An integrative monograph of Carex section Schoenoxiphium (Cyperaceae).

Carex section Schoenoxiphium (Cariceae, Cyperaceae) is endemic to the Afrotropical biogeographic region and is mainly distributed in southern and eastern Africa, with its center of diversity in eastern South Africa. The taxon was formerly recognized as a distinct genus and has a long history of taxonomic controversy. It has also an important morphological and molecular background in particular dealing with the complexity of its inflorescence and the phylogenetic relationships of its species. We here present a fully updated and integrative monograph of Carex section Schoenoxiphium based on morphological, molecular and cytogenetic data. A total of 1,017 herbarium specimens were examined and the majority of the species were studied in the field. Previous molecular phylogenies based on Sanger-sequencing of four nuclear and plastid DNA regions and RAD-seq were expanded. For the first time, chromosome numbers were obtained, with cytogenetic counts on 44 populations from 15 species and one hybrid. Our taxonomic treatment recognizes 21 species, one of them herein newly described (C. gordon-grayae). Our results agree with previous molecular works that have found five main lineages in Schoenoxiphium. We provide detailed morphological descriptions, distribution maps and analytical drawings of all accepted species in section Schoenoxiphium, an identification key, and a thorough nomenclatural survey including 19 new typifications and one nomen novum.

Efectividad del protocolo ACTG076 en la transmisión vertical en embarazadas con VIH/SIDA. Enero 2011- septiembre 2017

La transmisión vertical del VIH es prevenible, aplicando los protocolos de profilaxis a tiempo. Su objetivo principal es reducir la transmisión vertical del VIH mediante la detección universal del virus en embarazadas y la ejecución de pautas para la disminución de la exposición al virus por parte del recién nacido. Objetivo General: Analizar la efectividad del Protocolo ACTG076 en la transmisión vertical del VIH/SIDA en pacientes atendidas en la consulta de Infectología del Hospital "Dr. Rafael González Plaza" en el período comprendido entre enero 2011 a septiembre 2017. Metodología: Se trata de una investigación de tipo observacional descriptiva, transversal y retrospectiva. La muestra estuvo conformada por 56 embarazadas mayores de 12 años, diagnosticadas con VIH. Resultados: Se estudiaron un total de 52 recién nacidos en quienes se cumplió completamente el Protocolo ACTG076 y los cuales resultaron negativos para VIH (92,86 %). Solo 4 recién nacidos resultaron positivos (7,14 %). Con relación a los recién nacidos que resultaron positivos, habría que mencionar que en 2 casos, sus madres no cumplieron con el protocolo y en los restantes 2 lo recibieron de manera incompleta. Se registró una edad promedio de 30,61 años ± 0,73 años, predominando aquellas embarazadas con edades comprendidas entre los 26 y 33 años (53,57 %). Fueron más frecuentes las embarazadas pertenecientes al estrato IV (44,64 %). También aquellas en segunda gestación (53,57 %) y con embarazos controlados (89,29 %). Un 50 % de las embarazadas estudiadas fue diagnosticado antes del embarazo, seguidas de aquellas diagnosticadas durante el embarazo (44,64 %). El nivel de CD4 estuvo comprendido entre 200 y 500 (46,43 %). En la segunda toma el nivel de CD4 que predominó fue el mayor a 500 (44,64 %). La carga viral predominante fue de menos de 20 copias (53,57 %). Conclusión: Se demostró que mediante el cumplimiento del Protocolo ACTG076 existe una alta efectividad en la prevención de la transmisión vertical del VIH.

Vertical transmission of HIV is preventable, appyling prophylaxis protocols on time. Their main goal is to reduce vertical HIV transmission through universal detection of the virus in pregnant and implementing guidelines to reduce the newborn exposure to the virus. General Objective: To analyze the effectiveness of the ACTG076 Protocol in the vertical transmission of HIV / AIDS in patients treated at the Infectious Diseases Consultation of "Dr. Rafael González Plaza" Hospital in the period from January 2011 to September 2017. Methods: It was a descriptive, observational, transversal and retrospective research. Sample consisted of 56 pregnant women over 12 years, diagnosed with HIV and treated at the health center and the time period described above. Results: A total of 52 newborns received complete ACTG076 protocol, resulting negative for HIV (92.86 %). There were 4 positive newborns (7.14 %). Two of them were born from women which not received ACTG076 protocol or received an incomplete one. An average age of 30.61 ± 0.73 years was recorded. Pregnant women between 26 and 33 years old predominated (53.57 %). Pregnant women who belongs to stratum IV were most frequently found (44.64 %). Also those with a second pregnancy (53.57 %) and controlled pregnancies (89.29 %). A 50.% of pregnant women studied were diagnosed before pregnancy, followed by those diagnosed during pregnancy (44.64). The level of CD4 was between 200 and 500 (46.43 %). It was over 500 and the second test (44.64 %). The viral load that predominated was less than 20 copies (53.57 %). Conclusion: It was demonstrated that there is a high effectiveness in preventing vertical transmission of HIV by fulfilling all stages of the protocol ACTG076.

Experimental Platform for Ultra-high Dose Rate FLASH Irradiation of Small Animals Using a Clinical Linear Accelerator.

PURPOSE: A key factor limiting the effectiveness of radiation therapy is normal tissue toxicity, and recent preclinical data have shown that ultra-high dose rate irradiation (>50 Gy/s, "FLASH") potentially mitigates this effect. However, research in this field has been strongly limited by the availability of FLASH irradiators suitable for small animal experiments. We present a simple methodologic approach for FLASH electron small animal irradiation with a clinically available linear accelerator (LINAC). METHODS AND MATERIALS: We investigated the FLASH irradiation potential of a Varian Clinac 21EX in both clinical mode and after tuning of the LINAC. We performed detailed FLUKA Monte Carlo and experimental dosimetric characterization at multiple experimental locations within the LINAC head. RESULTS: Average dose rates of ≤74 Gy/s were achieved in clinical mode, and the dose rate after tuning exceeded 900 Gy/s. We obtained 220 Gy/s at 1-cm depth for a >4-cm field size with 90% homogeneity throughout a 2-cm-thick volume. CONCLUSIONS: We present an approach for using a clinical LINAC for FLASH irradiation. We obtained dose rates exceeding 200 Gy/s after simple tuning of the LINAC, with excellent dosimetric properties for small animal experiments. This will allow for increased availability of FLASH irradiation to the general research community.

Quiste aracnoidal cervical anterior en edad pediátrica / Anterior cervical arachnoid cyst in pediatric age

Los quistes aracnoidales espinales son lesiones poco comunes en la población pediátrica. La mayor parte de ellos, se ubican en los segmentos dorsales y la posición anterior respecto a la médula es rara en todos los casos. Si bien su patogenia no está aclarada, se han asociado a defectos del tubo neural y traumas previos. Clínicamente, pueden presentarse con síndrome medular que en ocasiones pueden empeorar con cambios posturales. El tratamiento, puede ser conservador o quirúrgico, el que está indicado en presencia de síntomas neurológicos secundarios a compresión medular, siendo el abordaje posterior el más frecuentemente utilizado. El propósito de la cirugía es la resección total o en su defecto, la fenestración del quiste para comunicarlo al espacio subaracnoídeo. Una potencial complicación de la vía posterior, es la herniación medular durante la durotomía, secundaria al efecto compresivo del quiste, la cual podría aumentar la morbilidad neurológica en el período postoperatorio. Se presentan 2 casos consecutivos en edad pediátrica con quistes intradurales espinales anteriores, el primero en la región cervico-dorsal cuya cirugía se vio dificultada por la presencia de herniación medular transdural y un segundo caso con un quiste exclusivamente cervical, en que mediante una punción lateral del quiste guiada por ecografía previo a la durotomía, se logró resecar la lesión sin esta complicación.

Spinal arachnoid cysts are rare lesions in pediatric population. Most of them are located posteriorly in dorsal segments ananterior position is rare. Although its pathogenesis has not been elucidated, they have been associated with neural tube defects and the presence of previous spinal traumas. Clinically, they present with a spinal cord syndrome which can sometimes worsen with postural changes. Treatment may be conservative or surgical, the latter indicated by the presence of neurological symptoms secondary to spinal cord compression, with the posterior approach being the most frequently used. The purpose of surgery is total or partial resection, or fenestration of the cyst to subarachnoid space. A potential intra-surgical complication of posterior approach in anterior cyst is spinal cord herniation during durotomy, secondary to the compressive effect of the cyst, which could increase neurological morbidity in the postoperative period (1 case with mortality is described in the literature). We present 2 consecutive cases in pediatric patients with previous spinal intradural cysts. The first in the cervico-dorsal region whose surgery was hampered by the presence of medullary transdural herniation and second case with an exclusively cervical cyst that through a side puncture cyst guided by ultrasound prior to durotomy, it was possible to resect the lesion without this complication.

Síndrome meningeo como manifestación de apoplejia hipofisiaria, análisis prospectivo de siete casos / Meningeal syndrome as manifestation of pituitary apoplexy, prospective analysis of seven cases

Introducción: la apoplejía hipofisiaria es una grave pero poco frecuente emergencia médico -neuroquirúrgica, con una incidencia global reportada del 1 por ciento a 2 por ciento Es causado por una hemorragia o infarto en relación a la glándula pituitaria, pudiendo existir extravasación de contenido necrótico o hemorrágico al espacio subaracnoideo, manifestándose como un síndrome meníngeo aséptico o hemorrágico. Sin embargo, su frecuencia no está estudiada. Material y Métodos: Se realizó un registro prospectivo entre enero de 2013 y agosto de 2014, para el estudio de líquido céfalo raquídeo, en pacientes con diagnóstico clínico- imagenológico de apoplejía hipofisiaria. Además un registró detallado de las manifestaciones clínicas y de laboratorio. Resultados: En este período se reclutaron 8 casos con apoplejía hipofisiaria clínica, de los cuales 7 fueron incluidos, siendo excluido un paciente por rechazar su participación en el estudio. De los 7 pacientes restantes, se evidenciaron signos meníngeos clínicos en el 86 por ciento (6/7), confirmando alteraciones del estudio cito-químico en todos ellos. En cada caso se descartó patología infecciosa o vascular como etiología. Conclusión: Si bien el debut de una apoplejía hipofisiaria como un síndrome meníngeo aséptico o hemorragia subaracnoidea, se encuentra documentado como casos anecdóticos, nuestros resultados apuntan a que sería una manifestación frecuente e importante a considerar para un adecuado diagnóstico diferencial y monitoreo de complicaciones infrecuentes.

Introduction: pituitary apoplexy is a serious but rare neurosurgical emergency, with an overall reported incidence of 1 percent to 2 percent. It is caused by bleeding or infarction related to the pituitary gland, there may be necrotic or hemorrhagic extravasation content to the subarachnoid space, manifesting as an aseptic o hemorrhagic meningeal syndrome. However, their frequency is not studied. Material and Methods: A prospective registry between January 2013 and August 2014, for the study of cerebro spinal fluid in patients with clinical and imaging diagnosis of pituitary apoplexy was performed. In addition, a detailed analysis of the clinical sintoms and laboratory was recorded. Results: In this period, 8 cases with clinical pituitary apoplexy were recluted, of which 7 were included, being excluded from a patient who refuses to participate in the study. Of the remaining 7 patients,clinical meningeal signs were evident in 86 percent (6/7), confirming alterations cyto-chemical study all of them. In each case infectious or vascular pathology was ruled out as a cause. Conclusion: While the debut of a pituitary apoplexy as an aseptic meningeal syndrome or subarachnoid hemorrhage, is documented as anecdotal cases, our results would suggest that is a common and important manifestation, to consider an appropriate differential diagnosis and monitoring of rare complications.

Simultaneous effect of initial moisture content and airflow rate on biodrying of sewage sludge.

The simultaneous effect of initial moisture content (initial Mc) and air-flow rate (AFR) on biodrying performance was evaluated. For the study, a 3(2) factorial design, whose factors were AFR (1, 2 and 3 L/min kg(TS)) and initial Mc (59, 68 and 78% w.b.), was used. Using energy and water mass balance the main routes of water removal, energy use and efficiencies were determined. The results show that initial Mc has a stronger effect on the biodrying than the AFR, affecting the air outlet temperature and improving the water removal, with higher maximum temperatures obtained around 68% and the lowest maximum matrix temperature obtained at initial Mc = 78%.Through the water mass balance it was found that the main mechanism for water removal was the aeration, with higher water removal at intermediate initial Mc (68%) and high AFR (3 L/min kg(TS)). The energy balance indicated that bioreaction is the main energy source for water evaporation, with higher energy produced at intermediate initial Mc (68%). Finally, it was found that low values of initial Mc (59%) improve biodrying efficiency.

Biodrying of sewage sludge: kinetics of volatile solids degradation under different initial moisture contents and air-flow rates.

This study focuses on the kinetics of the biodegradation of volatile solids (VS) of sewage sludge for biodrying under different initial moisture contents (Mc) and air-flow rates (AFR). For the study, a 3(2) factorial design, whose factors were AFR (1, 2 or 3L/minkgTS) and initial Mc (59%, 68% and 78% w.b.), was used. Using seven kinetic models and a nonlinear regression method, kinetic parameters were estimated and the models were analyzed with two statistical indicators. Initial Mc of around 68% increases the temperature matrix and VS consumption, with higher moisture removal at lower initial Mc values. Lower AFRs gave higher matrix temperatures and VS consumption, while higher AFRs increased water removal. The kinetic models proposed successfully simulate VS biodegradation, with root mean square error (RMSE) between 0.007929 and 0.02744, and they can be used as a tool for satisfactory prediction of VS in biodrying.

Biodrying of pulp and paper secondary sludge: kinetics of volatile solids biodegradation.

This study focuses on the kinetics of volatile solids (VS) biodegradation of the biodrying process using pulp and paper secondary sludge. The experiments were carried out with air-flow rates of 0.51, 1.61, 3.25 and 5.26L/minkgVS) and initial moisture content of 64-66% w.b. Using five kinetic models and a nonlinear regression method, kinetic parameters were estimated and the models were analyzed with two statistical indicators. Higher air-flow rates cause greater moisture content reduction, lower temperature in the matrix, and lower VS reduction. At an air-flow rate as high as 5.26L/minkgVS there is no biodrying but only convective drying. The kinetic models used successfully simulate the VS biodegradation under biodrying conditions, with a root mean square error (RMSE) between 0.007929 and 0.02744. In conclusion, we show for the first time that VS biodegradation in the biodrying process can be successfully modeled with a kinetic model.

[Relevance of CYP2C19 2 regarding platelet reactivity in patients with acute coronary syndrome treated with clopidogrel]. / Impacto de CYP2C19 2 en la reactividad plaquetar en pacientes con síndrome coronario agudo tratados con clopidogrel.

BACKGROUND AND OBJECTIVE: Previous studies have shown that the metabolism of P2Y12 receptor blockers is influenced not only by CYP2C19 2 but also by PON1-Q192R alelles. We aimed to evaluate the impact of CYP2C19 2 and PON1-Q192R polymorphisms carriage in platelet reactivity and clinical outcome in patients with ischemic heart disease undergoing cardiac catheterization. PATIENTS AND METHOD: We recruited prospectively patients with acute coronary syndrome undergoing cardiac catheterization (n=247). We evaluated the genotype (CYP2C19 2, CYP2C19 17, PON1-Q192R) with TaqMan(®) assay and platelet aggregometry in all patients. We assessed both in and out-of-hospital events (unstable angina, periprocedural and spontaneous myocardial infarction, myocardial infarction, all-cause death, stent thrombosis and stroke) during follow-up. RESULTS: Carriers of CYP2C19 2 alleles showed a significant higher residual platelet reactivity (PRU, mean [SD], 252 [76] vs. 287 [74], P=.002). Carriers of PON1-Q192R CT(RQ) and TT(QQ) alleles and CYP2C19 17 did not present a different response to clopidogrel. In a multivariable setting for the prediction of platelet reactivity, the contribution of CYP2C19 2 was modest (Wald=7.5; odds ratio [OR] for ≥ 1 alelle 2=2,786, 95% confidence interval [95% CI] 1,337-5,808). Independent predictors were baseline hemoglobin levels (g/dL, OR .666, 95% CI .555-.801) and the use of statins (OR .376, 95% CI .162-.873). Body mass index was a risk factor (OR 1,074, CI 95% 1,005-1,148). Studied polymorphisms did not predict an adverse outcome. CONCLUSIONS: CYP2C19 2 polymorphism influenced moderately platelet reactivity but did not show an impact on clinical outcome in patients with acute coronary syndrome. Neither CYP2C19 17 nor PON1-Q192R polymorphisms showed an impact upon platelet reactivity or outcome.

Characteristics of culprit atheromatous plaques obtained in vivo by intravascular ultrasound radiofrequency analysis: results from the CULPLAC study.

OBJECTIVES: We used virtual histology-intravascular ultrasound (VH-IVUS) to investigate the characteristics of culprit lesions in acute coronary syndromes (ACS). BACKGROUND: Autopsy studies of patients who died of ACS have shown that culprit atheromatous plaques almost always contain a large lipid-necrotic core covered by a ruptured thin fibrous cap. There are no studies of sufficient size that have assessed the in vivo characterization of plaques responsible for ACS. METHODS: Patients undergoing angiography for stable ischemic heart disease and ACS (with and without ST-segment elevation) were enrolled in a prospective study. Lesions in patients with stable angina were classified as stable and those in patients with ACS as culprit or nonculprit. RESULTS: The study included 189 patients: VH-IVUS was used to assess 253 lesions (73 stable, 82 nonculprit, and 98 culprit lesions). The thin-cap fibroatheroma phenotype (VH-TCFA) was more frequent among lesions in patients with ACS (55.1% in culprit lesions, 36.6% in nonculprit lesions and 14.4% in stable lesions; P = .007). The arc of the VH-TCFA exposed to the vessel lumen was significantly greater in culprit lesions than in nonculprit lesions (122.28° ± 58 vs 89.46° ± 52; respectively; P = .007). Multivariate analysis showed that VH-TCFA (OR 2.1; P = .033), calcified nodules (OR 2.1; P = .046), positive remodeling (OR 3.5; P < .001) and necrotic core volume (OR 1.02;P = .009) were independently associated with a clinically identified culprit lesion. CONCLUSIONS: Plaque phenotype, rather than the proportion of each tissue, appears to be associated with plaque instability. VH-TCFA, particularly subtype IV, is associated with lesions responsible for ACS.

Angiografía del día siguiente tras fibrinólisis exitosa frente al tratamiento convencional, en el síndrome coronario agudo con elevación del segmento ST, fibrinolisado / Angiography performed the next day after successful thrombolysis versus conventional treatment in acute coronary syndrome with ST segment elevation

Introducción y objetivos: la incorporación de las nuevas guías de actuación de la Sociedad Europea de Cardiología en el síndrome coronario agudo, con coronariografía precoz (24 horas) tras trombólisis, incluso si es efectiva y sin necesidad de demostrar signos de isquemia residual, en los casos en los que no se realiza angioplastia primaria, ha supuesto un reto respecto a la forma tradicional de actuar en los Servicios de Cardiología. Métodos: durante 2007, 2008 y la primera mitad de 2009 se atendieron 266 pacientes con infarto agudo del miocardio con ST elevado tratados con trombólisis. De ellos, y tras excluir los rescates (41), en 94 (42%) se realizó cateterismo dentro de las primeras 24 horas (angiografía del día siguiente) y en los 131 (58%) restantes se siguió una estrategia convencional con test de provocación de isquemia (tratamiento convencional). Resultados: en el primer grupo, la estancia media fue de 7,3 ± 3 días [mediana, rango intercuantílico: 7 (5-8)]. La incidencia de eventos mortales al año fue de 3 (4%). No hubo ningún sangrado mayor; sólo 20 de ellos (22%) presentaron hematomas inguinales mayores de 2 cm. En el segundo, la estancia media fue de 10,2 ± 6,3 días [9 (6-13)], significativamente mayor (p<0,001). El número de eventos mortales al año fue de 7 (11%), sin que se observaran diferencias estadísticamente significativas (p=0,52). Conclusiones: la angiografía del día siguiente se asocia con una reducción de la estancia media respecto al tratamiento convencional. Además, parece mostrar una tendencia (no significativa) de reducción de mortalidad al año, sin que aumente el número de complicaciones hemorrágicas.

Introduction and objectives: The introduction of new practice guidelines of the European Society of Cardiology in acute coronary syndrome with early coronary angiography (24 hours) after thrombolysis, even if it is effective without showing signs of residual ischemia in the cases where primary angioplasty is not performed, has been a challenge over the traditional approach in the Departments of Cardiology. Methods: During 2007, 2008 and the first half of 2009, 266 patients with acute myocardial infarction with ST segment elevation were treated with thrombolysis. After excluding the bailouts (41), in 94 (42%) of them, a catheterization was peformed within the first 24 hours (next day angiography) and the remaining 131 (58%) underwent a conventional strategy with a provocation test to elicit ischemia (conventional treatment). Results: In the first group, the average stay was 7.3 ± 3 days [median interquartile range: 7 (5-8)]. The incidence of fatal events per year was 3 (4%). There were no major bleeding, only 20 of them (22%) had groin hematomas larger than 2 cm. In the second group, the average stay was 10.2 ± 6.3 days [9 (6-13)], significantly higher (p <0.001). The number of fatal events per year was 7 (11%) and no statistically significant differences were observed (p = 0.52). Conclusions: Angiography performed the next day is associated with reduced length of stay compared to conventional treatment. It also seems to show a trend (not significant) of reduction in year mortality without increasing the number of bleeding complications.

Casos clinicos: sindrome de Prune Belly en el sexo femenino / Clinical cases: Prune Belly syndrome in women

El Síndrome de Prune Belly en el sexo femenino es poco frecuente, siendo un 3 a 5 por ciento del total de casos masculinos.

Prognostic value of the Thrombolysis in Myocardial Infarction risk score in a unselected population with chest pain. Construction of a new predictive model.

INTRODUCTION: The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven to be a useful and simple tool for risk stratification of patients with chest pain in intermediate- and high-risk populations. There is little information on its applicability in daily clinical routine with unselected populations. AIMS: The aims of the study were to prospectively analyze the predictive value of the TRS in a heterogeneous population admitted for chest pain and to construct where possible a new modified model with a greater prognostic capacity. POPULATION AND METHODS: Seven hundred eleven consecutive patients were admitted over a 1-year period to the cardiology unit for chest pain without ST-segment elevation. Thrombolysis in Myocardial Infarction risk score variables, relevant medical history variables, in-hospital examination results, and therapy information were collected. Cardiac events at 1 and 6 months were recorded. RESULTS: Seventy-one (9.8%) patients had a compound event (myocardial infarction/revascularization/cardiac death) at 6 months. On multivariate analysis, the variables associated with cardiac events were left ventricular ejection fraction (EF) of <35% (hazard ratio [HR] = 2.9, P = .002), diabetes (HR = 1.8, P = .02), and TRS (HR = 1.3, P = .007). Events at 6 months were 2.3% for a TRS of 0/1, 4.2% for 2, 10.2% for 3, 11.0% for 4, and 18.7% for a score of more than 5. A new modified scale was constructed to include EF and diabetes as independent variables, and this yielded an increase of 44% in the combined event at 6 months per score unit increase (HR = 1.44, P = .001). The modified scale showed a greater predictive capacity than the original model. CONCLUSIONS: The TRS is an important short- and long-term prognostic predictor when applied to an unselected population consulting for chest pain. The inclusion of diabetes and EF as variables in the model increases predictive capacity at no expense to simplicity.

Heart-hand syndrome.

Heart-hand syndromes show substantial clinical and genetic heterogeneity. The unusual case of a patient with a heart-hand syndrome consisting of preaxial polydactylia, postaxial syndactylia, parachute mitral valve, mild subaortic stenosis, and double outlet right ventricle is presented and discussed. The importance of distinguishing Holt-Oram syndrome from its phenocopies and other heart-hand syndromes is underlined.

[Use of a coronary risk score (the TIMI Risk Score) in a non-selected patient population assessed for chest pain at an emergency department]. / Aplicación de una puntuación de riesgo coronario (TIMI Risk Score) en una población no seleccionada de pacientes que consultan por dolor torácico en un servicio de urgencias.

INTRODUCTION AND OBJECTIVES: Stratification algorithms for acute coronary syndrome enable the identification of high-risk patients who will benefit from more aggressive treatment. The TIMI Risk Score (TRS) has been shown to be useful in intermediate- and high-risk patients. However, little is known about its value in non-selected patients. Our aim was to assess the efficacy of the TRS for risk stratification in a non-selected population with chest pain. PATIENTS AND METHOD: We evaluated 1254 consecutive patients (age, 54 [19] years; 57% male) attending an emergency department for chest pain. Overall, 343 (27%) were admitted and 911 (73%) were discharged. All cardiac events during 6-month follow-up were recorded. RESULTS: Of the 911 discharged patients, 45 (5.3%) were admitted during follow-up: 9 (1.1%) underwent revascularization, 5 (0.6%) had a myocardial infarction (MI), and 2 (0.2%) died from cardiovascular disease. Patients with a high TRS had a significantly higher risk of reaching the composite endpoint of death, MI, or revascularization (relative risk per unit of TRS increase, 3.63; 95% CI, 2.20-6.00; P < .001). Of the patients who were initially admitted, 22 (6.4%) underwent revascularization, 4 (1.2%) had an MI, and 14 died (4.1%) from cardiovascular disease during follow-up. The relative risk of the composite endpoint per unit of TRS increase was 1.72 (95% CI, 1.32-2.24; P < .001). CONCLUSIONS: The TIMI risk score is useful for stratifying cardiovascular event risk in non-selected patients with chest pain. The score can identify high-risk patients who will benefit from hospital admission and early aggressive treatment.

Factores de riesgo asociados a sepsis neonatal / Risk factors associated to neonatal sepsis

Objetivos: identificar los factores de riesgo y el grado de asociación de los mismos con la sepsis neonatal precoz y tardía. Métodos: se realizó un estudio analítico observacional de casos y controles en el Servicio de Neonatología del Hospital de la Mujer, La Paz Bolivia, de 322 recién nacidos (historias clínicas), 108 casos y 214 controles. Resultados: se analizaron 322 historias clínicas y los factores que tuvieron significancia como riesgo para sepsis neonatal precoz fueron: edad gestacional pretérmino (OR 5.47, IC 95% 2.14-14.83), el bajo peso al nacer (OR 3.09, IC 95% 1.55-6.16), la ruptura prematura de membranas (OR 3.87, IC 95% 2.06-7.32), la infección de vías urinarias (OR 3.21, IC 95% 1.49-6.89) y la corioamnionitis (OR 4.69, IC 95% 1.0521.63). La hipertensión arterial (OR 114.44, IC 95% 37.90-366), la utilización de vía central (OR 5.41, IC 95% 2.57-11.4) y ventilación mecánica (OR 3.26, IC 95% 1.6-6.66) como procedimientos invasivos fueron factores de riesgo significantes para sepsis neo natal tardía. Los factores de riesgo para el fallecimiento de los niños fueron: ser recién nacido pretermino (OR 3.3, IC 95% 1.6-6.87), tener bajo peso al nacer (OR 13.07, IC 95% 6.84-25.13), que la madre haya presentado infección de vías urinarias (OR 2.08, IC 95% 1.03-4.15) y la utilización de vía central (OR 8.46, IC 95% 4.43-16.26) y ventilación mecánica (OR 17.94 IC 95% 9.17-35.45) en los neonatos. Conclusiones: los hallazgos del presente estudio demuestran que la sepsis es una causa de mortalidad neonatal y que la presencia de esta patología ya sea de tipo precoz o tardía, esta determinada por varios factores, los cuales, al estar presentes en la madre o el niño se convierten en factores de riesgo que puedes ser tratados o prevenidos una vez que son diagnosticados.

Objectives: Identifying risk factors and to what degree are these associated to early and delayed neo natal sepsis. Method: An analytical study was carried out observing cases and their follow-up at the Neonatology Department of the Women's Hospital in La Paz, Bolivia. The study included 322 newborn clinical histories, 108 cases and 214 follow-ups. Results: 322 clinical histories were revised. Risk factors that were significant for neo natal sepsis, either early of delayed were: premature birth (OR 5.47, IC 95% 2.14-14.83), low birth weight (OR 3.09, IC 95% 1.55-6.16), premature membrane rupture (OR3.87, IC 95% 2.06-7.32), urinary tract infection (OR 3.21, IC 95% 1.49-6.89) and "chorioarnnionitis" (OR 4.69, IC 95% 1.05,-21.63). Significant risk factors for delayed neonatal sepsis were invasive procedures such as high blood pressure (OR 114.44, IC 95% 37.90-366), use of main pathway (OR 5.41, IC 95% 2.57-11.4) and mechanical ventilation (OR 3.26, IC 95% 1.6-6.66). Risk factors for newborn deaths were: premature births, (OR 3.3, IC 95% 1.6-6.87), low birth weight (OR 13.07, IC 95% 6.84-25.13), urinary tract infection in the mother (OR 2.08, IC 95% 1.03-4.15) use of main pathway (OR 8.46, IC 95% 4.43-16.26) and mechanical ventilation (OR 17.94, IC 95% 9.17-35.45) Conclusions: findings in this study show that sepsis causes neonatal death be it early or delayed and that it is caused by several factors which may originate either in the mother or the baby which turn into risk factors that may be treated or prevented once they are diagnosed.

Neonatología: el recien nacido de alto riesgo / Neonatology: the high-risk newborn

Este capítulo esta dedicado plenamente a la atención del recién nacido, el diagnostico de posibles enfemerades que deriven a una atención mas prolija si asi lo requiere u posibles complicaciones que se puedan presentar