A tale of two cities: STEMI interventions in developed and developing countries and the potential of telemedicine to reduce disparities in care.

OBJECTIVES: To utilize telemedicine as a foundation platform for creating population-based STEMI networks. BACKGROUND: Disparate acute myocardial infarction (AMI) management occurs in developed and developing countries on account of differences in infrastructure resources. As a result, developed countries utilize primary percutaneous coronary intervention (PCI) and second- and third-generation thrombolytic therapy, in contrast to developing countries, which primarily rely on earlier-generation thrombolytic therapy and basic medical management. Reducing the vast gap in AMI care between developed and developing countries is an abysmally slow process. METHODS: Remote access, telemedicine IT platforms, expert EKG interpretation, teleconsultation, and a strict quality assurance process are incorporated into a population-based AMI network. RESULTS: Lumen Americas Telemedicine Infarct Network (LATIN) is an applied hub-and-spoke strategy, which creates a telemedicine-based STEMI management network across large populations. Primary PCI with targeted door-to-balloon times is the preferred strategy for the hub sites. Telemedicine-guided accurate EKG interpretation and teleconsultation are applied at the spoke sites. An integrated IT platform is used to navigate an effective prehospital triage system. The pilot phase has created 100 LATIN sites in Brazil and Colombia. CONCLUSION: Telemedicine provides an attractive strategy to reduce the gaps that presently exist in managing AMI in developed and developing countries.

Primary Langerhans Cell Histiocytosis of the Extrahepatic Bile Duct Occurring in an Adult Patient

Background: Langerhans cell histiocytosis is characterized by an abnormal proliferation of neoplastic Langerhans cells. Langerhans cell histiocytosis commonly affects the pediatric population, whereas presentation in adults remains a rare event. The presentation of Langerhans cell histiocytosis is highly variable, but the involvement of skin, bone, and lung is very common. Langerhans cell histiocytosis presenting as a bile duct mass is rare and usually occurs as part of a multiorgan system disease. Case Report: We present a case of Langerhans cell histiocytosis confined to the extrahepatic bile duct in a 62-year-old female patient with sclerosing cholangitis. The mass was composed of mononuclear cells with cleaved nuclei that were positive for CD68, S100, and CD1a as assessed by immunohistochemistry. Conclusion: This is the first report of Langerhans cell histiocytosis limited to the extrahepatic bile duct in an adult patient. We discuss the clinical manifestations and the challenges encountered in the diagnosis and treatment of this rare entity.

[Metabolic Syndrome and Bipolar Affective Disorder: A Review of the Literature]. / Síndrome metabólico y trastorno afectivo bipolar: una revisión de la literatura.

Bipolar disorder (BD) is a chronic psychiatric disorder that is found within the first ten causes of disability and premature mortality. The metabolic syndrome (MS) is a group of risk factors (RF) that predispose to cardiovascular disease (CV), diabetes and early mortality. Both diseases generate high costs to the health system. Major studies have shown that MS has a higher prevalence in patients with mental disorders compared to the general population. The incidence of MS in BD is multifactorial, and due to iatrogenic, genetic, economic, psychological, and behavioral causes related to the health system. The most common RF found is these patients was an increased abdominal circumference, and it was found that the risk of suffering this disease was greater in women and Hispanic patients. As regards the increase in RF to develop a CV in patients with BD, there have been several explanations based on the risky behavior of patients with mental illness, included tobacco abuse, physical inactivity and high calorie diets. An additional explanation described in literature is the view of BD as a multisystemic inflammatory illness, supported by the explanation that inflammation is a crucial element in atherosclerosis, endothelial dysfunction, platelet rupture, and thrombosis. The pathophysiology of MS and BD include factors such as adrenal, thyroid and sympathetic nervous system dysfunction, as well as poor lifestyle and medication common in these patients. This article attempts to give the reader an overall view of the information published in literature to date, as regards the association between BD and MS.