Ultrasound-Assisted Extraction of Phenolic Compounds from Psidium cattleianum Leaves: Optimization Using the Response Surface Methodology.

In this study, conditions for the ultrasound-assisted extraction (UAE) of soluble polyphenols from Psidium cattleianum (PC) leaves were optimized using response surface methodology (RSM) by assessing the effect of extraction time (XET = 2, 4, and 6 min), sonication amplitude (XSA = 60, 80, and 100%), and pulse cycle (XPC = 0.4, 0.7, and 1 s). Furthermore, the optimized UAE conditions were compared with a conventional aqueous-organic extraction (AOE) method for extracting total phenolics; moreover, a phenolic profile using HPLC and antioxidant activity (DPPH, ABTS, and FRAP) were also compared. According to the RSM, the best conditions for UAE to extract the highest soluble polyphenol content and yield (158.18 mg/g dry matter [DM] and 15.81%) include a 100% sonication amplitude for 4 min at 0.6 s of pulse cycle. The optimal UAE conditions exhibited an effectiveness of 1.71 times in comparison to the AOE method for extracting total phenolics, in 96.66% less time; moreover, PC leaf extracts by UAE showed higher antioxidant values than AOE. Additionally, gallic, protocateic, chlorogenic, caffeic, coumaric, trans-cinnamic, 4-hydroxybenzoic, and syringic acids, as well as kaempferol were identified in PC leaves under UAE. PC leaf extracts are widely used for therapeutic and other industrial purposes; thus, the UAE proves to be a useful technology with which to improve the yield extraction of PC leaf phytochemicals.

PTPN22 gene functional polymorphism (rs2476601) in older adults with frailty syndrome.

The frailty syndrome is a common clinical marker of vulnerability in older adults conducive to an overall decline in inflammatory stress responsiveness; yet little is known about the genetic risk factors for frailty in elderly. Our aim was to investigate the association between the rs2476601 polymorphism in PTPN22 gene and susceptibility to frailty in Mexican older adults. Data included 630 subjects 70 and older from The Coyoacán cohort, classified as frail, pre-frail, and non-frail following Fried's criteria. Sociodemographic and clinical characteristics were compared between groups at baseline and after a multivariate analysis. The rs2476601 polymorphism was genotyped by TaqMan genotyping assay using real-time PCR and genotype frequencies were determined for each frailty phenotype in all participants and subsets by age range. Genetic association was examined using stratified and interaction analyses adjusting for age, sex and variables selected in the multivariate analysis. Disability for day-life activities, depression and cognitive impairment were associated with the risk of pre-frailty and frailty at baseline and after adjustment. Carrying the T allele increased significantly the risk of frailty in patients 76 and older (OR 5.64, 95% CI 4.112-7.165) and decreased the risk of pre-frailty under no clinical signs of depression (OR 0.53; 95% CI 0.17-1.71). The PTPN22 polymorphism, rs2476601, could be a genetic risk factor for frailty as subject to quality of life. This is the first study analyzing such relationship in Mexican older adults. Confirming these findings requires additional association studies on wider age ranges in populations of older adults with frailty syndrome.

Rare intronic variants of TCF7L2 arising by selective sweeps in an indigenous population from Mexico.

BACKGROUND: Genetic variations of the TCF7L2 gene are associated with the development of Type 2 diabetes (T2D). The associated mutations have demonstrated an adaptive role in some human populations, but no studies have determined the impact of evolutionary forces on genetic diversity in indigenous populations from Mexico. Here, we sequenced and analyzed the variation of the TCF7L2 gene in three Amerindian populations and compared the results with whole-exon-sequencing of Mestizo populations from Sigma and the 1000 Genomes Project to assess the roles of selection and recombination in diversity. RESULTS: The diversity in the indigenous populations was biased to intronic regions. Most of the variation was low frequency. Only mutations rs77961654 and rs61724286 were located on exon 15. We did not observe variation in intronic region 4-6 in any of the three indigenous populations. In addition, we identified peaks of selective sweeps in the mestizo samples from the Sigma Project within this region. By replicating the analysis of association with T2D between case-controls from the Sigma Project, we determined that T2D was most highly associated with the rs7903146 risk allele and to a lesser extent with the other six variants. All associated markers were located in intronic region 4-6, and their r(2) values of linkage disequilibrium were significantly higher in the Mexican population than in Africans from the 1000 Genomes Project. We observed reticulations in both the haplotypes network analysis from seven marker associates and the neighborNet tree based on 6061 markers in the TCF7L2 gene identified from all samples of the 1000 Genomes Project. Finally, we identified two recombination hotspots in the upstream region and 3' end of the TCF7L2 gene. CONCLUSIONS: The lack of diversity in intronic region 4-6 in Indigenous populations could be an effect of selective sweeps generated by the selection of neighboring rare variants at T2D-associated mutations. The survivors' variants make the intronic region 4-6 the area of the greatest population differentiation within the TCF7L2 gene. The abundance of selective peak sweeps in the downstream region of the TCF7L2 gene suggests that the TCF7L2 gene is part of a region that is in constant recombination between populations.

Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly.

OBJECTIVE: Since vitamin D is an important regulator of muscle function, the effect of vitamin D deficiency on frailty syndrome has been recently studied. This cross-sectional study aimed to determine the association between 25(OH)-vitamin D levels and frailty status in Mexican community-dwelling elderly. METHODS: Sample of 331 community-dwelling elderly aged 70 or older, a subset of those included in the "Coyoacán cohort" were included. 25(OH)-vitamin D assay and frailty status were measured. RESULTS: Mean age was 79.3 years and 54.1% were women. Those classified as frail were more likely to have lower Mini-Mental State Examination score (p = 0.015), more disability for instrumental activities of daily living (p < 0.001) and for activities of daily living (p < 0.001). Serum 25(OH)-vitamin D levels were lower in the frail subgroup when compared with the non-frail one (p < 0.001). Multivariate logistic regression analyses showed a significant association between intermediate tertile [odds ratios (OR) = 4.13; 95% confidence intervals (CI) 2.00-8.56] or insufficient tertile (OR = 8.95; 95% CI 2.41-33.30) of vitamin D levels and frailty even after adjusting for potential confounders. CONCLUSION: These results suggest that older adults with low 25(OH)-vitamin D levels are associated with the probability to being frail compared with those with sufficient vitamin D levels.

Autocrine/paracrine proliferative effect of ovarian GH and IGF-I in chicken granulosa cell cultures.

It is known that growth hormone (GH) and its receptor (GHR) are expressed in granulosa cells (GC) and thecal cells during the follicular development in the hen ovary, which suggests GH is involved in autocrine/paracrine actions in the female reproductive system. In this work, we show that the knockdown of local ovarian GH with a specific cGH siRNA in GC cultures significantly decreased both cGH mRNA expression and GH secretion to the media, and also reduced their proliferative rate. Thus, we analyzed the effect of ovarian GH and recombinant chicken GH (rcGH) on the proliferation of pre-hierarchical GCs in primary cultures. Incubation of GCs with either rcGH or conditioned media, containing predominantly a 15-kDa GH isoform, showed that both significantly increased proliferation as determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, proliferating cell nuclear antigen (PCNA) quantification and ((3)H)-thymidine incorporation ((3)H-T) assays in a dose response fashion. Both, locally produced GH and rcGH also induced the phosphorylation of Erk1/2 in GC cultures. Furthermore, GH increased IGF-I synthesis and its release into the GC culture incubation media. These results suggest that GH may act through local IGF-I to induce GC proliferation, since IGF-I immunoneutralization completely abolished the GH-induced proliferative effect. These data suggest that GH and IGF-I may play a role as autocrine/paracrine regulators during the follicular development in the hen ovary at the pre-hierarchical stage.

VNTR polymorphisms of the IL-4 and IL-1RN genes and their relationship with frailty syndrome in Mexican community-dwelling elderly.

Inflammation is a key event that is closely associated with the pathophysiology of frailty. The relationship of genetic polymorphisms into inflammatory cytokines with frailty remains poorly understood. The aim of this study was to investigate the association between VNTR polymorphisms of the IL-4 and IL-1RN genes with the risk of frailty. We included a sample of 630 community-dwelling elderly aged 70 and older. Both IL-4 and IL-1RN VNTR polymorphisms were genotyped by the polymerase chain reaction (PCR) method. Mean age was 77.7 years (SD = 6.0) and 52.5 % were women. The participants classified as frail were more likely to be older, had lower MMSE score (p < 0.001), and had more disability for IADL (p < 0.001) and ADL (p < 0.001). Genotypic and allelic frequencies for the IL-4 VNTR polymorphism did not show significant differences between study groups (p > 0.05). However, we just observed a significant difference in the allelic frequencies for the A2 allele of the IL-1RN VNTR polymorphism between frail and nonfrail groups (OR 1.84, 95 % CI 1.08-3.12, p = 0.02). In addition, we analyzed the combined effect of the IL-4 and IL-1RN VNTR polymorphisms and their possible association with frailty, where the combined IL-4 (low) -IL-1Ra (high) genotype was identified as a marker of risk to frailty syndrome (OR 7.86, 95 % CI 1.83-33.69, p = 0.006). Our results suggest that both A2 allele and the combined IL-4 (low) -IL-1Ra (high) genotype might be genetic markers of susceptibility to frailty in Mexican elderly.

Direct antiapoptotic effects of growth hormone are mediated by PI3K/Akt pathway in the chicken bursa of Fabricius.

Growth hormone (GH) is expressed in several extra-pituitary tissues, including the primary and secondary lymphoid organs of the immune system. In birds, GH mRNA and protein expression show a specific developmental distribution pattern in the bursa of Fabricius (BF), particularly in epithelial and B cells. Changes in the bursal concentration and distribution of locally produced GH during ontogeny suggest it is involved in B cell differentiation and maturation, as well as in a functional survival role in this organ, which may be mediated by paracrine/autocrine mechanisms. Here, we analyzed the anti-apoptotic effect of GH in BF and the intracellular signaling pathways involved in this activity. Also, we studied if this effect was exerted directly by GH or mediated indirectly by IGF-I. Bursal cell cultures showed an important loss of their viability after 4h of incubation and a significant increase in apoptosis. However, treatment with 10nM GH or 40 nM IGF-I significantly increased B cell viability (16.7 ± 0.67% and 13.4 ± 1.12%, respectively) when compared with the untreated controls. In addition, the presence of apoptotic bodies (TUNEL) dramatically decreased (5.5-fold) after GH and IGF-I treatments, whereas co-incubation with anti-GH or anti-IGF-I, respectively, blocked their anti-apoptotic effect. Likewise, both GH and IGF-I significantly inhibited caspase-3 activity (by 40 ± 2.0%) in these cultures. However, the use of anti-IGF-I could not reverse the GH anti-apoptotic effects, thus indicating that these were exerted directly. The addition of 100 nM wortmannin (a PI3K/Akt inhibitor) blocked the GH protective effects. Also, GH stimulated (3-fold) the phosphorylation of Akt in bursal cells, and adding wortmannin or an anti-GH antibody inhibited this effect. Furthermore, GH was capable to stimulate (7-fold) the expression of Bcl-2. Taken together, these results indicate that the direct anti-apoptotic activity of GH observed in the chicken bursal B cell cultures might be mediated through the PI3K/Akt pathway.

Expression and function of chicken bursal growth hormone (GH).

Growth hormone (GH) has several effects on the immune system. Our group has shown that GH is produced in the chicken bursa of Fabricius (BF) where it may act as an autocrine/paracrine modulator that participates in B-cell differentiation and maturation. The time course of GH mRNA and protein expression in the BF suggests that GH may be involved in development and involution of the BF, since GH is known to be present mainly in B lymphocytes and epithelial cells. In addition, as GH is anti-apoptotic in other tissues, we assessed the possibility that GH promotes cell survival in the BF. This work focused on determining the mechanism by which GH can inhibit apoptosis of B cells and if the PI3K/Akt pathway is activated. Bursal cell cultures were treated with a range of GH concentrations (0.1-100nM). The addition of 10nM GH significantly increased viability (16.7±0.6%) compared with the control and decreased caspase-3 activity to 40.6±6.5% of the control. Together, these data indicate that GH is produced locally in the BF and that the presence of exogenous GH in B cell cultures has antiapoptotic effects and increases B cell survival, probably through the PI3k/Akt pathway.

Neuro-protective effects of growth hormone (GH) after hypoxia-ischemia injury in embryonic chicken cerebellum.

Neuroprotection is a mechanism within the central nervous system (CNS) that protects neurons from damage as a result of a severe insult. It is known that growth hormone (GH) is involved in cell survival and may inhibit apoptosis in several cell types, including those of the CNS. Both GH and GH-receptor (GHR) genes are expressed in the cerebellum. Thus, we investigated the possible neuroprotective role of GH in this organ, which is very sensitive to hypoxic/ischemic conditions. Endogenous GH levels increased in the brain and cerebellum (30% and 74%, respectively) of 15-day-old chicken embryos exposed to hypoxia during 24h compared to normoxia. In primary embryonic cerebellar neuron cultures treated under hypoxia (0.5% O(2)) and low glucose (1g/L) conditions (HLG) for 1h, GH levels increased 1.16-fold compared to the control. The addition of 1nM recombinant chicken GH (rcGH) to cultures during HLG increased cell viability (1.7-fold) and the expression of Bcl-2 (1.67-fold); in contrast the caspase-3 activity and the proportion of apoptotic cells decreased (37% and 54.2%, respectively) compared to HLG. rcGH activated the PI3K/Akt pathway both under normoxic and HLG conditions, increasing the proportion of phosphorylated Akt (1.7- and 1.4-fold, respectively). These effects were abolished by wortmannin and by immunoneutralization, indicating that GH acts through this signaling pathway. Furthermore, the 15-kDa GH variant (10nM) significantly increased cell viability and decreased caspase-3 activity during HLG condition. Thus GH may act as a paracrine/autocrine neuroprotective factor that preserves cellular viability and inhibits apoptotic cell death.

Rhizobial extrachromosomal replicon variability, stability and expression in natural niches.

In bacteria, niche adaptation may be determined by mobile extrachromosomal elements. A remarkable characteristic of Rhizobium and Ensifer (Sinorhizobium) but also of Agrobacterium species is that almost half of the genome is contained in several large extrachromosomal replicons (ERs). They encode a plethora of functions, some of them required for bacterial survival, niche adaptation, plasmid transfer or stability. In spite of this, plasmid loss is common in rhizobia upon subculturing. Rhizobial gene-expression studies in plant rhizospheres with novel results from transcriptomic analysis of Rhizobium phaseoli in maize and Phaseolus vulgaris roots highlight the role of ERs in natural niches and allowed the identification of common extrachromosomal genes expressed in association with plant rootlets and the replicons involved.

Physiological Effects and Human Health Benefits of Hibiscus sabdariffa: A Review of Clinical Trials.

Hibiscus sabdariffa Linn. Malvaceae (HS) is characterized by its edible calyxes. The HS calyxes are widely used for cosmetic, food, and medicinal applications. According to ethnobotanical evidence, decoction, infusion, or maceration extracts from HS calyxes have been used in folk medicine to treat many ailments. Moreover, several in vitro and in vivo studies have demonstrated the pharmacological properties and potential human health benefits of HS consumption. On the other hand, the evaluation of the physiological effects and health benefits of HS in clinical studies is most challenging. Therefore, this narrative review summarizes and discusses the physiological effects and health benefits of HS calyxes reported in clinical trials. Preparations obtained from HS calyxes (extracts, infusions, decoction, teas, beverages, capsules, and pills) are used as non-pharmacological therapies to prevent/control diverse chronic non-communicable diseases. The most-reported HS health benefits are its antihypertensive, antidyslipidemic, hypoglycemic, body fat mass reduction, nephroprotective, antianemic, antioxidant, anti-inflammatory, and anti-xerostomic activities; these effects are associated with the phytochemicals found in HS. Moreover, no adverse effects were reported during the clinical trials. However, clinical studies exhibited some limitations; thus, further studies are required to validate the clinical efficacy of HS in large-scale studies with higher doses and a good experimental design.

[Oxidative stress level and placental histological changes during preeclampsia]. / Grado de estrés oxidativo y cambios histológicos placentarios durante la preeclampsia.

BACKGROUND: Oxidative stress has been related to several conditions during pregnancy (preeclampsia, abortions and premature rupture of membranes); it causes higher sensitivity of the endothelial blood vessel constriction and aggravates the endothelium dependent vasodilatación. OBJECTIVE: To determine the oxidative stress level and histological changes in preeclamptic women's placenta. PATIENTS AND METHOD: Longitudinal and comparative study. There were included 25 patients referred from second level health units (IMSS, ISSSTE and Hospital General de Zacatecas). To evaluate oxidative stress level, a sample of blood and placenta were obtained during delivery and a second sample was taken during mediate puerperium (10 days). RESULTS: In control group, total lipidic peroxide levels in serum were 135.6 +/- 7.3 nmol of MDA/mL of serum, compared with the group of moderate hypertension, which registered 222.0 +/- 35.15 nmol MDA/mL. Total lipidic peroxides in serum during puerperium for control group were 150.4 +/- 30.8 and 183.3 +/- 18.51 nmol MDA/mL for the group of moderate hypertension. Placental lipoperoxidation for control group was 0.40 +/- 0.03 microg MDNg, and of 0.32 +/- 0.03 microg MDN/g for the group of mild hypertension. Patients of moderate hypertension group showed an increase at 34% on placental lipoperoxidation over control group. Placental histological alterations where characterized by vascular remodeling loss, deposits of proteinaceous material and macrophagic process. CONCLUSION: Total lipidic peroxide levels in serum increases during preeclampsia. Histological changes refer uterus-placental ischemia that, probably, induces the oxidative stress.

Complete Genome Sequences of Three Rhizobium gallicum Symbionts Associated with Common Bean (Phaseolus vulgaris).

The whole-genome sequences of three strains of Rhizobium gallicum reported here support the concept that the distinct nodulation host ranges displayed by the symbiovars gallicum and phaseoli can be largely explained by different symbiotic plasmids.

Rhizobium etli taxonomy revised with novel genomic data and analyses.

The taxonomic position of Phaseolus vulgaris rhizobial strains with available sequenced genomes was examined. Phylogenetic analyses with concatenated conserved genomic fragments accounting for over half of each genome showed that Rhizobium strains CIAT 652, Ch24-10 (newly reported genome) and CNPAF 512 constituted a well-supported group independent from Rhizobium etli CFN 42(T). DNA-DNA hybridization results indicated that CIAT 652, Ch24-10 and CNPAF 512 could correspond to R. etli, although the hybridization values were at the borderline that distinguishes different species. In contrast, experimental hybridization results were higher (over 80%) with Rhizobium phaseoli type strain ATCC 14482(T) in congruence to phylogenetic and ANIm analyses. The latter criterion allowed the reclassification of R. etli strains 8C-3 and Brasil5 as R. phaseoli. It was therefore concluded, based on all the evidence, that the CIAT 652, Ch24-10, and CNPAF 512 strains should be reclassified as R. phaseoli in spite of several common features linking them to R. etli. The R. phaseoli and R. etli speciation process seems to be a more recent event than the speciation that has occurred among other sister species, such as R. leguminosarum-R. etli or R. rhizogenes-R. tropici.

Intervalo QTU prolongado durante el uso de cisapride / Prolonged QTU interval during cisapride use

El cisapride es el fármaco de elección en casos de reflujo gastroesofágico. Dentro de sus efectos colaterales se detalla la prolongación del intervalo QTU. En este artículo describimos un caso de prolongación del QTU probablemente asociado a esta medicación. El uso del cisapride debe ser vigilado, particularmente en grupos de alto riesgo, por lo que se recomienda realizar electrocardiogramas seriados. También deben recordarse los otros fármacos que prolongan el QT que no deben asociarse al cisapride y tampoco combinarse entre sí

Análisis de la variabilidad de la frecuencia cardíaca ¿instrumento u ornamento? / Heart rate variability analysis: ornament or device?

El corazón está inmerso dentro de una red que recibe y entrega información generando control y ajuste continuo, buscando la adaptación al medio. La variabilidad de la frecuencia cardíaca es una de las resultantes de estos mecanismos y expresa la modulación del nódulo sinusal. En consecuencia, el estudio da la variabilidad permite analizar los procesos dinámicos envueltos en el mantenimiento de la homeostasis, donde el sistema nervioso autónomo juega un papel protagónico. La normalidad del sistema se expresa por la variación, preparando continuamente al aparato cardiovascular para enfrentar al ambiente. La perturbación de los reflejos altera la modulación de la frecuencia cardíaca, con la consiguiente pérdida de la protección, creando un entorno inestable. Existen diferentes técnicas para medir la variabilidad, en este trabajo describimos las más simples, como las medidas de dispersión, varianza o el desvío estándar de los ciclos cardíacos. Otros métodos más complejos recurren al análisis espectral, o el uso de gráficos de Poincaré que se describen en detalle. Finalmente se desarrollan diferentes usos del análisis de la variabilidad de la frecuencia cardíaca en la clínica y en el campo de la investigación, donde impresiona ser muy prometedora. Su estudio permite comprender más claramente algunos fenómenos cardiovasculares. Eventualmente, puede transformarse en una herramienta más del clínico para el estudio de pacientes luego de un infarto agudo de miocardio y en diabéticos

Ablación por radiofrecuencia de extrasistolía ventricular frecuente sintomática / Radiofrequency ablation of symptomatic frequent ventricular extrasistolia

La actividad ectópica ventricular es una arritmia de habitual observación, que puede estar asociada o no a enfermedad cardíaca evidente. En este trabajo describimos una paciente con actividad ectópica ventricular muy frecuente y sintomática, incluso incapacitante, sin cardiopatía estructural, refractaria al tratamiento antiarrítmico. Dada estas características se decidió realizar un procedimiento de ablación por radiofrecuencia para eliminar la arritmia y en consecuencia con sus síntomas

Variabilidad de la frecuencia cardíaca durante la prueba de inclinación / Heart rate variability during inclination test

El rol del sistema nervioso autónomo en la fisiopatología del síncope mediado neurológicamente es trascendental. La respuesta autonómica durante la prueba de inclinación puede ser estudiada con la variabilidad de la frecuencia cardíaca buscando explicar los cambios autonómicos previos al síncope. Objetivos: estudiar la variabilidad de la frecuencia cardíaca en pacientes con síncope recurrente sometidos a una prueba de inclinación. Material y método: analizamos 19 pacientes consecutivos. Se midieron los intervalos RR de los últimos 5 minutos a 0° y a 75° en los pacientes negativos y en los 5 minutos previos al síncope en los positivos. Los intervalos RR se analizaron en el dominio temporal y espectral. También estudiamos el promedio y el desvío estándar de la presión arterial sistólica y diastólica a 75°. Resultados: la edad media fue 26,8±7 años, 78 por ciento eran mujeres. Diez pacientes (grupo 1) tuvieron una respuesta positiva a los 12±5 minutos de iniciada la prueba. Nueve pacientes (grupo 2) no desarrollaron síncope. En ambos grupos se observó un incremento significativo de la frecuencia cardíaca. El desvío estándar de los intervalos RR normales (SDNN) a 75° aumentó significativamente en el grupo l. El desvío estándar de la presión arterial durante la inclinación fue significativamente mayor en los positivos. No encontramos otras diferencias significativas. Conclusiones: los pacientes con síncope mediado neurológicamente mostraron variaciones en el tono autonómico y desarrollaron síncope cuando se incrementó el SDNN. El análisis de la variabilidad de la frecuencia cárdiaca permite conocer en mayor profundidad los cambios autonómicos que ocurren previo al síncope.

Síncope en el adulto anciano / Syncope in the elderly

El síncope es una consulta frecuente, más de 3 por ciento de la población adulta sufre de síncope. En pacientes añosos su estudio es más complejo por los numerosos diagnósticos a considerar. Los objetivos de este trabajo fueron: estudiar una población con síncope o presíncope recurrente; establecer su causa y realizar seguimiento para precisar recurrencias, el efecto del tratamiento y la mortalidad global. Analizamos retrospectivamente 39 pacientes consecutivos, con una edad media de 73 ñ 7 años, desde abril de 1995 a setiembre de 1997. Cincuenta y nueve por ciento eran del sexo femenino, 23 por ciento tenían enfermedad cardiovascular. Todos fueron sometidos a un interrogatorio detallado, electrocardiograma y prueba de inclinación. Resultados: la historia clínica y examen físico detallados orientaron a un diagnóstico en 29 pacientes (66 por ciento). Registros electrocardiográficos mostraron taquiarritmias en 7139 (17,9 por ciento). La prueba de inclinación fue positiva en 18 pacientes, diez desarrollaron síncope neurocardiogénico y ocho hipotensión ortostática. En 12 pacientes no se aclaró la causa. Pudimos contactar 38 pacientes, con un seguimiento medio de 14 ñ 8 meses. Una paciente murió y 29 no tuvieron recurrencias. Ocho pacientes tuvieron recurrencias, cuatro, más de un episodio, todos portadores de hipotensión ortostática. Conclusiones: nuestro principal hallazgo fue la alta incidencia de estados asociados a inestabilidad vasomotora. La historia clínica es de enorme utilidad, siempre y cuando se realice detalladamente. Un enfoque ordenado es crítico y permite la utilización racional de nuestras herramientas diagnósticas

Ablación por radiofrecuencia por vía auricular transeptal de un haz accesorio postero-lateral izquierdo / Radiofrequency ablation through the atrial septum in the left posterolateral region accesory pathway

La ablación por radiofrecuencia (ARF) es una técnica revolucionaria en el tratamiento de las arritmias. Su introducción en el arsenal terapéutico es relativamente reciente, con resultados excelentes. En este breve trabajo mostramos un procedimiento de ARF que utiliza una técnica diferente a la habitual. Nuestra paciente de 13 años es portadora de un síndrome de Wolf-Parkinson-White con historia de mareos y palpitaciones. Durante el estudio electrofisiológico se indujo taquicardia ortodrómica, comprobandose que el circuito de la taquicardia utilizaba el haz accesorio en forma retrógrada, que se localizó en la región postero-lateral izquierda. Un catéter de ablación se introdujo en la aurícula izquierda por vía femoral derecha a través del septum auricular, posicionándolo en el área donde se interesaba la vía anómala. Luego de 2 lesiones, utilizando ondas de radiofrecuencia se logró la ablación del haz accesorio, evidenciada por la desaparición de la onda delta y disociación ventrículo auricular por estimulación ventricular a frecuencias bajas. La técnica transeptal es ideal para esta localización, ya que el catéter es más estable, fácilmente manipulable y sin riesgo de dañar la válvula aórtica