Sistema de vigilancia en Chagas facilitado por tecnologías de información y comunicación / Surveillance system in Chagas facilitated by information and communication technologies

La aplicación de las tecnologías de información ycomunicación para los sistemas de vigilancia especializadosen enfermedades prioritarias en América Latina como laenfermedad de Chagas, constituye un nuevo y valiosoaporte para el control de la enfermedad que representa ungrave problema de salud pública. El objetivo del presentetrabajo fue evaluar un sistema de vigilancia epidemiológica yatención médica con el apoyo de tecnologías de informacióny comunicación (TICs), con la finalidad de detectar eintroducir precozmente al sistema de salud a los individuosseropositivos para Chagas en un área endémica del interiorde Argentina.

[Risk factors for arterial disease]. / Factores de riesgo de enfermedad arterial.

The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

Factores de riesgo de enfermedad arterial / [Risk factors for arterial disease]

The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

Atrial Mechanical Function Before and After Electrical or Amiodarone Cardioversion in Atrial Fibrillation: Assessment by Transesophageal Echocardiography and Pulsed Doppler.

In some patients with atrial fibrillation (AF), it has been suggested that left atrial mechanical dysfunction can develop after successful electrical cardioversion, justifying postcardioversion anticoagulant treatment. The purpose of this study was to investigate differences in left atrial appendage peak flow velocities and the incidence of left atrial spontaneous echo contrast in patients with AF before and after electrical cardioversion or intravenous amiodarone, studied using transesophageal echocardiography (TEE) and pulsed Doppler. We performed a control TEE in 7 patients in the electrical group and 6 in the amiodarone group, with no significant clinical differences between both groups. A second TEE was performed immediately in the 7 patients with successful electrical cardioversion. The peak flow velocities in the appendage before and after the procedure were: filling 43.3 +/- 22 vs 27.7 +/- 28 cm/sec (P = 0.01) and emptying 35.5 +/- 22 vs 23.6 +/- 17 cm/sec (P = 0.01), respectively. The spontaneous echo contrast increased in 4 of the 7 patients. In 4 patients of the amiodarone group, the peak flow velocities in the appendage during AF and within the first 24 hours after restoration of sinus rhythm were: filling 37.4 +/- 12 vs 37.8 +/- 18 cm/sec and emptying 36.4 +/- 18 vs 35.9 +/- 18 cm/sec, respectively (P = NS). There was no change in spontaneous echo contrast. In conclusion, patients with AF reverted to sinus rhythm using amiodarone did not show changes in left atrial mechanical function; however, patients with electrical cardioversion showed mechanical dysfunction. Further investigations on the effects of amiodarone and other drugs on the mechanical function of the atria are needed to determine if patients reverted pharmacologically require anticoagulation post reversion. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Hallazgo de fuentes cardioembolicas y analiss de la función de auricula izquierda en pacientes con fibrilación auricular: Estudio con ecocardiografia transesofagica

Introducción: La fibrilación auricular es una arrítmia muy frecuente en la práctica diaria. Su alta morbi-mortalidad está relacionada entre otras causas con los fenómenos embólicos que produce, desde allí la indicación de anticuagulación a todos los pacientes con esta arrítmia. Sin embargo, en la práctica, no se ha generalizado su uso, probablemente por la dificultad en el seguimiento de los pacientes. Objetivos: Con el objetivo de aportar nuevos elementos que identifiquen otros factores de riesgo para embolias, además de la arrítmia misma, se estudiaron en forma prospectiva y consecutiva con ecocardiografía transesofágica, pacientes portadores de fibrilación auricular no reumáttica de más de 48 hs. de evolución, en la búsqueda de fuentes cardioembólicas. Así mismo se analizó la función de orejuela izquierda a través de la ecocardiografía Doppler pulsada. Material y Método: Fueron estudiados con ecocardiografías transesofágicas 50 pacientes divididos de acuerdo a la presencia o no, de accidentes embólicos. En el grupo A con accidentes embólicos hubo 17 pacientes con edad TM 74ñ9 años,9 hombres (53 por ciento ) y en el grupo B, sin accidentes embólico, 33 pacientes con edad TM65ñ10 años, 21 hombres (64 por ciento). No hubo diferencias significativas en los hallazgos clínicos, electrocardiográficos ni en el ecocardiograma transtoráxico. Resultado: Se observó diferencia significativa al analizar las edades de los grupos siendo de mayor edad los del grupo A(P<0.05). El análisis de los hallazgos en el ecocardiogramas transesófagico solo demostró diferencias significativa entre los grupos en la presencia de contraste espontaneo. Grupos A:75 (por ciento) vs. Grupo B: 46(por ciento) (P<0.05). No se encontraron diferencias en la presencia de trombos, vegetaciones, aneurisma del septum interauricular, foramen oval permeable y prolapso de válvula mitral. El análisis de la función de la orejuela izquierda de Doppler pulsado demostró flujos más bajos en el grupo A TM 240ñ130 cm/seg. que en el grupo B TM 350ñ180 cm/seg.(P<0.05). La morfología de los flujos demostró mayor frecuencia del tipo III o desorganizados en los pacientes del grupo A y mayor frecuencia del tipo I en el grupo B (P0.002 - P<0.05 respectivamente)...