Implantable cardioverter defibrillators and Chagas' disease: results of the ICD Registry Latin America.

AIMS: Chagas' disease is an endemic parasitic affliction in Latin America. It is frequently associated with ventricular tachyarrhythmia and sudden death. The aim of this study is to assess the evolution of patients with Chagas' disease treated with an implantable cardioverter defibrillator (ICD). METHODS AND RESULTS: Eighty-nine chagasic patients with ICD were included for analysis from the Medtronic ICD Registry Latin America. At implant, mean age was 59 +/- 10 years, and 72% were male. Eighty-one patients (91%) had secondary prevention indications. Mean left ventricular ejection fraction was 40 +/- 11%, and mean follow-up was 12 +/- 7 months. During follow-up, six patients died (6.7%); three due to congestive heart failure, one due to sudden death, and two due to non-cardiac cause. Hospitalization occurred in seven patients. Thirty-eight patients (42%) received appropriate ICD therapies. A total of 737 episodes were detected by the ICD. The mean period between ICD implantation and the first appropriate therapy was 104 days. Electrical storms were observed in 14 of the 89 patients (15.7%). Inappropriate therapies were observed in seven patients. CONCLUSION: This registry confirms that ICD therapy provides protection by effectively terminating life-threatening arrhythmias in patients with Chagas' disease. This is especially so when patients receive the device for secondary prevention.

[Primary and secondary prevention of sudden cardiac death in the ICD Registry-Latin America]. / Prevención primaria y secundaria de muerte súibita en el ICD Registry Latin America.

INTRODUCTION AND OBJECTIVES: The ICD Registry is an observational study conducted in Latin America to collect data on indications and follow-up care for primary or secondary prevention of sudden cardiac death patients. The objective of this study is to compare and evaluate the characteristics of primary versus secondary prevention in the patient population enrolled in the registry. METHODS: Demographic data, indication, etiology, NYHA functional class and left ventricular ejection fraction (LVEF), pharmacological treatment at implant and the type of ICD implanted were also collected. During the follow-up period the ICD therapies delivered, patient hospitalizations and mortality were evaluated. RESULTS: 507 patients were evaluated. Average age 60 +/- 14 years old, 78% male. Coronary heart disease was the most common etiology (43.6%). NYHA Functional Class I/II at the time of implant (73.6%). Average LVEF was 34 +/- 16%. Out of 507 patients, 189 received an ICD for primary prevention; 318 for secondary prevention. Primary prevention patients were older, predominantly male and had a lower EF. The rate of mortality and hospitalizations were similar between both groups with a higher rate of appropriate therapies in secondary prevention patients. CONCLUSIONS: This is the first study to demonstrate clinical characteristics of primary prevention patients in Latin America. There were no significant statistically differences in a short follow-up period in mortality or hospitalization as compared to the secondary prevention patient population in the Registry.

En el cincuentenario del DUOC: Una acción concreta para acortar las brechas educacionales y laborales. Chile / On the 50th Anniversary of DUOC: A Concrete Action to Bridge the Educational and Labor Gaps in Chile

Resumen. A finales del año 2018 se recordaron 50 años de la fundación del Departamento Universitario Obrero Campesino -DUOC- en la Pontificia Universidad Católica de Chile, organización surgida a partir de la acción decidida de tres dirigentes estudiantiles del Instituto Pedagógico, alumnos de Pedagogía en Filosofía, de esa universidad. La labor inicial del DUOC iba en favor de los más desposeídos y que se deseaba entregarles herramientas para su crecimiento personal y laboral. Esta acción obedecía a la Reforma Universitaria iniciada el 11 de agosto de 1967 en esa organización perteneciente a la Iglesia Católica. Aún hoy subsiste esta institución, aunque ha variado en su objetivo inicial.

Abstract. At the end of 2018, 50 years were remembered since the founding of the Departamento Universitario Obrero Campesino -DUOC- at the Pontificia Universidad Católica de Chile, an organization that arose from the determined action of three student leaders of the Instituto Pedagógico, students of Philosophy Pedagogy, of that university. DUOC's initial work was in favor of the most disadvantaged students, who wanted to provide them with tools for their personal and professional growth. This action obeyed the University Reform initiated on August 11, 1967 in this organization belonging to the Catholic Church. This institution still exists today, although its initial objective has changed.

Corrigendum to "Regional variations in baseline characteristics of cardiac rhythm device recipients: The PANORAMA observational cohort study" [Int. J. Cardiol. Heart Vessels (2014) 90-96].

[This corrects the article DOI: 10.1016/j.ijchv.2014.06.008.].

Treatment of Osteoarthritis of the Knee with a Combination of Autologous Conditioned Serum and Physiotherapy: A Two-Year Observational Study.

BACKGROUND: Autologous conditioned serum (ACS) is an autologous blood product that has shown efficacy against knee osteoarthritis (OA) in randomized controlled trials. However, there are few reports of its effectiveness in everyday practice. Here, we report clinical efficacy results from a two-year prospective observational study of patients with highly symptomatic knee OA who received ACS in conjunction with physiotherapy. METHODS: 118 patients with unilateral knee OA (Kellgren-Lawrence grades I-IV), who were candidates for surgery but instead chose conservative treatment, were treated with a combination of four intra-articular injections of ACS (2 mL each) once weekly over four weeks and subsequent physiotherapy applied 4 weeks after ACS injection. Main endpoints of the study were pain (Numeric Rating Scale [NRS]) assessed at 0, 3, 6, 12 and 24 months, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score, assessed at 0 and 24 months. The effect size (Cohen's d) was calculated for pain and WOMAC outcomes, with effect sizes >0.8 considered large. RESULTS: By 3 months, there were significant improvements in pain (NRS) from baseline (-63.0%, p<0.001), which were maintained over 24 months. Mean WOMAC global score was reduced at 24 months compared to baseline (-56.9%, p<0.001), as were WOMAC subscores of pain (-86.0%, p<0.001) and function (-51.3%, p<0.001). Effect sizes for pain (>5) and WOMAC improvement (8.0-13.6) were very large. Only one patient received total knee joint replacement during the study. Clinical improvement did not correlate with gender, age, Kellgren-Lawrence grade, or body mass index. CONCLUSIONS: Treatment with ACS and physiotherapy produced a rapid decline in pain, which was sustained for the entire two years of the study. This was accompanied by a large improvement in WOMAC scores at two years. These results confirm that ACS combined with physiotherapy is an effective treatment for OA of the knee.

Regional variations in baseline characteristics of cardiac rhythm device recipients: The PANORAMA observational cohort study.

BACKGROUND: The PANORAMA study was designed to collect concurrent data on subjects from different worldwide regions implanted with CRM devices. METHODS: In this prospective, multi-center study, we analyzed baseline data on 8586 subjects implanted with CRM devices with no additional selection criteria (66% pacemaker (IPG), 16% implantable cardiac defibrillators (ICD), 17% cardiac resynchronization therapy (CRT) and < 1% Internal Loop Recorder) from 156 hospitals across 6 geographical regions between 2005 and 2011. RESULTS: Regardless of the device implanted, subjects from the Middle East and India often had more diabetes than other regions. Eastern and Western Europe had higher rates of atrial fibrillation reported, and men were more likely to smoke than women (46% vs 11%, p < 0.001). Within the CRT cohort there was significant variation in the proportion of males receiving a device, ranging from 55% in India to 83% in Eastern Europe. CONCLUSIONS: We provide comprehensive descriptive data on patients receiving CRM devices from a range of geographies that are not typically reported in literature. We found significant variations in clinical characteristics and implant practices. Long term follow-up data will help evaluate if these variations require adjustments to outcome expectations.

Presencia franciscana en las universidades durante los siglos XIII y XIV / Franciscan presence in the universities during the XIII and XIV centuries

Se presentan insumos de análisis que aportan en el reconocimiento del origen de la filosofía franciscana, sus principales exponentes europeos y su incursión en los centros educacionales superiores en el siglo XIII, resaltando su aporte a la ciencia y a la configuración del pensamiento moderno.

Inputs from analyses, which provide recognition of the origin of the Franciscan philosophy, its mainEuropean exponents, and its incursion into educational universities in the 13th century, highlighting its contribution to science and to the configuration of modern thought, are presented.

Prevención primaria y secundaria de muerte súibita en el ICD Registry Latin America / Primary and secondary prevention of sudden cardiac death in the icd registry-latin america

INTRODUCTION AND OBJECTIVES: The ICD Registry is an observational study conducted in Latin America to collect data on indications and follow-up care for primary or secondary prevention of sudden cardiac death patients. The objective of this study is to compare and evaluate the characteristics of primary versus secondary prevention in the patient population enrolled in the registry. METHODS: Demographic data, indication, etiology, NYHA functional class and left ventricular ejection fraction (LVEF), pharmacological treatment at implant and the type of ICD implanted were also collected. During the follow-up period the ICD therapies delivered, patient hospitalizations and mortality were evaluated. RESULTS: 507 patients were evaluated. Average age 60 +/- 14 years old, 78% male. Coronary heart disease was the most common etiology (43.6%). NYHA Functional Class I/II at the time of implant (73.6%). Average LVEF was 34 +/- 16%. Out of 507 patients, 189 received an ICD for primary prevention; 318 for secondary prevention. Primary prevention patients were older, predominantly male and had a lower EF. The rate of mortality and hospitalizations were similar between both groups with a higher rate of appropriate therapies in secondary prevention patients. CONCLUSIONS: This is the first study to demonstrate clinical characteristics of primary prevention patients in Latin America. There were no significant statistically differences in a short follow-up period in mortality or hospitalization as compared to the secondary prevention patient population in the Registry.

Incapacidades prolongadas inadecuadas: ¿un problema del asegurado, del médico o de los servicios de salud? / Inadequate long term disability claims: Is the problem due to the insured patient, the physician or medical services?

Para identificar la frecuencia del otorgamiento inadecuado de la incapacidad prolongada y los factores relacionados, se evaluó mediante comités la aplicación del proceso técnico médico en el otrogamiento de 138 incapacidades prolongadas. La consistencia inter-intra comités fue adecuada. Las deficiencias más frecuentes del proceso técnico médico en el primer nivel de atención estuvieron en la incongruencia clínica diagnóstica terapéutica y la falta de referencia oportuna. En el segundo nivel, fueron la falta de contrarreferencia oportuna y la falta de apego al Programa de Atención Prioritaria al Trabajador. Los factores que se encontraron relacionados al otorgamiento inadecuado fueron la rama de enfermedad general (p=0.039) y los diagnósticos diferentes a fracturas (p=0.026). Hubo ganancia secundaria del asegurado en 47.4 por ciento de los otorgamientos inadecuados. Las características del asegurado, del médico y del servicio no tuvieron relación con el otorgamiento inadecuado. Se propone llevar a cabo estrategias de incapacidad para mejorar la aplicación del proceso técnico médico.

Epidemiología de la hepatitis viral en Venezuela: resultados preliminares de la etapa 1. Prevalencia en el área metropolitana / Epidemiological study of viral hepatitis in Venezuela

Se investigó la condición inmunológica relacionada con los virus de la hepatitis A,B,C y agente delta, en 557 sujetos seleccionados aleatoriamente sobre la población sana de dos zonas diferentes del área metropolitana. Se realizó historia clínica con énfasis en hepatopatías, que permitió obtener mas de 20 datos por sujeto, los cuales se asociaron posteriormente con investigaciones sobre la evidencia sérica de marcadores virales realizados con métodos inmunoenzimáticos, en el caso de los Anticuerpos para el Virus C, inmunoensayo de segunda generación. Los resultados informaron sobre la prevalencia del virus en los encuestados, la cual en general es algo inferior a la reportada previamente: anticuerpos para el virus A: 90.84 por ciento , antígeno de superficie para el virus B: 1,62 por ciento , anti core: 10.6 por ciento , anticuerpos del virus C: 0,36 por ciento y anticuerpos para el virus delta en sujetos con positividad para el virus B: 0 por ciento . Estos resultados inducen a extender el estudio en la población a fín de conocer la estabilidad ó los cambios en las tendencias del virus, y las variables a las que se asocian