside the cleft prevalence of dental anomalies (DA) between patients with cleft lip and palate (CLP) and a control group. This retrospective cross-sectional study was done under a case-control design. The case group consisted of 192 non-syndromic patients with complete CLP, while the control group included 411 patients. All subjects had orthopantomography, intra, and extraoral photographs. The prevalence of dental agenesis, supernumerary teeth, impacted teeth, dental transposition, and microdontia were compared using a chi-squared test (P < .05). Next, a second test was made, but only the anomalies outside the cleft were considered for this study. Total prevalence was 89.1% for cases, and 20.9% for controls (P < .01). The prevalence of each DA was significantly higher for the case group. In the analysis of DAs outside the cleft, the total prevalence was still significantly associated (P < .01); however, only dental agenesis was statistically significant (P < .01). Further analysis found that a high rate of upper premolar absence (P < .01) could explain this event. Patients with CLP have a higher prevalence of DAs compared to controls. After considering only the DAs outside the cleft, the total prevalence remains significantly higher. However, this phenomenon is explained mainly by the elevated prevalence of upper premolars' agenesis. This study's results suggest that environmental factors are behind the high prevalence of DAs in subjects with CLP.

Assuntos

RESUMO

Resumen La derivada aVR es frecuentemente olvidada al interpretar un electrocardiograma. Esto se explica en gran medida debido a que no aporta información específica sobre el ventrículo izquierdo. Sin embargo, tiene gran utilidad en términos tanto de diagnóstico como de pronóstico en múltiples condiciones clínicas, como el síndrome coronario agudo, la pericarditis, la disección aórtica, la intoxicación por antidepresivos tricíclicos, las arritmias y múltiples trastornos de la conducción cardiaca. El objetivo de este artículo es resaltar la importancia clínica de esta derivada y así incentivar su evaluación sistemática en la práctica clínica.

Abstract aVR lead is a frequently forgotten derivative when interpreting an electrocardiogram. This may be largely explained by the fact that it does not provide specific information on the left ventricle. However, it is very useful in terms of both, diagnosis and prognosis, of different clinical entities such as acute coronary syndrome, pericarditis, aortic dissection, tricyclic antidepressants intoxication, arrhythmias and multiple cardiac conduction disorders. The main purpose of this article is to highlight the clinical importance of aVR lead and thus encourage its use in clinical practice.

RESUMO

Background: This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity. Methods: A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (n = 76, group A) and subjects with mouth-opening limitation (group B, n = 20). Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables. Results: Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain. Conclusions: Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain.

Assuntos

RESUMO

ABSTRACT Introduction: Catamenial epilepsy refers to the worsening or exacerbation of seizures due to hormonal changes during the menstrual cycle. It is thought to be secondary to the neuroactive properties of endogenous steroid hormones and the natural cyclic variation in their serum levels throughout the menstrual cycle. Case presentation: A 31-year-old female patient from Bogotá (Colombia) was admitted to the emergency department due to an episode of tonic-clonic seizure associated with the menstrual period. Since the onset of the seizures was related to menstruation (every 28 days), it was established that the patient had structural focal epilepsy with catamenial features. Advantages of medical vs. surgical treatment were discussed during a multidisciplinary medical board and it was decided to start pharmacological treatment with progestogens, which resulted in complete remission of the seizures as established during a follow-up visit. Conclusions: Catamenial epilepsy should be considered as a cause of epilepsy refractory to antiepileptic medications. Furthermore, it should be approached from a multidisciplinary perspective and its management should be focused on improving the patients' quality of life.

RESUMEN Introducción. La epilepsia catamenial se define como un empeoramiento o la exacerbación de las crisis epilépticas en relación con el cambio hormonal durante el ciclo menstrual femenino. Se cree que esta se produce por las propiedades neuroactivas de las hormonas esteroides endógenas y la variación cíclica natural en sus niveles séricos a lo largo de dicho ciclo. Presentación del caso. Mujer de 31 años de Bogotá (Colombia), quien fue llevada al servicio de urgencias por un episodio de crisis epiléptica con convulsiones tonicoclónicas asociado al período menstrual. Debido a que la aparición de las crisis epilépticas se asociaba con la menstruación (cada 28 días), se estableció que la paciente presentaba epilepsia focal estructural de características catameniales. En junta médica multidisciplinar se discutieron las ventajas del manejo médico y el manejo quirúrgico, y se decidió instaurar tratamiento farmacológico con progestágenos, el cual, tras seguimiento, evidenció supresión total de las crisis. Conclusiones. La epilepsia catamenial debe considerarse como una causa de epilepsia refractaria al tratamiento antiepiléptico. Además, su abordaje debe ser multidisciplinario y su tratamiento debe ir enfocado a mejorar la calidad de vida de los pacientes.

RESUMO

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

RESUMO

Resumen La fibrilación auricular es la arritmia más prevalente en la práctica clínica, y se asocia con una morbimortalidad significativa, la cual, en parte, se explica por el riesgo de fenómenos embólicos. En la actualidad, el uso de anticoagulantes es el estándar de manejo en aquellos pacientes con riesgo embólico significativo (dado por un puntaje ≥ 2 en la escala CHA2DS2Vasc). Sin embargo, algunos pacientes tienen contraindicaciones que impiden recibir este tipo de tratamiento a largo plazo, en cuyo caso se considera el cierre percutáneo de la orejuela como medida para la disminución del riesgo de embolia. Al requerir una punción transeptal, la presencia de dispositivos de cierre de defectos del septo interauricular dificulta el procedimiento de manera significativa. Se presenta el caso de una paciente con contraindicación absoluta para recibir anticoagulantes debido a sangrado gastrointestinal y antecedente de cierre percutáneo de comunicación interauricular sometida a cierre percutáneo de orejuela como alternativa terapéutica a la anticoagulación.

Abstract Atrial fibrillation is the most prevalent arrythmia in clinical practice, associated with a significant morbimortality explained, in part, by the high risk of embolic phenomena. The use of anticoagulation is the standard of care in those patients with increased embolic risk (given by a score ≥ 2 in the CHA2DS2Vasc scale). However, some patients have contraindications to receiving this treatment long-term, in which case percutaneous left atrial appendage occlusion can be considered as a means of decreasing their embolic risk. Because the procedure requires transeptal puncture, the presence of devices for atrial septal defect closure can difficult the technique. We present the case of a patient with absolute contraindication to anticoagulation therapy given gastrointestinal bleeding, with history of percutaneous closure of interauricular communication, who was treated with percutaneous left atrial appendage occlusion as an alternative to oral anticoagulants.

RESUMO

Resumen Objetivo: Describir las características demográficas, ecocardiográficas y angiográficas, así como la presentación clínica, los hábitos, los antecedentes y los desenlaces de pacientes menores de 50 años atendidos por síndrome coronario agudo (SCA). Método: Estudio observacional, retrospectivo y descriptivo, con análisis univariado y bivariado, que incluyó información de pacientes atendidos en una clínica de tercer nivel de la ciudad de Medellín, Colombia. Resultados y conclusiones: Se identificaron 127 casos, de los que el 79.5% eran hombres y el tipo de SCA más frecuente fue el infarto agudo de miocardio (IAM) no ST (43%), seguido por el IAM ST (23%). Los factores de riesgo más prevalentes fueron el sobrepeso, la obesidad y las alteraciones del perfil lipídico (triglicéridos elevados y colesterol ligado a lipoproteínas de alta densidad bajo). Se encontró baja prevalencia en tabaquismo y diabetes mellitus. El 78% de los casos tenían una fracción de eyección del ventrículo izquierdo preservada, con presencia de trastornos segmentarios en la ecocardiografía basal en un 55%. El 20% tenían enfermedad coronaria grave de tres o más vasos. La coronaria más comprometida fue la arteria descendente anterior (58.2%). Las escalas de riesgo GRACE, Killip-Kimball y TIMI clasificaron a los pacientes en bajo riesgo, siendo congruentes con los pacientes estudiados intrahospitalariamente, pues se encontró una mortalidad del 0%; sin embargo, debe primar el criterio clínico al tomar decisiones sobre el método de estratificación y el ámbito hospitalario o ambulatorio. Se plantea la necesidad de establecer protocolos para una evaluación funcional y estructural de la microcirculación coronaria en pacientes con cuadro clínico sugestivo, electrocardiograma y pruebas de inducción de isquemia positivas a pesar de tener coronariografía sin lesiones epicárdicas.

Abstract Objective: To describe the demographic, echocardiographic, angiographic characteristics, clinical presentation, habits, history, and outcomes of patients younger than 50 years attended for acute coronary syndrome (ACS). Method: An observational, retrospective and descriptive study was performed, with univariate and bivariate analysis that included information of patients treated at a third level clinic in Medellín, Colombia. Results and conclusions: 127 cases were identified where 79.5% were men and the most frequent type of ACS was NSTEMI (43%) followed by STEMI (23%). The most prevalent risk factors were overweight, obesity, and changes in the lipid profile (high triglycerides and low HDL), with low prevalence in smoking and diabetes mellitus. 78% of the cases had preserved LVEF with the presence of segmental contractility disorders on baseline echocardiography in 55% of the patients. 20% had severe coronary heart with 3 or more vessel disease. The most frequently compromised coronary artery was the LAD (58.2%). GRACE, Killip-Kimball and TIMI risk scales classified the patients as low risk, being congruent with the hospitalized patients with a mortality rate of 0%; However, clinical criteria should prevail when making decisions about the stratification method and the place (in-hospital or outpatient setting). The need to establish protocols for a functional and structural evaluation of coronary artery microcirculation in patients with a suggestive clinical history, ECG, and positive ischemia induction tests, despite having coronary angiography without epicardial lesions, is demanded.

RESUMO

Resumen Introducción: La obesidad es uno de los principales problemas de salud pública en el mundo. Se considera detonante de múltiples enfermedades cardiometabólicas, como el infarto agudo de miocardio, la hipertensión arterial, la diabetes mellitus tipo 2 y el accidente isquémico cerebral. Es interesante conocer diversos factores fisiopatológicos que no dependen solo de la adiposidad, sino también de la masa muscular. Al entender que el músculo como órgano endocrino corresponde al 40% del peso corporal, las miocinas, como sustancias propias de este órgano liberadas desde la contracción, cobran importancia por su efecto antiinflamatorio y cardioprotector, y suponen un esfuerzo mayor para, a partir de su comprensión, realizar una prescripción adecuada del ejercicio. Objetivo: Estudiar las funciones de las miocinas como sustancias reguladoras de diversos procesos metabólicos, fundamentales en la homeostasis corporal. Método: Se hizo una revisión de tema, resultado de la revisión crítica de la literatura disponible sobre las miocinas, sus funciones y los efectos de la actividad física y el ejercicio en su liberación y acción. Conclusiones: El estudio de las miocinas viene en aumento y cobra relevancia clínica. Los efectos antiinflamatorios y cardioprotectores de las miocinas dependen del tipo de entrenamiento y de las cargas aplicadas al músculo una vez ha sido sometido a diferentes tipos de estímulo (aeróbico/anaeróbico, fuerza). Por tanto, la prescripción correcta del ejercicio es crucial en la modulación de estos mediadores: la optimización de su efecto, el acondicionamiento físico y el mantenimiento del peso adecuado.

Abstract Introduction: Obesity is one of the main public health problems worldwide being considered as a trigger for multiple cardiometabolic diseases such as acute myocardial infarction, high blood pressure, type 2 diabetes mellitus, cerebral ischemic accident among others. For this reason, it is of interest to know the various pathophysiological factors which depend not only on adiposity but also on muscle mass. Taking into account that the muscle as an endocrine organ corresponds to 40 % of the body weight, the importance that myokines charge as substances of this organ with an anti-inflammatory and cardioprotective character and which are released from muscle contraction is an additional study to perform an adequate Prescription of the exercise. Objective: To study the functions of myokines as regulatory substances in various metabolic processes, being essential in body homeostasis. Method: It is presented a topic review article, the result of a critical review of the available literature on myokines, their functions and the effects of physical activity and exercise on their release and action. Conclusions: that the study of myokines is increasing and is becoming more important clinical. The anti-inflammatory and cardioprotective effects of myokines depend on the type of training and loads applied to the muscle once subjected to different types of stimulation (aerobic/anaerobic, strength). Therefore, the proper prescription of exercise becomes crucial in the physical conditioning and in the maintenance of the appropriate weight.