Impact of the complex humanitarian crisis on the epidemiology of the cardiometabolic risk factors in Venezuela.

BACKGROUND: The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown. AIM: To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC. METHODS: A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020. RESULTS: Seven studies (National EVESCAM 2014-2017, 3 regions VEMSOLS 2006-2010, Maracaibo city 2007-2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003-2005, and Zulia state 1999-2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003-2005) to 11.7% (2014-2017) and for obesity from 33.3% (2007-2010) to 24.6% (2014-2017). In contrast, there was an apparent increase in diabetes from 6% (2003-2005) to 12.3% (2014-2017), prediabetes 14.6% (2006-2010) to 34.9% (2014-2017), and hypertension 24.7% (2003-2005) to 34.1% (2014-2017). The most prevalent dyslipidemia - a low HDL-cholesterol - remained between 65.3% (1999-2001) and 63.2% (2014-2017). From 2006-2010 to 2014-2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006-2010) to 47.6% (2014-2017). Insufficient physical activity remained steady from 2007-2010 (34.3%) to 2014-2017 (35.2%). CONCLUSION: Changes in the prevalence of cardiometabolic risk factors in Venezuela are heterogeneous and can be affected by various social determinants of health. Though the Venezuelan healthcare system has not successfully adapted, the dynamics and repercussions of the CHC on population-based cardiometabolic care can be instructive for other at-risk populations.

Considerations and Guidance for the Structure, Organisation, and Operation of Cardiometabolic Prevention Units: A Consensus Statement of the Inter-American Society of Cardiology.

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, particularly in low- and middle-income regions such as Latin America. This is because of the combination and interaction in different proportions of a high prevalence of cardiometabolic risk factors and socio-economic and cultural characteristics. This reality brings about the need to change paradigms to consistently and systematically boost cardiovascular prevention as the most cost-effective medium- to long-term strategy to reduce their prevalence in medium- and low-resource countries, not only in Latin America but also in other global regions. To achieve the therapeutic goals in various diseases, including CVD, the current literature demonstrates that the most effective way is to carry out the patient's diagnosis and treatment in multidisciplinary units. For this reason, the Inter American Society of Cardiology (IASC) proposes the creation of cardiometabolic prevention units (CMPUs) as a regional initiative exportable throughout the world to standardise cardiovascular prevention based on the best available evidence. This ensures homogeneity in the global management of cardiometabolic risk factors and access to quality medicine independently of the population's social situation. These guidelines, written by a panel of experts in cardiovascular prevention, defines what a CMPU is, its objectives and the minimum requirements for it, as well as proposing three categories and suggesting an operational scheme. It must be used as a guide for all individuals or centres that, aware of the need for multidisciplinary and standardised work, want to create a unit for the comprehensive management of cardiometabolic risk established as an international research network. Lastly, the document makes meaningful points on the determination of cardiovascular risk and its importance. These guidelines do not cover specific targets and therapeutic schemes, as these topics will be extensively discussed in another SIAC publication, namely a statement on residual cardiometabolic risk.

Subepithelial connective tissue graft conjugated to minimally invasive ceramic laminates-1 year follow-up.

OBJECTIVE: Commonly, esthetic procedures involve ceramic laminates and gingivectomy. However, the clinical demand caused by dental wear and gingival recessions due to parafunctional habits is increasing. Thus, in addition to restoring the anatomical and esthetic dental form, it is also necessary to restore the lost gingival volume. CLINICAL CONSIDERATIONS: This article presents a case report of the treatment of a patient with marked incisal wear and gingival recessions. Initially, endodontic treatment of the upper lateral incisors was performed, which presented with pulp necrosis due to the marked wear caused by bruxism. Subsequently, the patient was treated with a subepithelial connective graft by a technique proposed by Zucchelli, along with minimally invasive ceramic laminates and finished with a myorelaxant plaque. CONCLUSIONS: This proposed approach aimed for and achieved esthetic excellence, and full recovery of function, which is of extreme clinical relevance. Ultimately, the stability of the surgery and the laminates after 1 year of follow-up is presented. CLINICAL SIGNIFICANCE: Patients with bruxism in addition to incisal and occlusal wear are more likely to have gingival recessions. The esthetic planning of these patients should contemplate interdisplinarity temporomandibular disorder, periodontics, and dentistry for the recovery of the function and reaching esthetic excellence.

Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment. Consensus / Dislipidemia aterogénica en Latinoamérica: prevalencia, causas y tratamiento. Un consenso

Abstract: Atherogenic dyslipidemia (DA) is a poorly recognized entity in the current clinical practice guidelines. Due to the frequent lipid alterations associated with this metabolic abnormality in Latin America (LA), we organized a group of experts that has adopted the name of Latin American Association for the study of Lipids (ALALIP), to generate a document for analyzing in LA the prevalence of the lipid profile related to this condition, and to offer practical recommendations for its optimal diagnosis and treatment. Methodology: It was is selected a group of regional experts and, using a modified Delphi methodology, we conducted a comprehensive literature review, with emphasis on studies or reviews that had implications for LA. Subsequently developed a series of key questions about the epidemiology, pathophysiology, diagnosis, and treatment of the AD to be discussed by the group of experts. As a convention those recommendations that had 100% acceptance was consider unanimous; those with at least 80% as for consensus, and of disagreement, those with less than 80%. Results: Although there is no a global study on risk factors that has been made on the basis of a representative sample of the entire population of LA, the systematic analysis of the national health surveys and regional cohort studies based on local population sampling shows a consistent evidence of the high prevalence of the lipid abnormalities that define the AD. The prevalence of low levels of high density lipoprotein cholesterol (HDL-C) ranges from 34.1% (CESCAS I study) to 53.3% (LASO study), with different frequencies between men and women and the selected cut-off point. The prevalence of elevated triglycerides (TRG) varies from 25.5% (LASO study) to 31.2% (National Health Survey of Chile) being always more prevalent in men than in women. Only two studies report the prevalence of AD in LA: the National Health Survey of Mexico 2006 with an 18.3%, and a Venezuelan study that estimates the weighted prevalence of AD in 24.7%. There are multiple causes for these findings: an inadequate nutrition-characterized for high consumption of foods with a high caloric density and a high intake of cholesterol and trans fats-, a sedentary lifestyle, a high prevalence of obesity in the region, and possibly epigenetic changes that make our population more susceptible for having this abnormal lipid profile. Conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between the style of living, the inheritance, and epigenetic changes possibly are its cause. Since they are considered as an important cause of residual cardiovascular risk, they must be diagnosed and treated actively as a secondary target after reaching the goal for low density lipoprotein-cholesterol (LDL-C). It is important to design a global study of risk factors in our region to let us know the true prevalence of AD and its causes, and to help us in the design of public policies adapted to our reality in a population and individual scale.

Resumen: La dislipidemia aterogénica (DA) es una entidad poco reconocida en las guías de práctica clínica actuales. Debido a las frecuentes alteraciones lipídicas asociadas a esta anomalía metabólica en América Latina (AL), hemos organizado un grupo de expertos que ha adoptado el nombre de Asociación Latinoamericana para el Estudio de Lípidos (ALALIP), para generar un documento en el que se analice la prevalencia en AL del perfil lipídico relacionado con esta afección y ofrecer recomendaciones prácticas para su óptimo diagnóstico y tratamiento. Metodología: Se seleccionó un grupo de expertos regionales y, utilizando una metodología Delphi modificada, se realizó una revisión bibliográfica exhaustiva, con énfasis en estudios o revisiones que tuvieran implicaciones para AL. Posteriormente se desarrolló una serie de preguntas clave sobre la epidemiología, la fisiopatología, el diagnóstico y el tratamiento de la DA, que fueron discutidas por el grupo de expertos. Como convención, las recomendaciones que tuvieron un 100% de aceptación fueron consideradas unánimes; aquellas con al menos el 80% como para el consenso, y de desacuerdo, aquellas con menos del 80%. Resultados: Aunque no existe un estudio global sobre los factores de riesgo que se haya realizado sobre la base de una muestra representativa de toda la población de AL, el análisis sistemático de las encuestas nacionales de salud y los estudios de cohortes regionales evidencian la alta prevalencia de las anormalidades lipídicas que definen la DA. La prevalencia de niveles bajos de colesterol de lipoproteínas de alta densidad (HDL-C) oscila entre el 34.1% (estudio CESCAS I) y el 53.3% (estudio LASO), con diferentes frecuencias entre hombres y mujeres y el punto de corte seleccionado. La prevalencia de triglicéridos elevados (TRG) varía de 25.5% (estudio LASO) a 31.2% (Encuesta Nacional de Salud de Chile) siendo siempre más prevalente en hombres que en mujeres. Sólo dos estudios informan la prevalencia de DA en AL: la Encuesta Nacional de Salud de México 2006 con un 18.3%, y un estudio venezolano que estima la prevalencia ponderada de la DA en 24.7%. Existen múltiples causas para estos hallazgos: una nutrición inadecuada -caracterizada por el alto consumo de alimentos con alta densidad calórica y un alto consumo de colesterol y grasas trans- un estilo de vida sedentario, una alta prevalencia de obesidad en la región y posiblemente cambios epigenéticos que hacen que nuestra población sea más susceptible a tener este perfil lipídico anormal. Conclusiones: Las anomalías lipídicas que definen la DA tienen una alta prevalencia en AL; la interacción entre el estilo de vida, la herencia, y los cambios epigenéticos posiblemente son su causa. Debido a que se consideran una causa importante de riesgo cardiovascular residual, deben ser diagnosticados y tratados activamente como un objetivo secundario después de alcanzar la meta para el colesterol de lipoproteína de baja densidad (LDL-C). Es importante diseñar un estudio global de los factores de riesgo en nuestra región para hacernos conocer la verdadera prevalencia de la DA y sus causas y ayudarnos en el diseño de políticas públicas adaptadas a nuestra realidad en una escala poblacional e individual.

Los orígenes del desarrollo de la salud y de la enfermedad en Venezuela / Developmental origins of health and disease in Venezuela

La Transición Alimentaria Nutricional (TAN) acelerada que se ha producido en Venezuela producto de la rápida urbanización ha generado cambios en los estilos de vida: sedentarismo y modificaciones de la dieta tradicional. La población del país es de alto riesgo: alto porcentaje de embarazo en adolescentes, aumento de la mortalidad materna e infantil, alta prevalencia de peso bajo al nacer, incremento de prevalencias de morbimortalidad por enfermedades crónicas relacionadas con la nutrición y baja práctica de lactancia materna exclusiva. En Venezuela prevalece la doble carga nutricional: sobrepeso y desnutrición. Existen nichos obesogénicos definidos y estilos de vida que conducen a la obesidad y sus comorbilidades. Los Orígenes del Desarrollo de la Salud y la Enfermedad (ODSE) y la programación fetal y posnatal temprana (los primeros 1.000 días) son determinantes a través de mecanismos epigenéticos que alteran la actividad génica sin cambiar la secuencia del ADN conducen a modificaciones con transmisión transgeneracional. Hipótesis propuestas: alimentación materna sub-óptima (composición corporal materna alterada, dieta materna hipocalórica, inadecuada transferencia placentaria); excesivo aporte calórico intrauterino; crecimiento acelerado posnatal. Recomendaciones: optimizar estado nutricional pre y postconcepcional, la ganancia de peso gestacional y promover el control prenatal temprano; prevención del embarazo precoz; promover la lactancia materna exclusiva el primer semestre y complementaria hasta los 2 años; evitar crecimiento compensatorio acelerado; considerar la doble carga de la malnutrición en programas de intervención nutricional individualizados y nunca masivos; promover la actividad física y las comidas en familia. El pediatra debe identificar los factores de riesgo cardiometabólicos en forma temprana.

The rapid nutrition transition in Venezuela is a result of a high urbanization process with changes in life style, a rise in sedentarism and the substitution of the traditional diet. The population is at risk: a high percentage of adolescent pregnancies, a rise in child and maternal mortality, a high prevalence of low birth weight, rising prevalence of morbidity and mortality of chronic diseases related to nutrition, insufficient exclusive breast feeding practices. A double burden of under nutrition and obesity is found. Although obesogenic niches and unhealthy life styles that lead to obesity and its morbidities are evident, developmental origins of health and disease (DOHaD) and early nutrition programming in the first 1000 days are determinant through epigenetic mechanisms that modulate gene function without altering DNA. The mismatch or the fuel-mediated, as well as the accelerated postnatal growth hypothesis are postulated. Optimal pre and post conception nutrition status is recommended as well as appropriate weight gain during pregnancy; promotion of exclusive breast feeding through the first semester and complementary up to 2 years, also physical activity and frequent family dining; prevention of accelerated postnatal growth; the double burden should be considered in intervention programs that should be focalized. Pediatricians must identify cardio metabolic risk at an early stage.

Variabilidade da frequência cardíaca em recém-nascidos de alto risco na presença de ruído

Objetivo: verificar mudanças na frequência cardíaca dos bebês de risco em uma unidade de tratamento intensivo na presença de ruído.Métodos: pesquisa quali-quantitativa. Analisou-se a variação da frequência cardíaca nos bebês expostos a diversas fontes geradores de ruído. As medições ocorreram, separadamente, em três áreas denominadas boxes, observadas em três intervalos de cinco minutos cada. As frequências cardíacas dos bebês foram verificadas pela leitura de monitores acoplados a aparelhos de oximetria de pulso. A medição do ruído foi feita ao lado posterior de cada box durante dois períodos/dias, entre oito e nove horas, com distância aproximada de 30cm da fonte ruidosa, utilizando-se decibelímetro digital IP-130, ponderação “C”, frequência de 31.5Hz ~8Khz. Os boxes eram equipados com saída de oxigênio, bomba de infusão, aspirador a vácuo, ar comprimido, aspiradores manuais, lavatório de inox e presença de, pelo menos, dois funcionários.Resultados: registrou-se, durante a pesquisa, níveis de ruído acima do recomendado pela American Academy of Pediatrics, Associação Brasileira de Normas Técnicas e Organização Mundial de Saúde. Ocorreu variação nas frequências cardíacas durante a medição, havendo variação de frequência cardíaca em todas as exposições de nível elevado de ruído. Os bebês do Box um apresentaram onze batimentos por minuto, no Box dois quatro batimentos por minuto e no Box três trezeConclusão: observaram-se variações de pico das frequências cardíacas em níveis elevados de ruído, não sendo relacionado que quanto maior o ruído maior a variação de frequência cardíaca.

Nutrición en recién nacidos a término y en niños de 1 a 6 meses / Nutrition in newborn term and the infant up to 6 months of age

La adecuada nutrición durante la infancia y niñez temprana garantiza el completo desarrollo del potencial humano de todo niño en cualquier parte del mundo, así como la prevención de la aparición de enfermedades crónicas relacionadas con la nutrición en la edad adulta. Las prácticas de alimentación correctas son fundamentales para lograr una salud óptima. La alimentación con leche humana de forma exclusiva cubre todos los requerimientos nutricionales los primeros seis meses de vida para luego ser continuada conjuntamente con la alimentación complementaria hasta los dos años. Las fórmulas artificiales se administran cuando la alimentación con leche humana no es posible ya sea por causas médicas inherentes a la madre o al niño. La alimentación con leche humana ejerce un efecto protector para la prevención de deficiencias de micronutrientes principalmente de hierro y vitamina A en los primeros seis meses de vida. La suplementación de la madre embarazada y durante la lactancia en riesgo de deficiencia es importante para el estado nutricional del niño en estas edades.

Nutrition in newborn term and the infant up to 6 months of age Adequate nutrition during infancy and early childhood ensures the full development of the human potential of every child in any part of the world, as well as the prevention of chronic diseases related to nutrition in adulthood. They are fundamental power of good practices to achieve optimal health. The human feeding exclusively covers all nutritional requirements during the first six months of life and to be then continued together with the complementary feeding up to two years. Artificial formulas are used when human milk feeding is not possible either by medical causes inherent to the mother or the child. Human milk feeding exerts protective effect for the prevention of micronutrient deficiencies mainly of iron and vitamin A to the first six months of life. The pregnant mother and supplementation during lactation at risk of deficiency is important to the nutritional status of the child at this age.

Consulta de detección temprana de factores de riesgo cardiometabólico en pediatría / Early screening of cardiometabolic risk factors in pediatrics

Las enfermedades cardiometabólicas ocupan el primer lugar en morbimortalidad en todo el mundo, como enfermedades crónicas no transmisibles. La detección de los factores de riesgo para el desarrollo de estas enfermedades representa la herramienta fundamental del clínico para evitar la morbimortalidad de la población por enfermedad cardiometabólica. El proceso ateroesclerótico comienza a desarrollarse desde la primera década de la vida, detectándose cada vez más a menor edad la presencia de enfermedad cardiovascular y metabólica en la población infantojuvenil. Por tal motivo, la identificación temprana del paciente en riesgo es prioritaria y debe generar intervención del equipo de salud para evitar complicaciones a futuro (prevención primordial y prevención primaria). Al identificar el individuo en riesgo, se realiza una intervención positiva modificando sus factores de riesgo para enfermedad cardiovascular, logrando cambiar su riesgo global y la prevención será más eficiente. El objetivo de este proyecto es desarrollar un instrumento sencillo y práctico que pueda aplicarse fácilmente en la mayoría de la población, dirigido al médico pediatra, de familia o general, para identificar precozmente el paciente en riesgo cardiometabólico global en edades pediátricas, con el fin de modificar estos factores y educar sobre la prevención de las enfermedades cardiometabólicas.

Cardiometabolic diseases occupy the first place in morbidity and mortality worldwide, as non-communicable chronic diseases. The detection of risk factors for the development of these diseases represents a fundamental tool for the clinician in order to prevent cardiometabolic disease morbidity and mortality. The atherosclerotic process begins to develop during the first decade of life, with cardiovascular and metabolic disease appearing with increasing frequency at early ages. For this reason, early identification of patients at risk is a priority and should motivate intervention of the health team in order to prevent future complications (primary prevention and primordial prevention). Individuals at risk are submitted to a positive intervention by modifying risk factors for cardiovascular disease, which will change overall risk and achieve a more efficient prevention. The objective of this project is to develop a simple and practical tool that can be applied in the majority of the population, aimed for pediatricians and family or general physicians, in order to identify patients with global cardiometabolic risk at an early age, and to modify these factors and educate in the prevention of cardiometabolic disease.

A prevalência de incontinência urinária em mulheres praticantes de jump / The prevalence of urinary incontinence in women practicing of jump

INTRODUÇÃO: A incontinência urinária (IU) é definida pela Sociedade Internacional de Continência (ICS) como qualquer perda involuntária de urina. Ela exerce múltiplos efeitos sobre as atividades diárias, interações sociais e percepção da saúde. A literatura afirma que a prática de atividades físicas de alto impacto e esforço pode comportar-se como um fator de risco para a IU. OBJETIVOS: identificar a prevalência de IU em um grupo de mulheres praticantes de jump. MATERIAIS E MÉTODOS:Estudo transversal quantitativo descritivo, com amostra de 32 voluntárias que responderam a questionário sobre antecedentes obstétricos e prática da atividade física e à tradução do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). RESULTADOS:Houve relato de perdas urinárias em 37,5% das entrevistadas. A média de idade das mulheres que referem incontinência foi de 31,58 anos (DP ± 9,39). As mulheres com filhos tiveram 1,2 mais chances de apresentar IU do que as nulíparas. As que fazem jump três ou mais vezes por semana apresentaram 2,45 mais chances de apresentar IU. Nas que sentiam vontade de urinar durante o jump, a chance de IU foi seis vezes maior. 62,5% das entrevistadas referiram nenhum impacto na qualidade de vida, e a atividade física foi apontada como situação mais comum de IU. CONCLUSÃO: Existe incontinência urinária nas praticantes de jump investigadas, multíparas e nulíparas, em jovens, durante a prática de jump e em outras ocasiões, apontando a necessidade de estudos mais abrangentes sobre a temática.

INTRODUTION: The urinary incontinence (UI) is defined by International Continence Society (ICS) as any involuntary lost of urine. It exerces numerous effects about the diary activities, social interaction and the perception of health. The literary affirms that the practice of physical activities of high impact and effort, can behave like a risk factor for the UI. OBJECTIVES: Identify the prevalence of UI in a group of women practicing of jump. MATERIALS AND METHODS: A descriptive cross-sectional quantitative study, with a sample of 32 volunteers that answered the questionnaire about obstetric records and practice of physical activities and traduction of International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). RESULTS:There was urinary lost in 37,5% of the interviewee. The medium age of the incontinents was about 31,58 years (DP ± 9,39). The women with sons had 1,2 more chances of shows UI than the nuliparous. Those who practice jump three or more times in a week, slows 2,45 more chances of shows UI. Those who want to urinate during the jump, the chance of UI was 6 times more. 62,5% of the incontinents has none impact in quality of life, and practice of physical activities was pointed as situation most common of UI. CONCLUSION:There is urinary incontinence in practitioners of jump investigated, multiparous and nuliparous, in youngs, during the practice of jump and in other occasions, pointing the necessity of study more comprehensive about the theme.

Taquicardia supraventricular en pediatría: Presentación clínica y manejo. Experiencia del servicio de cardiología hospital de Niños JM de los Ríos. Caracas, Venezuela. 2001-2011

Introducción: La taquicardia paroxística supraventricular (TPSV) representa la segunda causa más frecuente de arritmias en pediatría (1). Objetivos 1. Determinar las características clínicas y el tratamiento en la emergencia. 2. Evaluar la respuesta al tratamiento y los fármacos utilizados. Metodología: Estudio retrospectivo de 69 casos con ingreso en el Servicio de Cardiología del Hospital de niños JM de los Ríos de 2001-2011. Criterio de Ingreso: pacientes con Diagnóstico de TPSV que ingresaron a la emergencia. Resultados: Se seleccionaron 69 pacientes. Edad promedio: 5,9 años (DE ± 3,5). Dos con antecedentes de Cardiopatía Congénita (2,9 %). La frecuencia cardíaca media fue de 284 lat./min (DE ± 30,66). El diagnóstico más frecuente fue TPSV por reentrada, en 35 pacientes (51%); el resto de los pacientes presentaron Wolff Parkinson White (WPW). Cinco pacientes respondieron a maniobras vagales. El tratamiento de elección en la crisis aguda fue Adenosina, y en casos de fallar el tratamiento inicial y de inestabilidad hemodinámica se utilizó la cardioversión eléctrica (16 pacientes). Para mantenimiento se indicó: Betabloqueantes y Amiodarona siendo efectivos (60,8%). Cuatro pacientes necesitaron ablación por radiofrecuencia (1 paciente presentó recaída posterior al tratamiento). Conclusiones: La presentación clínica de la TPSV varía con la edad. La mayoría de pacientes respondieron al tratamiento con adenosina. El tratamiento de mantenimiento con Betabloqueantes y Amiodarona es efectivo.

Paroxysmal supraventricular tachycardia (PSVT) is the most common pediatric arrhythmia. The objectives of this study were to determine the clinical features and treatment of PSVT in the emergency room and to evaluate the response to treatment and drugs employed. Methods: This is a retrospective study of 69 children admitted to the cardiology department of the Children's Hospital JM de los Rios from 2001 to 2011. Inclusion criteria: patients diagnosed with PSVT who were admitted to the emergency room. Results: 69 patients. Mean age: 5.9 years (SD ± 3.5). Two had a history of congenital heart disease (2.9%). The average heart rate was 284 beats / min (SD ± 30.66). The most frequent diagnosis was reentrant SVT, 35 patients (51%); the rest corresponded to Wolf Parkinson White syndrome. Five patients responded to vagal maneuvers. The treatment of choice in the acute crisis was adenosine. Electrical cardioversion was utilized in cases of initial treatment failure and hemodynamic inestability (16 patients). Maintenance treatment with beta-blockers and amiodarone was indicated in most cases (60.8%) with an effective response. Four patients required ablation, one of them relapsed. Conclusions: 1. clinical presentation of PSVT varies with age. 2. most patients responded to treatment with adenosine. 3. maintenance therapy with beta blockers and amiodarone is effective.

Matrix metalloproteinase-9 in an exploratory trial of intravenous minocycline for acute ischemic stroke.

BACKGROUND AND PURPOSE: Plasma matrix metalloproteinase-9 levels predict posttissue plasminogen activator (tPA) hemorrhage. METHODS: The authors investigated the effect of minocycline on plasma matrix metalloproteinase-9 in acute ischemic stroke in the Minocycline to Improve Neurological Outcome in Stroke (MINOS) trial and a comparison group. RESULTS: Matrix metalloproteinase-9 level decreased at 72 hours compared with baseline in MINOS (tPA, P=0.0022; non-tPA, P=0.0066) and was lower than in the non-MINOS comparison group at 24 hours (tPA, P<0.0001; non-tPA, P=0.0019). CONCLUSIONS: Lower plasma matrix metalloproteinase-9 was seen among tPA-treated subjects in the MINOS trial. Combining minocycline with tPA may prevent the adverse consequences of thrombolytic therapy through suppression of matrix metalloproteinase-9 activity.

Tratamiento no farmacológico del asma bronquial

El manejo no farmacológico del asma debe incluir la evaluación exhaustiva de los factores de riesgo que podrían contribuir a desencadenar las crisis y/o agravar el asma en los niños. Los factores fundamentales a considerar son: el control ambiental, insistiendo primordialmente en mantener un ambiente intradomiciliario libre de tabaco, humedad e irritantes pulmonares como quemas, cloro, humo de tráfico e industrias. Se debe promover la actividad física regular, adecuándola al estado de salud del niño, y la misma debe ser individualizada, recomendando actividades poco asmógenas (aeróbicos, yoga, natación, caminar, juegos, entre otros). Por último recomendamos una nutrición balanceada, enfatizando en la lactancia materna y en el control de la obesidad. Conclusiones y recomendaciones: la multicausalidad es determinante en la etiopatogenia del asma; por lo que la mejor opción en su manejo es utilizar múltiples recursos terapéuticos integrados para poder garantizar una mejor calidad de vida, tanto al niño como a sus familiares.

Non-pharmacological management of asthma should include the comprehensive assessment of risk factors that could contribute to trigger the crisis and/or aggravate asthma in children. The fundamental factors to be considered are: the environmental control, insisting primarily in maintaining an environment free of tobacco, humidity and lung irritating substances such as burning fumes, chlorine, and smoke from traffic and industries. Physical activity should be promoted and adapted to the state of health of the child. It must be individualized recommending activities with poor asthma generating power (aerobics, yoga, swimming, walking among others). Finally we recommend a balanced nutrition emphasizing on breast-feeding and obesity control. Multi causality is determinant in the etiopathology of asthma, so that the best option for its management is to integrate multiple therapeutic resources in order to ensure a better quality of life for the child and their families.

Minocycline and tissue-type plasminogen activator for stroke: assessment of interaction potential.

BACKGROUND AND PURPOSE: New treatment strategies for acute ischemic stroke must be evaluated in the context of effective reperfusion. Minocycline is a neuroprotective agent that inhibits proteolytic enzymes and therefore could potentially both inactivate the clot lysis effect and decrease the damaging effects of tissue-type plasminogen activator (t-PA). This study aimed to determine the effect of minocycline on t-PA clot lysis and t-PA-induced hemorrhage formation after ischemia. METHODS: Fibrinolytic and amidolytic activities of t-PA were investigated in vitro over a range of clinically relevant minocycline concentrations. A suture occlusion model of 3-hour temporary cerebral ischemia in rats treated with t-PA and 2 different minocycline regimens was used. Blood-brain barrier basal lamina components, matrix metalloproteinases (MMPs), hemorrhage formation, infarct size, edema, and behavior outcome were assessed. RESULTS: Minocycline did not affect t-PA fibrinolysis. However, minocycline treatment at 3 mg/kg IV decreased total protein expression of both MMP-2 (P=0.0034) and MMP-9 (P=0.001 for 92 kDa and P=0.0084 for 87 kDa). It also decreased the incidence of hemorrhage (P=0.019), improved neurologic outcome (P=0.0001 for Bederson score and P=0.0391 for paw grasp test), and appeared to decrease mortality. MMP inhibition was associated with decreased degradation in collagen IV and laminin-alpha1 (P=0.0001). CONCLUSIONS: Combination treatment with minocycline is beneficial in t-PA-treated animals and does not compromise clot lysis. These results also suggest that neurovascular protection by minocycline after stroke may involve direct protection of the blood-brain barrier during thrombolysis with t-PA.

Candesartan augments ischemia-induced proangiogenic state and results in sustained improvement after stroke.

BACKGROUND AND PURPOSE: We have shown that acute treatment with candesartan in an experimental model of stroke resulted in vascular protection and improved outcomes at 24 hours poststroke, but the mechanisms are unknown. We now examine effects of candesartan on proangiogenic factors and 7-day outcomes using the same treatment paradigm. METHODS: Male Wistar rats underwent 3 hours of middle cerebral artery occlusion followed by reperfusion. A single dose of 1 mg/kg candesartan intravenously was given at reperfusion. Animals received neurobehavioral testing before middle cerebral artery occlusion, at 24 hours after middle cerebral artery occlusion, and at 7 days. Blood pressure was measured by telemetry. Animals euthanized at 24 hours had brain tissue and cerebrospinal fluid collected for matrix metalloproteinase activity, vascular endothelial growth factor expression, and tube formation assay. Neurobehavioral testing included elevated body swing test, Bederson, beam walk, and paw grasp. Cerebrovascular density was quantified using immunohistochemistry at 24 hours and 7 days. RESULTS: Matrix metalloproteinase-2 activity and vascular endothelial growth factor expression were higher (P=0.035, P=0.042, respectively) and cerebrospinal fluid was significantly more proangiogenic (5x tube formation; P=0.002) in the candesartan group at 24 hours. Although no difference was seen in infarct size at 7 days, treatment improved Bederson scores (2.1 versus 2.9, P=0.0083), elevated body swing test (22.9 versus 39.4, P=0.021), and paw grasp (1.29 versus 2.88, P=0.0001) at 7 days. Candesartan treatment resulted in increased vascular density in the striatum at 7 days (P=0.037). CONCLUSIONS: Candesartan after reperfusion augments ischemia-induced angiogenic state and provides long-term benefits. The beneficial effects may involve vascular protection and enhancement of early angiogenic remodeling.

A formação profissional das técnicas de ginástica rítmica / Rhythm gymnastic technician professional formation

A Ginástica Rítmica é um esporte que encanta pessoas em todo o mundo, destaca-se pela elegância e beleza dos movimentos. A complexidade de seus movimentos requer o desenvolvimento de qualidades físicas que exige muito treino, muita aplicação e um grande entendimento do professor responsável. Por esse motivo, o objetivo deste estudo foi analisar a formação profissional das técnicas queatuam com Ginástica Rítmica nos Jogos Regionais da 4ª região do Estado de São Paulo. O método empregado foi uma pesquisa bibliográfica e de campo, a qual, utilizou um questionário semi-estrutrura doque buscou informações básicas sobre a formação e atualização das técnicas. Os resultados encontrados foram que a maioria das técnicas é graduada e pós-graduada. Além de darem continuação a sua formação participando de cursos pelo menos uma vez por ano. Assim, consideramos importante a ênfase dada aoscursos de pós-graduação e de formação continuada para o aprimoramento nas áreas específicas.

The Rhythmic Gymnastic is a sport that enchant people in the entire world, it appeals because itsmovement elegance and beauty. The complexity of its movements requires the development of physical qualities and a lot of practice, dedication and a huge teacher’s knowledge. Because of this, the purpose ofthe study was to analyze the rhythmic gymnastic technician’s professional formation during 4th Regional Games of São Paulo State. The method used was the bibliographical and field research, which used asemi-structured questionnaire searching basic information about formation and actualization of technicians.The found results showed that most technicians is graduated and post graduated. They also continuous their formation attending specific courses at least once a year. Thus, we consider that is important to give relevance to post graduation and continued formation to improvements in specific areas.

Delayed minocycline inhibits ischemia-activated matrix metalloproteinases 2 and 9 after experimental stroke.

BACKGROUND: Matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9) are increased in the brain after experimental ischemic stroke in rats. These two proteases are involved with the degradation of the basal lamina and loss of stability of the blood brain barrier that occurs after ischemia and that is associated with thrombolytic therapy in ischemic stroke. Minocycline is a lipophilic tetracycline and is neuroprotective in several models of brain injury. Minocycline inhibits inflammation, apoptosis and extracellular matrix degradation. In this study we investigated whether delayed minocycline inhibits brain MMPs activated by ischemia in a model of temporary occlusion in Wistar rats. RESULTS: Both MMP-2 and MMP-9 were elevated in the ischemic tissue as compared to the contra-lateral hemisphere after 3 hours occlusion and 21 hours survival (p < 0.0001 for MMP-9). Intraperitoneal minocycline at 45 mg/kg concentration twice a day (first dose immediately after the onset of reperfusion) significantly reduced gelatinolytic activity of ischemia-elevated MMP-2 and MMP-9 (p < 0.0003). Treatment also reduced protein concentration of both enzymes (p < 0.038 for MMP-9 and p < 0.018 for MMP-2). In vitro incubation of minocycline in concentrations as low as 0.1 mug/ml with recombinant MMP-2 and MMP-9 impaired enzymatic activity and MMP-9 was more sensitive at lower minocycline concentrations (p < 0.05). CONCLUSION: Minocycline inhibits enzymatic activity of gelatin proteases activated by ischemia after experimental stroke and is likely to be selective for MMP-9 at low doses. Minocycline is a potential new therapeutic agent to acute treatment of ischemic stroke.

Minocycline for short-term neuroprotection.

Minocycline is a widely used tetracycline antibiotic. For decades, it has been used to treat various gram-positive and gram-negative infections. Minocycline was recently shown to have neuroprotective properties in animal models of acute neurologic injury. As a neuroprotective agent, the drug appears more effective than other treatment options. In addition to its high penetration of the blood-brain barrier, minocycline is a safe compound commonly used to treat chronic infections. Its several mechanisms of action in neuroprotection -- antiinflammatory and antiapoptotic effects, and protease inhibition -- make it a desirable candidate as therapy for acute neurologic injury, such as ischemic stroke. Minocycline is ready for clinical trials of acute neurologic injury.

Effect of neutrophil depletion on gelatinase expression, edema formation and hemorrhagic transformation after focal ischemic stroke.

BACKGROUND: While gelatinase (MMP-2 and -9) activity is increased after focal ischemia/reperfusion injury in the brain, the relative contribution of neutrophils to the MMP activity and to the development of hemorrhagic transformation remains unknown. RESULTS: Anti-PMN treatment caused successful depletion of neutrophils in treated animals. There was no difference in either infarct volume or hemorrhage between control and PMN depleted animals. While there were significant increases in gelatinase (MMP-2 and MMP-9) expression and activity and edema formation associated with ischemia, neutrophil depletion failed to cause any change. CONCLUSION: The main finding of this study is that, in the absence of circulating neutrophils, MMP-2 and MMP-9 expression and activity are still up-regulated following focal cerebral ischemia. Additionally, neutrophil depletion had no influence on indicators of ischemic brain damage including edema, hemorrhage, and infarct size. These findings indicate that, at least acutely, neutrophils are not a significant contributor of gelatinase activity associated with acute neurovascular damage after stroke.

Tactics for vascular protection after acute ischemic stroke.

BACKGROUND: The vascular events that happen during ischemic stroke worsen outcomes in patients by causing edema, hemorrhagic transformation, and general neurologic tissue compromise. In the past 2 decades, clinical trials in patients after ischemic stroke focused on neuroprotection, but these strategies have failed in providing actual benefit. Vascular protection represents a new field to be explored in acute ischemic stroke in order to develop new approaches to therapeutic intervention. PURPOSE: We identified tactics likely to provide vascular protection in patients with ischemic stroke. These tactics are based on knowledge of the molecular processes involved. SUMMARY OF REVIEW: The pathologic processes due to vascular injury after an occlusion of a cerebral artery can be separated into acute (those occurring within hrs), subacute (hrs to days), and chronic (days to mo). Targets for intervention can be identified for all three stages. In the acute phase, superoxide is the predominant mediator, followed by inflammatory mediators and proteases in the subacute phase. In the chronic phase, proapoptotic gene products have been implicated. Many already-marketed therapeutic agents (statins, angiotensin modulators, erythropoietin, minocycline, and thiazolidinediones), with proven safety in patients, have been shown to have activity against some of the key targets of vascular protection. CONCLUSION: Currently available pharmacologic agents are poised for clinical trials of vascular protection after acute ischemic stroke.