Anticoagulation Therapy by Age and Embolic Risk for Nonvalvular Atrial Fibrillation in Mexico, an Upper-Middle-Income Country: The CARMEN-AF Registry.

Background: Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF). Objective: To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country. Material and methods: There were 1,423 consecutive patients ≥18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA2DS2-VASc score. Results: Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects <65 years to 22.5% in those ≥75 years old (P <0.0001). Concomitantly, an increase in both APD and no antithrombotic treatment was observed with increasing age. DOAC were prescribed equally among all age groups (34.2% in <65, 36.0% in 65-74, and 33.9% in ≥75). According to the type of AF, VKA use was more common in patients with permanent AF (32.7%). A lower use of DOAC was observed in high thromboembolic risk subjects (33.6% in CHA2DS2-VASc ≥2) compared with the moderate risk group (41% in CHA2DS2-VASc = 1). Conclusions: VKA use for NVAF in Mexico decreased in relation to increasing age. The proportion of DOAC therapy was the same in all age groups. Nevertheless, elderly patients with high thromboembolic risk received a suboptimal thromboprophylaxis. These data could help to improve gaps in the implementation of global guidelines. Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT02334852. Highlights: CARMEN-AF is a nationwide multi-centric registry seeking to bridge the data gap on anticoagulation therapy for NVAF in Mexico.Elderly patients are more prone to receive suboptimal OAT for NVAF.DOAC were less frequently used in high thromboembolic risk patients (CHA2DS2-VASc ≥2).

Síndrome de Guillain-Barré concomitante con infección por virus Zika / Guillain-Barre syndrome associated with Zika virus infection

Resumen OBJETIVOS Comunicar una serie de casos de síndrome de Guillain-Barré y describir las características clínicas de una posible asociación con infección previa por virus Zika. MATERIAL Y MÉTODO Estudio descriptivo de serie de casos en el que se recolectaron datos clínicos, bioquímicos y demográficos de los pacientes con síndrome de Guillain-Barré tratados en el Hospital General Acapulco con antecedente reciente de síndrome viral agudo sospechoso de infección por virus Zika, del 24 de julio al 24 de agosto de 2016, con realización de estudio de líquido cefalorraquídeo y comprobación de disociación albúmino-citológica. Se estableció diagnóstico de certeza de síndrome de Guillain-Barré según los criterios de Asbury-Cornblath y Brighton. RESULTADOS Se estudiaron 10 pacientes con síndrome de Guillain-Barré y antecedente reciente de síndrome viral agudo compatible con infección por virus Zika; la edad media de los sujetos en estudio fue de 47.8 años, 4 eran hombres. Los déficits motor y sensitivo sobrevinieron en una mediana de 4.5 y 4.3 días, respectivamente, después del inicio de los síntomas de infección viral. Hubo complicaciones, como neumonía asociada con ventilación mecánica, infección de vías urinarias en tres casos y disautonomía en dos casos. CONCLUSIONES Todos los casos de este brote de síndrome de Guillain-Barré tenían antecedente reciente de infección sospechosa por virus Zika, lo que refuerza la evidencia existente de la asociación entre el síndrome de Guillain-Barré y la infección por virus Zika.

Abstract OBJECTIVES To communicate a series of cases of Guillain-Barre syndrome and to describe the clinical characteristics related to a possible association with previous infection due to Zika virus. MATERIAL AND METHOD A descriptive study of series of cases in which clinical, biochemical and demographic data were collected from patients with Guillain-Barre syndrome treated at the Hospital General Acapulco with a recent history of acute viral syndrome suspected of infection due to Zika virus, performed from July 24 to August 24, 2016, with conducting study of cerebrospinal fluid and ascertainment of cytological albuminous dissociation. A certainty diagnosis was established for Guillain-Barre syndrome according to the criteria of Asbury-Cornblath and Brighton. RESULTS Ten patients with GBS and a recent history of acute viral syndrome compa-tible with Zika virus infection were included. The mean age was 47.8 years, 4 were male. The motor and sensitive deficits were developed at a median of 4.5 and 4.3 days, respectively after the onset of symptoms of viral infection. The complications found were ventilator-associated pneumonia, urinary tract infection and dysautonomia. CONCLUSIONS All cases of this outbreak of Guillain-Barre syndrome had a recent history of suspected infection due to Zika virus, reinforcing the evidence for the association between Guillain-Barre syndrome and infection due to Zika virus.

Ventrículos superior e inferior: análisis angiográfico de un caso / Superior and inferior ventricles: angiographia analysis of a case

Se describe un caso de ventrículos superior e inferior con dextroversión, concordancia auriculoventricular y discordancia ventrículo-arterial tipo doble vía de salida del ventrículo derecho con aorta en posición D. Se analizan las características angiográficas y embriológicas de esta cardiopatía diagnosticada angiográficamente

Conexión atrioventricular cruzada con cabalgamiento de la válvula atrioventricular derecha / Crossed atrioventricular connection with stradding of the right atrioventricular valve

Se describe un caso de conexión atrioventricular cruzada (o "Criss-Cross") en situs inversus, conexión atrioventricular concordante, conexión ventrículo arterial tipo doble vía de salida del ventrículo derecho y cabalgamiento de la válvula atrioventricular derecha. Se hace una revisión de la literatura y se analizan las características angiográficas de esta malformación, destacando la importancia de la angiografía selectiva para conocer las conexiones atrioventriculares y ventrículo arteriales en forma precisa, y la presentación de varias lesiones raras asociadas en el mismo caso. Se comenta la utilidad del ecocardiograma para el diagnóstico de las malformaciones asociadas