Construcción del índice de vulnerabilidad sexual de las mujeres trans

Objetivo: Construir un índice que determine la vulnerabilidad sexual de las mujeres trans. Material y Método: Estudio mixto realizado entre los años 2020 y 2021 que en su primera fase utilizó el análisis de contenido para textos que describían los conceptos básicos de vulnerabilidad, vulnerabilidad social y riesgo, apoyado con los relatos obtenidos en grupos focales y entrevistas a 14 mujeres transgénero para generar el constructo teórico de vulnerabilidad sexual de las mujeres transgénero. Para la segunda parte, a partir de la información recolectada de 417 mujeres transgénero de las ciudades de Bogotá y Cali que habían participado del estudio "Vulnerabilidad y Prevalencia de VIH en Mujeres Transgénero en tres ciudades de Colombia: Bogotá, Medellín y Santiago de Cali-2019", se seleccionaron las variables que serían parte de un análisis factorial exploratorio para construir la versión preliminar del índice. Resultados: Se construyó el índice de riesgo de vulnerabilidad sexual de las mujeres transgénero compuesto por 3 factores: apoyo social, prácticas sexuales y cuidado de la salud. El índice consta de 10 preguntas que se evalúan como 0 o 1, donde los puntajes más altos evidencian un mayor riesgo de vulnerabilidad sexual. Conclusiones: La vulnerabilidad sexual es un fenómeno construido por factores propios de la experiencia trans e influenciado por las características del contexto donde la persona habita; el índice construido cuenta con buena consistencia interna (alfa ordinal 0,90). Asimismo, se encontró concordancia entre el modelo teórico de la fase cualitativa y los resultados del análisis factorial exploratorio.

Objective: To construct an index to determine the sexual vulnerability of trans women. Materials and Methods: Mixed study conducted between 2020 and 2021, which in its first phase used content analysis for texts describing the basic concepts of vulnerability, social vulnerability and risk. This was supported by accounts from focus groups and interviews with 14 transgender women to generate the theoretical construct of sexual vulnerability of transgender women. For the second phase, from the information provided by 417 transgender women from the cities of Bogotá and Cali, who participated in the study "Vulnerability and HIV Prevalence in Transgender Women in three cities of Colombia: Bogota, Medellin and Santiago de Cali - 2019", variables were selected to be part of an exploratory factor analysis to construct the preliminary version of the index. Results: The sexual vulnerability risk index of transgender women was based on 3 factors: social support, sexual practices, and health care. The index consisted of 10 questions scored as 0 or 1, with higher scores indicating a higher risk of sexual vulnerability. Conclusions: Sexual vulnerability is a phenomenon based on factors which are specific to the trans experience and it is influenced by the characteristics of the context in which the person lives. The constructed index has good internal consistency (ordinal alpha 0.90) and shows concordance between the theoretical model of the qualitative phase and the results of the exploratory factor analysis.

Objetivo: Construir um índice para determinar a vulnerabilidade sexual de mulheres transgênero. Material e Método: Estudo misto realizado entre 2020 e 2021 que, em sua primeira fase, utilizou a análise de conteúdo para textos que descrevem os conceitos básicos de vulnerabilidade, vulnerabilidade social e risco; apoiado por relatos obtidos em grupos focais e entrevistas com 14 mulheres transgênero para gerar o construto teórico de vulnerabilidade sexual de mulheres transgênero. Para a segunda fase, a partir das informações fornecidas por 417 mulheres transgênero das cidades de Bogotá e Cali que participaram do estudo "Vulnerabilidade e Prevalência de HIV em Mulheres Transgênero em três cidades da Colômbia: Bogotá, Medellín e Santiago de Cali-2019", foram selecionadas variáveis que fizeram parte de uma análise fatorial exploratória para construir a versão preliminar do índice. Resultados: O índice de risco de vulnerabilidade sexual de mulheres transgênero foi construído com base em três fatores: apoio social, práticas sexuais e assistência à saúde. Consiste em 10 perguntas que são avaliadas como 0 ou 1, em que as pontuações mais altas evidenciam um risco maior de vulnerabilidade sexual. Conclusões: A vulnerabilidade sexual é um fenômeno baseado em fatores que são específicos da experiência trans e é influenciado pelas características do contexto em que a pessoa vive. Além disso, o índice construído tem boa consistência interna (alfa ordinal 0,90) e mostra concordância entre o modelo teórico da fase qualitativa e os resultados da análise fatorial exploratória.

Comparison of Four Real-Time Polymerase Chain Reaction Assays for the Detection of SARS-CoV-2 in Respiratory Samples from Tunja, Boyacá, Colombia.

Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. In Colombia, many commercial methods are now available to perform the RT-qPCR assays, and laboratories must evaluate their diagnostic accuracy to ensure reliable results for patients suspected of being positive for COVID-19. The purpose of this study was to compare four commercial RT-qPCR assays with respect to their ability to detect the SARS-CoV2 virus from nasopharyngeal swab samples referred to Laboratorio Carvajal IPS, SAS in Tunja, Boyacá, Colombia. We utilized 152 respiratory tract samples (Nasopharyngeal Swabs) from patients suspected of having SARS-CoV-2. The diagnostic accuracy of GeneFinderTM COVID-19 Plus RealAmp (In Vitro Diagnostics) (GF-TM), One-Step Real-Time RT-PCR (Vitro Master Diagnostica) (O-S RT-qPCR), and the Berlin modified protocol (BM) were assessed using the gold-standard Berlin protocol (Berlin Charité Probe One-Step RT-qPCR Kit, New England Biolabs) (BR) as a reference. Operational characteristics were estimated in terms of sensitivity, specificity, agreement, and predictive values. Using the gold-standard BR as a reference, the sensitivity/specificity of the diagnostic tests was found to be 100%/92.7% for GF-TM, 92.75%/67.47% for O-S RT-qPCR, and 100%/96.39% for the BM protocol. Using BR as a reference, the sensitivity/specificity for the diagnostic tests were found to be 100%/92.7% for the GF-TM assay, 92.72%/67.47% for the O-S RT-qPCR, and 100%/96.39% for BM. Relative to the BR reference protocol, the GF-TM and BM RT-PCR assays obtained similar results (k = 0.92 and k = 0.96, respectively), whereas the results obtained by O-S-RT-qPCR were only moderately similar. We conclude that the GF-TM and BM protocols offer the best sensitivity and specificity, with similar results in comparison to the gold-standard BR protocol. We recommend evaluating the diagnostic accuracy of the OS-RT-qPCR protocol in future studies with a larger number of samples.

Dry Needling Produces Mild Injuries Irrespective to Muscle Stiffness and Tension in Ex Vivo Mice Muscles.

Numerous studies have suggested that the myofascial trigger points are responsible for most of the myofascial pain syndrome, so it seems reasonable that its destruction is a good therapeutic solution. The effectiveness of dry needling (DN) has been confirmed in muscles with myofascial trigger points, hypertonicity, and spasticity. The objective of this study is to analyze the need of repetitive punctures on muscles in different situations. The levator auris longus (LAL) muscle and gastrocnemius muscle from adult male Swiss mice were dissected and maintained alive, while being submerged in an oxygenated Ringer's solution. DN was evaluated under four animal models, mimicking the human condition: normal healthy muscles, muscle fibers with contraction knots, muscles submerged in a depolarizing Ringer solution (KCl-CaCl2), and muscles submerged in Ringer solution with formalin. Thereafter, samples were evaluated with optical microscopy (LAL) and scanning electron microscopy (gastrocnemius). Healthy muscles allowed the penetration of needles between fibers with minimal injuries. In muscles with contraction knots, the needle separated many muscle fibers, and several others were injured, while blood vessels and intramuscular nerves were mostly not injured. Muscles submerged in a depolarizing solution inducing sustained contraction showed more injured muscular fibers and several muscle fibers separated by the needle. Finally, the muscles submerged in Ringer solution with formalin showed a few number of injured muscular fibers and abundant muscle fibers separated by the needle. Scanning electron microscopy images confirm the optical analyses. In summary, dry needling is a technique that causes mild injury irrespective of the muscle tone.

Diseno del trabajo, bienestar y salud mental: Revision de literatura / Work Design, Well-being, and Mental Health: Literature Review

Resumen. El presente texto aporta al conocimiento sobre la relación entre diseno del trabajo, bienestar y salud mental. Realizamos una revisión de las publicaciones más recientes en relación con las variables estudiadas para ofrecer una sintesis de los principales conceptos, modelos teóricos y la evidencia empirica que explican la relación. Efectuamos la búsqueda en cuatro bases de datos: Web of Science, Springer, Ebsco y Pro-Quest en las que identificamos N = 11,878 artículos sobre Work design (N = 4,332), Job Desgin (N = 4,854) y Job Demands-Resources (N = 2,692). Destacamos los modelos de características del trabajo y de demandas-recursos laborales, para promover el bienestar y salud mental de los trabajadores. Analizamos la importancia de integrar las variables a nivel práctico, en relación con las unidades de análisis individual, grupal y organizacional; así como la necesidad de tener en cuenta la variedad de ocupaciones, cargos y la forma en que sus empleados se interrelacionan.

Abstract. This text contributes to the knowledge about the relationship between work design, well-being and mental health. We review the most recent publications concerning the variables studied to offer a synthesis of the main concepts, theoretical models and the empirical evidence that explain the relationship. We searched four databases: Web of Science, Springer, Ebsco and Pro-Quest, in which we identified N = 11,878 articles on Work design (N = 4,332), Job design (N = 4,854) and Job Demands-Resources (N = 2,692). We highlight the models of job characteristics and job-demand resources, to promote the well-being and mental health of workers. We discuss the importance of integrating the variables at a practical level, about the individual, group and organizational units of analysis; as well as the need to take into account the variety of occupations, positions and how their employees interact.

Fuzzy dynamic parameter adaptation in the bird swarm algorithm for neural network optimization.

Fuzzy dynamic parameter adaptation has proven to be of great help when it is implemented in bio-inspired algorithms for optimization in different application areas, such as control, mathematical functions, classification, among others. One of the main contributions of this work is the proposed improvement of the Bird Swarm algorithm using a Fuzzy System approach, and we called this improvement the Fuzzy Bird Swarm Algorithm. Furthermore, we use a set of complex Benchmark Functions of the Congress on Evolutionary Computation Competition 2017 to compare the results between the original algorithm and the proposed improvement of the algorithm. The fuzzy system is utilized for the dynamic parameter adaptation of the C1 and C2 parameters of the Bird Swarm Algorithm. As a result, the Fuzzy Bird Swarm Algorithm has enhanced exploration and exploitation abilities that help in achieving better results than the Bird Swarm Algorithm. We additionally test the algorithm's performance in a real problem in the medical area, using the optimization of a neural network to obtain the risk of developing hypertension. This neural network uses information, such as age, gender, body mass index, systolic pressure, diastolic pressure, if the patient smokes and if the patient has parents with hypertension. Hypertension is one of the leading causes of heart problems, which in turn are also one of the top causes of death. Moreover, these days it causes more complications and deaths in people infected with COVID-19, the virus of the ongoing pandemic. Based on the results obtained through the 30 experiments carried out in three different study cases, and the results obtained from the statistical tests, it can be concluded that the proposed method provides better performance when compared with the original method.

Dimensiones de la medición de la calidad de vida en personas trans: una revisión sistemática / Dimensions of measuring quality of life in transgender people: a systematic review / Dimensões da medição da qualidade de vida em pessoas trans: uma revisão sistemática

Resumen La calidad de vida está compuesta por elementos subjetivos y objetivos que varían entre la población, para su adecuada medición se han generado diversos instrumentos con el propósito de obtener una adecuada medición. Objetivo: identificar las dimensiones de calidad de vida que se han evaluado en personas trans. Métodos: revisión sistemática de la literatura científica aplicando un protocolo de investigación con términos de búsqueda "quality of life" y "transgender"; realizada por cuatro investigadores para verificar la información encontrada. Resultados: inicialmente se identificaron 565 artículos, después de un proceso de revisión se eligieron 34 publicados entre los años 2006 y 2018. Se encontraron 13 herramientas para medir la calidad de vida en población trans. Las más utilizadas fueron las genéricas (38,2%), las de calidad de vida relacionada con la salud (35,3%) y las relacionadas con la voz (20,6%), las dimensiones más evaluadas fueron la física, la psicológica y la social. Conclusión: la calidad de vida en esta población debe medirse de manera más ajustada teniendo en cuenta las realidades de dicho grupo humano. Se identificó un bajo número de instrumentos de calidad de vida diseñados específicamente para las personas trans.

Abstract The quality of life is composed of subjective and objective elements that vary among the population. Various instruments have been generated for its adequate measurement with the purpose of obtaining an adequate measurement. Objective: To identify the dimensions of quality of life that have been evaluated in transgender people. Methods: Systematic review of the scientific literature carried out by three researchers applying a research protocol with the search terms "quality of life" and "transgender" to verify the information found. Results: A total of 565 articles were identified initially after a review process, from which 34, published between 2006 and 2018, were chosen. Thirteen tools were found to measure the quality of life in the transgender population. The most used were generic (38.2%), healthrelated quality of life (35.3%) and those related with the voice (20.6%). The dimensions most evaluated were physical, psychological and social. Conclusion: The quality of life in this population should be measured more closely, taking into account the realities of that human group. A low number of quality of life instruments designed specifically for transgender people were identified.

Resumo A qualidade de vida é composta por elementos subjetivos e objetivos que variam na população para sua adequada medição. Tem sido gerados diversos instrumentos com o propósito de obter uma adequada medição. Objetivo: identificar as dimensões de qualidade de vida que têm sido avaliadas em pessoas trans. Métodos: revisão sistemática da literatura científica aplicando um protocolo de pesquisa com termos de busca "quality of life" e "transgender"; realizada por quatro pesquisadores para verificar a informação encontrada. Resultados: inicialmente foram identificadas 565 artigos, depois de um processo de revisão foram escolhidas 34 publicações entre os anos 2006 e 2018. Encontraram-se 13 ferramentas para medir a qualidade de vida na população trans. As mais utilizadas foram as genéricas (38,2%), as de qualidade de vida relacionada com a saúde (35,3%) e as relacionadas com a voz (20,6%), as dimensões mais avaliadas foram a física, a psicológica e a social. Conclusão: a qualidade de vida nesta população deve medir-se de maneira mais ajustada levando em conta as realidades desse grupo humano. Identificou-se um baixo número de instrumentos de qualidade de vida desenhados especificamente para as pessoas trans.

Liderazgo, factores de riesgo psicosocial y estrés en la Dirección de Tránsito y Movilidad en Zapotlán el Grande (Jalisco) / Leadership, psychosocial risk factors and stress in the Traffic and Mobility Directorate in Zapotlán el Grande (Jalisco)

RESUMEN Objetivo: El presente trabajo se centra en evaluar algunos factores de riesgo psicosocial como son, organización del tiempo de trabajo, liderazgo y relación, ambiente de trabajo y factores propios de la actividad, así como el estrés y el liderazgo en trabajadores de la Dirección de Tránsito y Movilidad de Zapotlán el Grande. Métodos: Se aplicaron los instrumentos de factores de riesgo de la Norma 035 de México, el cuestionario de liderazgo (MQL) y el cuestionario de estrés de la Organización Internacional del Trabajo y la Organización Mundial para la Salud. Resultados: El nivel de estrés encontrado fue de M = 51.09 (D.E. = 20.97) y el nivel de factores de riesgo psicosociales fue de M = 66.19 (D.E. = 15.53) puntos. El estrés se encontró relacionado con la escala global de factores de riesgo (r = 0.422; p < 0.01). El liderazgo transformacional se correlacionó de manera inversa con factores de riesgo psicosocial (r = -0.642; p < 0.01). Conclusiones: Se encontraron niveles de estrés que pueden no ser dañinos y factores de riesgo propios de la actividad elevados. Los factores de riesgo de ambiente de trabajo, jornada de trabajo, interferencia familia-trabajo y violencia se correlación con el estrés. El liderazgo presentó una correlación inversa con factores de riesgo. Se recomienda realizar una intervención en la población con el fin de brindar un apoyo psicológico, emocional y consejería, con el fin de evitar el estrés y disminuir los factores de riesgo presentes en el trabajo.

ABSTRACT Objective: The present work focuses on evaluating some psychosocial risk factors such as, organization of work time, leadership and relationship, work environment and factors specific to the activity, as well as stress and leadership in management workers of Transit and Mobility of Zapotlán el Grande. Methods: Te risk factor instruments of the Mexican Standard 035, the leadership questionnaire (MQL) and the Stress questionnaire of the International Labor Organization and the World Health Organization were applied. Results: Te stress level found was M = 51.09 (SD = 20.97), and the level of psychosocial risk factors was M = 66.19 (SD = 15.53) points. Stress was found related to the global scale of risk factors (r = 0.422; p <0.01). The leadership transformational was inversely correlated with psychosocial risk factors (r = -0.642; p <0.01). Conclusions: Stress levels that may not be harmful and risk factors characteristic of the activity were found. Risk factors for work environment, work day, family-work interference and violence are correlated with stress. The leadership presented an inverse correlation with risk factors. It is recommended to carry out an intervention in the population in order to provide psychological, emotional and counseling support, in order to avoid stress and reduce risk factors present at work.

Slowdown intracranial glioma progression by optical hyperthermia therapy: study on a CT-2A mouse astrocytoma model.

Metallic nanorods are promising agents for a wide range of biomedical applications. We report an optical hyperthermia method capable of inducing slowdown tumor progression of an experimental in vivo CT-2A glioblastoma tumor. The tumor model used in this research is based on the transplantation of mouse astrocytoma CT-2A cells in the striatum of mice by intracranial stereotaxic surgery. Two weeks after cell implant, the resulting tumor is treated by irradiating intratumoral injected gold nanorods, biofunctionalized with CD133 antibody (B-GNRs), using a continuous wave laser. Nanoparticles convert the absorbed light into localized heat (reaching up to 44 °C) due to the effect of surface plasmon resonance. A significant slowdown in CT-2A tumor progression is evident, by histology and magnetic resonance imaging, at one (p = 0.03) and two weeks (p = 0.008) after irradiation treatment. A notable deceleration in tumor size (15%-75%) as compared to the control untreated groups, it is observed. Thus, laser irradiation of B-GNRs is found to be effective for the treatment of CT-2A tumor progression. Similarities between the pre-clinical CT-2A tumor model and the human astrocytoma disease, in terms of anatomy, metastatic behavior and histopathology, suggest that hyperthermic treatment by laser irradiation of B-GNRs administered into high-grade human astrocytoma might constitute a promising alternative treatment to limit the progression of this deadly disease.

Influence of medium viscosity and intracellular environment on the magnetization of superparamagnetic nanoparticles in silk fibroin solutions and 3T3 mouse fibroblast cell cultures.

Biomedical applications based on the magnetic properties of superparamagnetic iron oxide nanoparticles (SPIONs) may be altered by the mechanical attachment or cellular uptake of these nanoparticles. When nanoparticles interact with living cells, they are captured and internalized into intracellular compartments. Consequently, the magnetic behavior of the nanoparticles is modified. In this paper, we investigated the change in the magnetic response of 14 nm magnetic nanoparticles (Fe3O4) in different solutions, both as a stable liquid suspension (one of them mimicking the cellular cytoplasm) and when associated with cells. The field-dependent magnetization curves from inert fluids and cell cultures were determined by using an alternating gradient magnetometer, MicroMagTM 2900. The equipment was adapted to measure liquid samples because it was originally designed only for solids. In order to achieve this goal, custom sample holders were manufactured. Likewise, the nuclear magnetic relaxation dispersion profiles for the inert fluid were also measured by fast field cycling nuclear magnetic relaxation relaxometry. The results show that SPION magnetization in inert fluids was affected by the carrier liquid viscosity and the concentration. In cell cultures, the mechanical attachment or confinement of the SPIONs inside the cells accounted for the change in the dynamic magnetic behavior of the nanoparticles. Nevertheless, the magnetization value in the cell cultures was slightly lower than that of the fluid simulating the viscosity of cytoplasm, suggesting that magnetization loss was not only due to medium viscosity but also to a reduction in the mechanical degrees of freedom of SPIONs rotation and translation inside cells. The findings presented here provide information on the loss of magnetic properties when nanoparticles are suspended in viscous fluids or internalized in cells. This information could be exploited to improve biomedical applications based on magnetic properties such as magnetic hyperthermia, contrast agents and drug delivery.

Effects of Ezetimibe/Simvastatin and Rosuvastatin on Oxidative Stress in Diabetic Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

OBJECTIVE: To evaluate the effects of ezetimibe/simvastatin (EZE/SIMV) and rosuvastatin (ROSUV) on oxidative stress (OS) markers in patients with diabetic polyneuropathy (DPN). METHODS: We performed a randomized, double-blind, placebo-controlled phase III clinical trial in adult patients with Type 2 Diabetes Mellitus (T2DM) and DPN, as evaluated by composite scores and nerve conduction studies (NCS). Seventy-four subjects with T2DM were allocated 1 : 1 : 1 to placebo, EZE/SIMV 10/20 mg, or ROSUV 20 mg for 16 weeks. All patients were assessed before and after treatment: primary outcomes were lipid peroxidation (LPO), and nitric oxide (NO) surrogate levels in plasma; secondary outcomes included NCS, neuropathic symptom scores, and metabolic parameters. Data were expressed as mean ± SD or SEM, frequencies, and percentages; we used nonparametric analysis. RESULTS: LPO levels were reduced in both statin arms after 16 weeks of treatment (p < 0.05 versus baseline), without changes in the placebo group. NO levels were not significantly affected by statin treatment, although a trend towards significance concerning increased NO levels was noted in both statin arms. No significant changes were observed for the NCS or composite scores. DISCUSSION: EZE/SIMV and ROSUV are superior to placebo in reducing LPO in subjects with T2DM suffering from polyneuropathy. This trial is registered with NCT02129231.

Effect of necrosectomy and vacuum-assisted closure (VAC) on mitochondrial function and oxidative stress markers in severe acute pancreatitis.

BACKGROUND: Severe acute pancreatitis (SAP) is associated with high morbidity and mortality. OBJECTIVE: To evaluate whether necrosectomy, alone or combined with vacuum-assisted closure (VAC), has any additional beneficial effects on mitochondrial function and/or oxidative stress markers in SAP. METHODS: Patients with SAP, APACHE II score > 8, and inadequate response to management in an intensive care unit were included in a prospective observational study. Sixteen underwent necrosectomy and 24 underwent necrosectomy plus VAC every 48 h. Patients were then categorized as survivors or deceased. Submitochondrial membrane fluidity of platelets and F0F1-ATPase hydrolysis were measured to represent mitochondrial function. Oxidative/nitrosative stress was measured using lipoperoxides (LPOs), nitric oxide (NO), erythrocyte membrane fluidity, and total antioxidant capacity (TAC). RESULTS: Membrane fluidity in submitochondrial particles of platelets remained significantly increased throughout the study, and then eventually rised in deceased patients managed with necrosectomy + VAC vs. survivors (p < 0.041). Hydrolysis was significantly increased from baseline to endpoint in all patients, predominating in those who died after management with necrosectomy (p < 0.03). LPO increased in all patients, and necrosectomy was more efficient for the eventual decrease in survivors (p < 0.039). NO was found to be increased for the baseline-endpoint result among both survivors and deceased patients with both management options. Erythrocyte membrane fluidity was increased in survivors managed with necrosectomy + VAC, and eventually returned to normal (p < 0.045). TAC was found to be consumed in all patients for the duration of the study. CONCLUSIONS: Mitochondrial dysfunction and oxidative/ nitrosative stress with significant systemic antioxidant consumption were found. Necrosectomy was more efficient and better cleared LPOs. Necrosectomy + VAC improved erythrocyte membrane fluidity and increased survival.

Péptido natriurético tipo B en pacientes con enfermedad de Chagas: utilidad diagnóstica en la insuficiencia cardíaca / Natriuretic peptide in patients with Chagas disease: diagnostic utility in heart failure

La determinación de los niveles sanguíneos del péptido natriurético tipo B (BNP) ha demostrado ser de utilidad como marcadora de diagnóstico y pronóstico en la insuficiencia cardíaca congestiva. El objetivo del estudio fue cuantificar el BNP para conocer su asociación con el grado de disfunción sistólica en la enfermedad de Chagas. Se evaluaron 64 pacientes de la consulta de Chagas en la Unidad Cardiopulmonar del Hospital Universitario “Dr. Luis Razetti”, Barcelona, estado Anzoátegui, Venezuela, durante el periodo 2010-2011. Luego de la confirmación de la seropositividad a anticuerpos anti T. cruzi mediante tres pruebas inmunoserológicas (ELISA, inmunofluorescencia indirecta y hemaglutinación indirecta), los pacientes fueron clasificados en los Grupos I, II y III de la enfermedad cardíaca mediante la valoración del electrocardiograma, ecocardiograma y radiografía de tórax. En el estudio se incluyeron como controles a 33 pacientes cardiópatas seronegativos y a ocho voluntarios sanos. Los valores de BNP en los grupos fueron: Chagas I=18,87±18,00 pg/mL (n=20), Chagas II=99,88±171,52 pg/mL (n=24) y Chagas III=365,80±280,54 pg/mL (n=20). Se empleó como parámetro de referencia a la fracción de eyección del ventrículo izquierdo (FEVI <40%), los valores de sensibilidad y especificidad del BNP fueron 85,0% y 93,2% respectivamente (p< 0,0001; IC 95%), con un valor pronóstico del 89,0% (p=0,006). Estos resultados colocan al BNP en una posición equivalente a la del ecocardiograma para la evaluación de los pacientes cardiópatas, con las ventajas de simplicidad y rapidez de esta prueba bioquímica que la hace aplicable a estudios de campo en zonas endémicas de acceso limitado a los estudios ecocardiográficos.

The assessment of the type-B natriuretic peptide (BNP) has shown utility as a diagnostic and prognostic tool of heart failure. The aim of this study was to evaluate the BNP levels and to know its association within the systolic dysfunction level on Chagas disease. During the period 2010-2011, 64 patients were evaluated in the Chagas clinic of the Cardiopulmonary Unit of the University Hospital Dr. Luis Razetti, Barcelona- Anzoátegui state, Venezuela. After confirming the seropositive state to antibodies anti-T. cruzi with three inmunoserological tests (ELISA, indirect inmunofluorescence and indirect hemaglutination), patients were classified into Groups I, II and III of cardiac disease, by the evaluation with electrocardiogram, echocardiogram and thorax radiography. Thirty three seronegative cardiological patients and eight healthy volunteers were included in the study as controls. BNP groups levels were as follow: Chagas I = 18.87±18.00 pg/mL (n=20), Chagas II = 99.88±171.52 pg/mL (n=24) y Chagas III = 365.80±280.54 pg/mL (n=20). The sensitivity and specificity of BNP were 85.0% y 93.2%, respectively, (p< 0.0001; IC 95%), employing as parameter of reference the left ventricle fraction ejection (LVFE <40%), with a prognostic value of 89.0% (p=0.006). These results place the BNP in an equivalent position with the echocardiogram for the evaluation of cardiological patients, with the benefits of rapidity and simplicity, which makes the determination of this biochemical parameter a useful tool to perform field studies in endemic zones with limited access to the echocardiographic test.

[Natriuretic peptide in patients with Chagas disease: diagnostic utility in heart failure]. / Péptido natriurético tipo B en pacientes con enfermedad de Chagas: utilidad diagnóstica en la insuficiencia cardíaca.

The assessment of the type-B natriuretic peptide (BNP) has shown utility as a diagnostic and prognostic tool of heart failure. The aim of this study was to evaluate the BNP levels and to know its association within the systolic dysfunction level on Chagas disease. During the period 2010-2011, 64 patients were evaluated in the Chagas clinic of the Cardiopulmonary Unit of the University Hospital Dr. Luis Razetti, Barcelona-Anzoátegui state, Venezuela. After confirming the seropositive state to antibodies anti-T. cruzi with three inmunoserological tests (ELISA, indirect inmunofluorescence and indirect hemaglutination), patients were classified into Groups I, II and III of cardiac disease, by the evaluation with electrocardiogram, echocardiogram and thorax radiography. Thirty three seronegative cardiological patients and eight healthy volunteers were included in the study as controls. BNP groups levels were as follow: Chagas I = 18.87 +/- 18.00 pg/mL (n=20), Chagas II = 99.88 +/- 171.52 pg/mL (n=24) y Chagas III = 365.80 +/- 280.54 pg/mL (n=20). The sensitivity and specificity of BNP were 85.0% and 93.2%, respectively, (p<0.0001; IC 95%), employing as parameter of reference the left ventricle fraction ejection (LVFE <40%), with a prognostic value of 89.0% (p=0.006). These results place the BNP in an equivalent position with the echocardiogram for the evaluation of cardiological patients, with the benefits of rapidity and simplicity, which makes the determination of this biochemical parameter a useful tool to perform field studies in endemic zones with limited access to the echocardiographic test.

Torsión de las puntas y marcapaso endocavitario ventricular de demanda / Torsade de pointes and demand endocavitary pacemaker: report of one case

We report a 81 years old female with a severe aortic insufficiency, treated with diuretics and antidepressants admitted due to recurrent syncopal episodes. During the first syncopal episode, an atrioventricular block was detected and an endocavitary demand pacemaker implanted. Two years later, she had a new syncope without evidences of pacemaker failure. The EKG during pacemaker rhythm showed a prolonged QT interval. During hospital monitoring, she presented a self limited polymorphic ventricular tachycardia (Torsade de pointes). Consequently, the pacemaker was programmed at a greater frequency, and the QT interval shortened from 0.73 to 0.56 sec. Thereafter, the patient no longer had tachycardia or syncopal episodes, after one year of follow up

Angioplastía coronaria primaria: factores pedictores de mortalidad, fracaso y de isquemia recurrente / Primary coronary angioplasty: predictors of mortality, procedure failure and recurrent ischemia

La angioplastía primaria (PTCAP) ha sido sugerida como el tratamiento de elección del infarto de miocardio (IAM). Para evaluar su uso en nuestro medio y los factores que predicen fracaso de la técnica,mortalidad o recurrencia de la isquemia se estudian 201 pacientes que cursan un IAM < 12 h: 43 mujeres (21 por ciento), 87 en pared anterior (43 por ciento), de 61 ñ 12 años y 138 en Killip I (69 por ciento). Responsable del IAM fue la descendente anterior en 83 p, la circunfleja en 33 p, la coronaria derecha en 81 p, puente safeno en 2 p y el tronco en 2 p. Presentaban enfermedad de un vaso: 83 p, de 2 v: 53 p, de 3 v: 56 p, de tronco; 7 p. Dos p carecían de lesión > 50 por ciento. En 5 p no se intentó la PTCAP: 2 p por lesión de tronco, 2 p por lesión < 50 por ciento y 1 p por arteria chica. En los otros 196 p se intentó la PTCA la que fue exitosa en 179 p (91 por ciento): lesión residual < 50 por ciento y flujo TIMI III en 174 p (89 por ciento) o TIMI II en 45 p con clínica y ECG de reperfusión. En horario hábil se abrió la arteria "culpable" a los 96 ñ 45 min del ingreso y en el inhábil a los 119 ñ 48 min (p < 0.01). Mueren 11 p (5.5 por ciento). La mortalidad se asoció a edad > 70 a, IAM anterior, Killip > II, y especialmente al fracaso de la PTCAP (p < 0,001). El fracaso se asoció sólo al Killip > I (p < 0.001). Presentan isquemia residual 19 p (9.5 por ciento). Se asocian a ella: lesión residual > 40 por ciento, flujo TIMI < III y enfermedad de 3 v (p < 0.01).Durante la hospitalización 15 p (8 por ciento) requirieron de otra PTCA y 33 p (16 por ciento) de una revascularización quirúrgica; 2 p de inmediato, 3 p de urgencia y 28 p electiva. En nuestro medio, la PTCAP puede ofrecerse como el tratamiento de elección del IAM al asegurar un alto éxito en reperfundir la arteria, sin demora y sin lesión residual. Si ella fracasa deben extremarse las otras medidas de reperfusión por predecir un alto riesgo de fallecimiento