Síndrome de Tako-Tsubo en perioperatorio: Una variante rara. Reporte de caso / Tako-Tsubo syndrome in perioperative: A rare variant. Case report

Tako-Tsubo syndrome or stress-induced cardiomyopathy has been described as a transient left ventricular apical dyskinesia with chest pain and ST-segment elevation on electrocardiogram in the absence of obstructive lesions in coronary arteriography, most commonly in perimenopausal women. It is a rare pathology, with five reported variations and debated pathophysiological mechanisms. The current most accepted theory is a surge of catecholaminergic discharge, associated with genetic predisposition and an emotional or physical stress factor as trigger. We report a case of a 27-year-old woman with a history of uncontrolled asthma and a brother with early heart disease. She underwent appendectomy under general anesthesia and immediately after extubation, she presented a drop in oxygen saturation, respiratory distress, oppressive chest pain, severe arterial hypotension and acute pulmonary edema, requiring reintubation. ST depression on electrocardiogram, positive troponins, coronary arteriography without obstructive lesions, and mid-ventricular hypokinesia was observed in the complementary cardiac studies. Based in these findings, stress cardiomyopathy was diagnosed. The patient progressed favorably, four months after discharge, the patient remained asymptomatic with no changes in the cardiac studies.

El síndrome de Tako-Tsubo o miocardiopatía por estrés es descrito como una discinesia apical transitoria con cuadro de dolor torácico típico y electrocardiograma con elevación del segmento ST ante ausencia de lesiones en arteriografía coronaria, presentada principalmente en mujeres perimenopáusicas. Se reconoce como una patología poco frecuente, con 5 variaciones reportadas y de la que aún se debaten los mecanismos fisiopatológicos, siendo la descarga catecolaminérgica, asociada a predisposición genética y un factor emocional y/o físico desencadenante, la teoría más aceptada hoy en día. Se presenta el caso de una mujer de 27 años con antecedente de asma no controlada y hermano con enfermedad cardiaca temprana, que es llevada a apendicectomía abierta bajo anestesia general e inmediatamente a la extubación presenta caída de la saturación de oxígeno, dificultad respiratoria, refiere dolor torácico opresivo, hipotensión arterial severa y edema agudo de pulmón, con requerimiento de nueva intubación; electrocardiograma con infradesnivel del ST, troponinas positivas, arteriografía coronaria sin lesiones e hipocinesia medioventricular, con lo que se diagnostica miocardiopatía por estrés. Evolución favorable y egreso, y seguimiento a los 4 meses con exámenes normales.

Evaluation of various ways to deliver information concerning non-steroidal anti-inflammatory drugs to osteoarthritis patients.

INTRODUCTION: It is essential to provide complete information to patients using non-steroidal anti-inflammatory drugs (NSAIDs) because of the risk of side effects. Today, most healthcare professionals recommend and privilege oral information regarding NSAIDs. OBJECTIVE: Evaluate the impact of three standardized NSAIDs information-delivery modalities on knowledge, anxiety and satisfaction of patients hospitalized in a Physical Medicine and Rehabilitation unit for debilitating and degenerative locomotor diseases. METHOD: Randomized prospective study with an alternate month design. Two control groups were provided with only one type of information modality: written (information sheet) or oral (presentation). The intervention group received both modalities of information. The information included: the definition of NSAIDs, advantages and side effects, and practical advice regarding proper use. The main evaluation criterion was knowledge progression assessed by a specific questionnaire. Secondary criteria were anxiety evolution (STAI-Y questionnaire) and satisfaction related to the information delivered. RESULTS: One hundred and forty patients were included. Knowledge was improved in the three groups, with a greater score improvement in the group that received both modalities (P=0.05). No intergroup difference was noted on anxiety or satisfaction. DISCUSSION AND CONCLUSION: Associating both information-delivery modalities (written+oral) contributes to improving knowledge but does not seem to have an impact on the anxiety of patients treated with NSAIDs for their degenerative locomotor disease. Using standardized information sheets with a validated content could help pharmacists in their role as healthcare education provider and effectively complement the information delivered orally.

Search for B(s)(0) → µ+ µ- and B(0) → µ+ µ- decays in pp collisions at sqrt[s] = 7 TeV.

A search for the rare decays B(s)(0) → µ+ µ- and B(0) → µ+ µ- is performed in pp collisions at sqrt[s] = 7 TeV, with a data sample corresponding to an integrated luminosity of 1.14 fb(-1), collected by the CMS experiment at the LHC. In both cases, the number of events observed after all selection requirements is consistent with expectations from background and standard-model signal predictions. The resulting upper limits on the branching fractions are B(B(s)(0) → µ+ µ-) < 1.9 × 10(-8) and B(B(0) → µ+ µ-)<4.6 × 10(-9), at 95% confidence level.

Search for new physics with a monojet and missing transverse energy in pp collisions at √s = 7 TeV.

A study of events with missing transverse energy and an energetic jet is performed using pp collision data at a center-of-mass energy of 7 TeV. The data were collected by the CMS detector at the LHC, and correspond to an integrated luminosity of 36 pb(-1). An excess of these events over standard model contributions is a signature of new physics such as large extra dimensions and unparticles. The number of observed events is in good agreement with the prediction of the standard model, and significant extension of the current limits on parameters of new physics benchmark models is achieved.

Search for supersymmetry at the LHC in events with jets and missing transverse energy.

A search for events with jets and missing transverse energy is performed in a data sample of pp collisions collected at √s=7 TeV by the CMS experiment at the LHC. The analyzed data sample corresponds to an integrated luminosity of 1.14 fb(-1). In this search, a kinematic variable α(T) is used as the main discriminator between events with genuine and misreconstructed missing transverse energy. No excess of events over the standard model expectation is found. Exclusion limits in the parameter space of the constrained minimal supersymmetric extension of the standard model are set. In this model, squark masses below 1.1 TeV are excluded at 95% C.L. Gluino masses below 1.1 TeV are also ruled out at 95% C.L. for values of the universal scalar mass parameter below 500 GeV.

Search for three-jet resonances in pp collisions at square root(s)=7 TeV.

A search for three-jet hadronic resonance production in pp collisions at a center-of-mass energy of 7 TeV has been conducted by the CMS Collaboration at the LHC, using a data sample corresponding to an integrated luminosity of 35 pb(-1). Events with high jet multiplicity and a large scalar sum of jet transverse momenta are analyzed using a signature-based approach. The number of expected standard model background events is found to be in good agreement with the observed events. Limits on the cross section times branching ratio are set in a model of gluino pair production with an R-parity-violating decay to three quarks, and the data rule out such particles within the mass range of 200 to 280 GeV/c2.

Measurement of the inclusive jet cross section in pp collisions at √s = 7 TeV.

The inclusive jet cross section is measured in pp collisions with a center-of-mass energy of 7 TeV at the Large Hadron Collider using the CMS experiment. The data sample corresponds to an integrated luminosity of 34 pb(-1). The measurement is made for jet transverse momenta in the range 18-1100 GeV and for absolute values of rapidity less than 3. The measured cross section extends to the highest values of jet p(T) ever observed and, within the experimental and theoretical uncertainties, is generally in agreement with next-to-leading-order perturbative QCD predictions.

Measurement of the t-channel single top quark production cross section in pp collisions at √s=7 TeV.

Electroweak production of the top quark is measured for the first time in pp collisions at √=7 TeV, using a data set collected with the CMS detector at the LHC and corresponding to an integrated luminosity of 36 pb⁻¹. With an event selection optimized for t-channel production, two complementary analyses are performed. The first one exploits the special angular properties of the signal, together with background estimates from the data. The second approach uses a multivariate analysis technique to probe the compatibility with signal topology expected from electroweak top-quark production. The combined measurement of the cross section is 83.6±29.8(stat+syst)±3.3(lumi) pb, consistent with the standard model expectation.

Indications of suppression of excited Υ states in Pb-Pb collisions at √(s(NN))=2.76 TeV.

A comparison of the relative yields of Υ resonances in the µ(+)µ(-) decay channel in Pb-Pb and pp collisions at a center-of-mass energy per nucleon pair of 2.76 TeV is performed with data collected with the CMS detector at the LHC. Using muons of transverse momentum above 4 GeV/c and pseudorapidity below 2.4, the double ratio of the Υ(2S) and Υ(3S) excited states to the Υ(1S) ground state in Pb-Pb and pp collisions, [Υ(2S+3S)/Υ(1S)](Pb-Pb)/[Υ(2S+3S)/Υ(1S)](pp), is found to be 0.31(-0.15)(+0.19)(stat)±0.03(syst). The probability to obtain the measured value, or lower, if the true double ratio is unity, is calculated to be less than 1%.

Measurement of the polarization of W bosons with large transverse momenta in W + jets events at the LHC.

A first measurement of the polarization of W bosons with large transverse momenta in pp collisions is presented. The measurement is based on 36 pb⁻¹ of data recorded at √s = 7 TeV by the CMS detector at the LHC. The left-handed, right-handed, and longitudinal polarization fractions (f(L), f(R), and f0, respectively) of W bosons with transverse momenta larger than 50 GeV are determined by using decays to both electrons and muons. The muon final state yields the most precise measurement: (f(L) - f(R))⁻ = 0.240 ± 0.036(stat) ± 0.031(syst) and f0⁻ = 0.183 ± 0.087(stat) ± 0.123(syst) for negatively charged W bosons and (f(L) - f(R))⁺ = 0.310 ± 0.036(stat) ± 0.017(syst) and f0⁺ = 0.171 ± 0.085(stat) ± 0.099(syst) for positively charged W bosons. This establishes, for the first time, that W bosons produced in pp collisions with large transverse momenta are predominantly left-handed, as expected in the standard model.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs in pp collisions at √s=7 TeV.

A search for neutral minimal supersymmetric standard model (MSSM) Higgs bosons in pp collisions at the LHC at a center-of-mass energy of 7 TeV is presented. The results are based on a data sample corresponding to an integrated luminosity of 36 pb(-1) recorded by the CMS experiment. The search uses decays of the Higgs bosons to tau pairs. No excess is observed in the tau-pair invariant-mass spectrum. The resulting upper limits on the Higgs boson production cross section times branching fraction to tau pairs, as a function of the pseudoscalar Higgs boson mass, yield stringent new bounds in the MSSM parameter space.

Measurement of the B0 production cross section in pp collisions at sqrt[s] = 7 TeV.

Measurements of the differential production cross sections dσ/dpTB and dσ/dyB for B0 mesons produced in pp collisions at sqrt[s] = 7 TeV are presented. The data set used was collected by the CMS experiment at the LHC and corresponds to an integrated luminosity of 40 pb-1. The production cross section is measured from B0 meson decays reconstructed in the exclusive final state J/ψKS0, with the subsequent decays J/ψ → µ + µ - and KS0 → π+}π-. The total cross section for pTB>5 GeV and |yB|<2.2 is measured to be 33.2 ± 2.5 ± 3.5 µb, where the first uncertainty is statistical and the second is systematic.

Search for pair production of first-generation scalar leptoquarks in pp collisions at √s = 7 TeV.

A search for pair production of first-generation scalar leptoquarks is performed in the final state containing two electrons and two jets using proton-proton collision data at √s = 7 TeV. The data sample used corresponds to an integrated luminosity of 33 pb⁻¹ collected with the CMS detector at the CERN LHC. The number of observed events is in good agreement with the predictions for the standard model background processes, and an upper limit is set on the leptoquark pair production cross section times ß² as a function of the leptoquark mass, where ß is the branching fraction of the leptoquark decay to an electron and a quark. A 95% confidence level lower limit is set on the mass of a first-generation scalar leptoquark at 384 GeV for ß = 1, which is the most stringent direct limit to date.

Search for pair production of second-generation scalar leptoquarks in pp collisions at √s = 7 TeV.

A search for pair production of second-generation scalar leptoquarks in the final state with two muons and two jets is performed using proton-proton collision data at √s = 7 TeV collected by the CMS detector at the LHC. The data sample used corresponds to an integrated luminosity of 34 pb⁻¹. The number of observed events is in good agreement with the predictions from the standard model processes. An upper limit is set on the second-generation leptoquark cross section times ß² as a function of the leptoquark mass, and leptoquarks with masses below 394 GeV are excluded at a 95% confidence level for ß = 1, where ß is the leptoquark branching fraction into a muon and a quark. These limits are the most stringent to date.

Measurement of dijet angular distributions and search for quark compositeness in pp collisions at √s = 7 TeV.

Dijet angular distributions are measured over a wide range of dijet invariant masses in pp collisions at √s = 7 TeV, at the CERN LHC. The event sample, recorded with the CMS detector, corresponds to an integrated luminosity of 36 pb⁻¹. The data are found to be in good agreement with the predictions of perturbative QCD, and yield no evidence of quark compositeness. With a modified frequentist approach, a lower limit on the contact interaction scale for left-handed quarks of Λ⁺ = 5.6 TeV (Λ⁻ = 6.7 TeV) for destructive (constructive) interference is obtained at the 95% confidence level.

Search for supersymmetry in pp collisions at √7 TeV in events with two photons and missing transverse energy.

A search for supersymmetry in the context of general gauge-mediated breaking with the lightest neutralino as the next-to-lightest supersymmetric particle and the gravitino as the lightest is presented. The data sample corresponds to an integrated luminosity of 36 pb(-1) recorded by the CMS experiment at the LHC. The search is performed by using events containing two or more isolated photons, at least one hadronic jet, and significant missing transverse energy. No excess of events at high missing transverse energy is observed. Upper limits on the signal cross section for general gauge-mediated supersymmetry between 0.3 and 1.1 pb at the 95% confidence level are determined for a range of squark, gluino, and neutralino masses, excluding supersymmetry parameter space that was inaccessible to previous experiments.

Study of Z Boson Production in PbPb Collisions at √S(NN)=2.76 TeV.

A search for Z bosons in the µ(+)µ(-) decay channel has been performed in PbPb collisions at √S(NN)=2.76 TeV with the CMS detector at the LHC, in a 7.2 µb(-1) data sample. The number of opposite-sign muon pairs observed in the 60-120 GeV/c(2) invariant mass range is 39, corresponding to a yield per unit of rapidity (y) and per minimum bias event of [33.8±5.5(stat)±4.4(syst)]×10(-8), in the |y|<2.0 range. Rapidity, transverse momentum, and centrality dependencies are also measured. The results agree with next-to-leading order QCD calculations, scaled by the number of incoherent nucleon-nucleon collisions.

Dijet azimuthal decorrelations in pp collisions at √s=7 TeV.

Measurements of dijet azimuthal decorrelations in pp collisions at √s=7 TeV using the CMS detector at the CERN LHC are presented. The analysis is based on an inclusive dijet event sample corresponding to an integrated luminosity of 2.9 pb⁻¹. The results are compared to predictions from perturbative QCD calculations and various Monte Carlo event generators. The dijet azimuthal distributions are found to be sensitive to initial-state gluon radiation.

Measurement of the B(+) production cross section in pp collisions at sqrt[s]=7 TeV.

Measurements of the total and differential cross sections dσ/dp(T)(B) and dσ/dy(B) for B(+) mesons produced in pp collisions at sqrt[s]=7 TeV are presented. The data correspond to an integrated luminosity of 5.8 pb(-1) collected by the CMS experiment operating at the LHC. The exclusive decay B(+)→J/ψK(+), with J/ψ→µ(+)µ(-), is used to detect B(+) mesons and to measure the production cross section as a function of p(T)(B) and y(B). The total cross section for p(T)(B)>5 GeV and |y(B)|<2.4 is measured to be 28.1±2.4±2.0±3.1 µb, where the first uncertainty is statistical, the second is systematic, and the last is from the luminosity measurement.

Measurement of the isolated prompt photon production cross section in pp collisions at √s=7 TeV.

The differential cross section for the inclusive production of isolated prompt photons has been measured as a function of the photon transverse energy E(T)(γ) in pp collisions at √s=7 TeV using data recorded by the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 2.9 pb(-1). Photons are required to have a pseudorapidity |η(γ)|<1.45 and E(T)(γ)>21 GeV, covering the kinematic region 0.006