Ventricular septal defects.

This is a review article that summarizes updated information concerning isolated ventricular septal defects (VSD). VSD are one of the most common congenital heart diseases. It includes anatomic consideration and classification of the different types of VSD, pathophysiologic categories, clinical features and diagnostic tools such as electrocardiography, chest radiography, echocardiography and cardiac catheterization. We also reviewed the most important aspects of the therapeutic management, including surgical indications for correction of ventricular septal defects.

Partial rupture of thoracic aortic aneurysm. Case presentation.

The presence of aortic aneurysm could lead to rupture and if not surgically corrected may lead to the death of the patient. We present the case of an 82 year old woman whose death was due to rupture of a thoracic aortic aneurysm. Physicians must be alert to help in obtaining the cooperation of patients in accepting the indicated therapy.

Tiempos de espera de pacientes programados en un servicio de ecografía de consulta externa / Scheduled patient waiting times in an outpatient ultrasound service

INTRODUCCIÓN: la seguridad social se encarga de la atención médica de los trabajadores asalariados. OBJETIVOS: determinar los tiempos de espera en las programaciones de ecografía y conocer el nivel de satisfacción de pacientes asegurados en el Policonsultorio 20 de octubre de la Caja Petrolera de Salud. MÉTODOS: estudio descriptivo de corte transversal y cuantitativo. Se seleccionaron 1110 solicitudes de las gestiones 2012 ­ 2014 y 1110 pacientes que tenían su solicitud de ecografía en programación actual. Se revisó los expedientes clínicos y archivos de ecografía y se realizó cuestionarios estandarizados con escala Likert a los pacientes para medir el nivel de satisfacción. RESULTADOS: el 26% de los pacientes esperaron de 4.1 a 5.1 semanas (29-35 días), existieron 2.2 solicitudes de ecografía por cada paciente, el 93% de los pacientes no está nada o poco satisfecho con los periodos de espera y el 58% considera aceptable esperar entre 1.1 a 2.0 semanas (2-14 días) para la realización del estudio. DISCUSIÓN: se deben realizar acciones que mejoren la calidad de atención y satisfacción del paciente, una de ellas es disminuir los periodos de espera en las programaciones de ecografía.

INTRODUCTION: social security provides medical care for salaried workers. OBJECTIVES: to determine waiting times for scheduled ultrasound appointments and the level of satisfaction of insured patients at Policonsultorio 20 octubre, Caja Petrolera the Salud. METHODS: this is a descriptive, cross sectional, quantitative study. One thousand one hundred and ten ultrasounds orders from the 2012 ­ 2014 administration and 1110 patients who had ultrasounds orders currently scheduled were selected for review. Clinical records and ultrasounds files were reviewed and patients answers using a standardized questionnaire using the Likert scale were used to measure their level of satisfaction. RESULTS: twenty-six percent of the patients waited 4.1 to 5.1 weeks (29-35 days), there were 2.2 ultrasounds orders per patient, 93% of the patients are somewhat or completely dissatisfied with the waiting times, and 58% consider it acceptable to wait from 1.1 to 2.0 weeks (2-14 days) to undergo the study. DISCUSSION: Actions are needed to improve the quality of care and patient satisfaction, one of which is to shorten waiting times for scheduled ultrasound.

Associative nitrogen fixation in nodules of the conifer Lepidothamnus fonkii (Podocarpaceae) inhabiting ombrotrophic bogs in southern Patagonia.

Biological N2 fixation (BNF) in the rhizosphere of Podocarpaceae is currently attributed to unspecific diazotrophs with negligible impact on N acquisition. Here, we report specific and high associative BNF in dead cells of root nodules of Lepidothamnus fonkii distributed in ombrotrophic peatlands of Patagonia. BNF of nodulated roots, intact plants of L. fonkii and rhizospheric peat was assessed by 15N2 and acetylene reduction. Diazotrophs were identified by electron microscopy, analysis of nitrogenase encoding genes (nifH) and transcripts, and 16S rRNA. Nitrogenase encoding nifH transcripts from root nodules point to Beijerinckiaceae (Rhizobiales), known as free-living diazotrophs. Electron microscopy and 16S rRNA analysis likewise identified active Beijerinckiaceae in outer dead cells of root nodules. NifH transcripts from the rhizopshere peat revealed diverse active diazotrophs including Beijerinckiaceae. Both methods revealed high activity of nitrogenase rates in cut roots of L. fonkii (2.5 µmol N g-1 d.w. d-1 based on 15N2 assay; 2.4 µmol C2H4 g-1 d.w. d-1 based on acetylene reduction assay). The data suggest that (i) nodules recruit diazotrophic Beijerinckiaceae from peat, (ii) dead nodule cells provide an exclusive habitat for Beijerinckiaceae, and (iii) BNF in L. fonkii is one potent pathway to overcome N deficiency in ombrotrophic peatlands of Patagonia.

Comparative regional pupillography as a noninvasive biosensor screening method for diabetic retinopathy.

PURPOSE: We describe infrared regional pupillometry as an objective comparative assessment of midperipheral to central retinal sensitivity and to correlate with midperipheral retinal ischemia in diabetic subjects. METHODS: We tested 12 normal and 17 diabetic subjects using bilateral infrared pupillometry. The diabetic cohort included seven subjects without, five with mild, three with moderate, and two with severe non-proliferative diabetic retinopathy (NPDR). Central and annular stimuli of varying intensity were presented to one eye, and pupillary amplitude and constriction velocity were measured from both eyes. Light stimulus of increasing intensity was presented as 20 consecutive trials (stimulus duration of 300 ms with 3000 ms intervals). The ratio of central to peripheral responses (Q values) was calculated for each stimulus configuration. Average responses with respect to the stimulus strength were regressed with Gompertz sigmoid function. RESULTS: Control and moderate/severe NPDR cases comparison showed statistically significant differences in amplitude (Q(A)) and constriction velocity (Q(CV)) (Wilcoxon rank sum test P = 0.002, respectively). Age difference for these groups was not statistically significant (Wilcoxon rank sum test P = 0.15). The comparison of control and diabetic subjects without NPDR/mild NPDR was statistically significant for Q(A) and Q(CV) (Wilcoxon rank sum test P = 0.0002 and P = 0.001, respectively). Q(A) and Q(CV) differences were statistically significant between moderate/severe NPDR cases and subjects without or mild NPDR cases (Wilcoxon rank sum test P = 0.013). CONCLUSIONS: Q(A) and Q(CV) values correlated highly with the severity of diabetic retinopathy, but not with the duration of diabetes.

Respiratory syncytial virus infection and recurrent wheezing in Chilean infants: a genetic background?

UNLABELLED: Respiratory syncytial virus (RSV) infection has been associated to recurrent wheezing, but pathogenic mechanisms are unclear. Interleukin-4/Interleukin-13 (IL-4/IL-13) pathway is involved in both conditions. A common host genetic susceptibility may exist in patients whom RSV will trigger severe illness and those who develop recurrent wheezing. OBJECTIVE: To assess, by a candidate-gene approach, whether genetic polymorphisms in IL-4/IL-13 pathway are associated with RSV infection severity and its outcome in Chilean children. A cohort of 118 RSV-infected infants was analyzed and followed for one year. Severity of acute infection and later recurrent wheezing were characterized. Alleles and genotypes frequencies were determined for two SNP in each of the genes IL-4, IL-13 and IL-4Rα. Association tests and interaction analyses were performed. Enrollment included 60 moderate and 58 severe cases. Two SNP were found associated to severity during acute infection in IL-4Rα gene (Gln551Arg, Ile50Val). The follow up was completed in 71% of patients (84/118). Later recurrent wheezing was 54% in severe group, versus 31% in moderate cases (p=0.035). In relation to outcome, allele Ile50 in IL-4Rα was more frequent in patients with moderate disease and no wheezing outcome. A common protector genotype is proposed for Chilean children: IL-4Rα Ile/Ile. CONCLUSION: Genetic variations in the host are associated to infection severity and outcome. A common genetic background might be influencing both pathologies.

Impaired immune response in severe human lower tract respiratory infection by respiratory syncytial virus.

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection in infants. The immune response plays a leading role in the severity of the disease. We hypothesized that severe RSV disease is associated with an impaired immune response characterized by low circulating T lymphocytes and plasma cytokine concentrations. METHODS: We evaluate the in vivo immune responses of previously healthy infants with their first proven RSV-acute lower respiratory infection that required hospitalization. According to the clinical severity, defined by using a strict scoring system, the in vivo immune response was compared through the analysis of plasma cytokine values and the phenotyping of peripheral blood lymphocyte and natural killer (NK) cells. RESULTS: Absolute blood cell counts of CD4+, CD8+, and CD19+ lymphocytes and NK cells were lower in subjects with RSV than in control infants. Lowest cell counts were observed in more severe RSV-infected infants. Significant low values were obtained in CD8+ lymphocytes (P = 0.03) and nonactive NK cells, that express CD94 antigen (P = 0.046). In contrast, activated NK cells that do not express CD94 molecules were significantly higher in RSV infected infants than in healthy controls (% of cells: P = 0.004). The interferon-gamma and tumor necrosis factor-alpha values in RSV infected patients were lower than in controls subjects. Interleukin-17 cytokine was not detected in healthy infants and the largest concentration was found in moderately ill patients as compared with severe cases (P = 0.033). RSV infection showed significantly higher interleukin-8 chemokine than in control infants (P = 0.024). CONCLUSION: We propose that severe RSV infection in very young infants is associated with poor blood proinflammatory cytokine production, low counts of CD8+ T cells and with a greater activity of a group of NK cells, that are independent of the major histocompatibility complex class Ib recognition system.

Nivel de dificultad y poder de discriminación del tercery quinto examen parcial de la cátedra de cito-histología2007 de la carrera de medicina de la UMSA / Level of difficulty and discrimination power of the third and fifth partial examination of the chair of cyto-histology 2007 of the medical career of UMSA

Objetivo:Determinar el nivel de dificultad y el índice de discriminación del tercer y quinto examen parcial de Cito-Histología. Diseño de investigación:Descriptivo de corte transversal. Lugar:Cátedra de Cito-HistologíaMuestra:388 exámenes de estudiantes que dieron el tercer parcial y 350 el quintoMétodo:Los datos se recolectaron a través de un formulario, el nivel de dificultad y poder de discriminación se obtuvieron por formulasestablecidas.Resultados:La media de dificultad del tercer parcial fue de 0,34, siendo medianamente difícil, la media del quinto fue 0,54 siendo de dificultad media. Lamedia del índice de discriminación del tercer parcial fue 0,57 y 0,45 del quinto, el coeficiente de discriminación fue 0,44 para el tercero y 0,54para el quinto, así, ambos parciales tuvieron una calidad excelente. Conclusiones:Según el nivel de dificultad del tercer parcial fue más difícil que el quinto, éste último estuvo dentro de parámetros esperados, el tercer parcialno tuvo reactivos fáciles. Ambos parciales discriminaron positivamente, una pregunta del tercer parcial debería descartarse y dos del quintorevisarse a profundidad.

Objective: To determine the level of difficulty and the power of discrimination of the third and fifth partial exam in Cytohistology Research Design: Descriptive, cross sectional Location: Chair of Cytohistology Sample:The students who took the third and fifth partial exams: 388 for the third and 350 for the fifth. Method: The data were collected by means of a form, the difficulty level and power of discrimination were calculated by established formulas Results: The average difficulty of the third partial exam was 0.34, qualified as moderately difficult. The average difficulty of the fifth partial exam was 0.54 which qualifies for half difficult. The average index of discrimination of the third partial exam was 0.57 and of the fifth 0.45. The discrimination quotient was 0.44 for the third and 0.54 for the fifth exam, and both partials were of excellent quality. Conclusions: Considering the difficulty level, the third partial exam was more difficult than the fifth the latter being within expected parameters . Both partials discriminated positively, one question of the third partial should be removed, and two questions of the fifth test should be reviewed in depth.

Anticoagulante lúpico: paradoja de la medicina

El anticoagulante lúpico es un inhibidor de la coagulación sanguínea adquirido espontáneamente que interfiere con la activación de la protrombina por el complejo activador. Este inhibidor, una inmunoglobulina, aparece más comúnmente en el plasma de pacientes con desórdenes autoinmunes incluyendo el lupus eritematoso sistémico, pero también ha sido asociado con enfermedades no relacionadas directamente con el sistema inmune y en pacientes sin ninguna enfermedad demostrable. Los pacientes con este "anticoagulante" usulamente están libres de sangrado a pesar de las anormalidades en su coagulación. Paradójicamente, han sido reportados episodios de trombosis venosa profunda, trombosis arterial u oclusión cerebrovascular, embolismo pulmonar y trombosis en la circulación renal. El mecanismo de estas asociaciones es desconocido, pero su comprensión será necesaria para un mejor diagnóstico y tratamiento de esta nueva entidad