Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months.

BACKGROUND: The aim of this study was to compare the outcome of 3 months vs. 18 months of amiodarone treatment after atrial fibrillation (AF) conversion in patients who experienced the first episode of persistent AF. METHODS: We included 51 patients who experienced the first episode of persistent AF receiving amiodarone (600 mg) daily for 4-6 weeks. If AF persisted, electrical cardioversion (ECV) was performed. All patients received amiodarone (200 mg daily) for 3 months and then were randomized to amiodarone (Group I) or placebo (Group II) and followed for 15 months. The control group comprised 9 untreated patients undergoing ECV. Treatment effectiveness was evaluated using a Bayesian model. RESULTS: Eighteen months after AF reversion, 22 (81.5%) patients in Group I, 13 (54.2%) patients in Group II, and 1 (11.1%) patient in the control group remained in sinus rhythm. No differences were found between Group I patients who required ECV and Group II patients. Sinus rhythm was preserved in all Group I patients when it was achieved during amiodarone administration. Limiting adverse effects occurred in 3 (11.1%) patients in Group I. CONCLUSIONS: In patients regaining sinus rhythm after the first episode of persistent AF, a 3-month amiodarone treatment after reversion is a reasonable option for rhythm control.

Actualización del diagnóstico de situación de la investigación en salud en el ámbito del Ministerio de Salud de la Nación y 19 Ministerios Provinciales / Update of Diagnosis of Health Research Situation in the Field of Argentine National and 19 Provincial Ministries of Health

Dado los escasos antecedentes de estudios sobre los sistemas de investigación para la salud en Argentina, el Ministerio de Salud de la Nación decidió realizar un diagnóstico de las actividades de investigación en el subsector público de salud. OBJETIVO: Describir las actividades de gestión, producción y difusión de la investigación realizadas por los ministerios de Salud y sus organismos dependientes entre 2010 y 2012. MÉTODOS: Estudio descriptivo transversal. Se estudiaron 20 ministerios (Nación, Ciudad Autónoma de Buenos Aires y provincias de Buenos Aires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuego y Tucumán). Se efectuó una encuesta estructurada a funcionarios responsables de organismos ministeriales de nivel central, descentralizados y servicios de salud. RESULTADOS: Se relevaron 299 organismos y 1.070 investigaciones; el 80% de las cuales se había realizado en servicios de salud. El 61,3% del total recibió financiamiento. CONCLUSIONES: La magnitud de las investigaciones halladas en este estudio evidencia la importancia que las actividades de investigación tienen en los ministerios de Salud estudiados, en consonancia con el apoyo que se le ha dado en los últimos años a esta actividad como política de Estado...

Considering the few background of studies about the health systems in Argentina, the National Ministry of Health decided to make a diagnosis of the research activities in the public health subsector. OBJECTIVE: To describe the activities of research management, production and dissemination conducted by health ministries and their agencies between 2010 and 2012. METHODS: Descriptive cross-sectional study. A total of 20 health ministries (National, Autonomous City of Buenos Aires and the provinces of BuenosAires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuegoa nd Tucumán) was studied. A structured survey to responsible officials of central level structures, decentralized institutionsand health services was conducted. RESULTS: 299 dependent agencies and 1070 research projects were surveyed, 80% of which had been conducted in health services and 61.3% of total had received financing. CONCLUSIONS: The magnitude of the research found in this study shows the importance that the research activities have in the ministries of health studied, in line with the support that has been given in recent years to this activity as state policy...

Pharmacologic reversion of persistent atrial fibrillation with amiodarone predicts long-term sinus rhythm maintenance.

OBJECTIVE: The study analyzed the role of different variables that determine long-term sinus rhythm maintenance in patients with persistent atrial fibrillation who are treated with amiodarone. BACKGROUND: It has been recognized that different factors influence long-term sinus rhythm preservation after the conversion of persistent atrial fibrillation. Although the duration of the arrhythmia appears to be the most important factor, consistent information regarding the role of the mode of arrhythmia conversion (pharmacologic or electric) is still lacking. METHODS: One hundred and forty one anticoagulated patients with persistent atrial fibrillation (median duration 8 months, percentiles 25 and 75: 2-24) were treated for 4 weeks with oral amiodarone (600 mg/day). Those in whom the arrhythmia persisted underwent electric cardioversion. After restoration of normal sinus rhythm (either pharmacologic or electric), all patients received a daily dose of amiodarone (200 mg) and were followed for a median of 19 months (percentiles 25 and 75: 8-34 months). RESULTS: Sixty eight patients (48.22%) regained sinus rhythm during the initial period of amiodarone treatment with 600 mg/day (Group I) and 73 (51.78%) required electric cardioversion (Group II). During the entire follow-up, atrial fibrillation relapsed in 63 patients: 17 (25%) in Group I and 46 (63%) in Group II. Recurrences of the arrhythmia were strikingly less frequent in patients whose atrial fibrillation lasted 12 months or less (33/103, 32.3%) than in those whose atrial fibrillation lasted more than 12 months (30/38, 78.94%). In the multivariate analysis, the mode of reversion (HR, 0.37; CI, 0.21-0.65) and the duration of the arrhythmia (HR, 2.55; CI, 1.54-4.20) were the determinants for long-term sinus rhythm maintenance. Age, sex, left atrium size, left ventricle diameter, and the shortening fraction did not significantly influence the rate of arrhythmia recurrence. Among the 141 patients included in the study, 113 patients were followed for at least 1 year, and cardiac rhythm was assessed at this time. Of these, only 1 of 48 patients (2.1%) in Group I was in atrial fibrillation, in marked contrast with 18 of 65 patients (27.8%) in Group II (RR, 0.075; 95% CI, 0.01-0.54). CONCLUSIONS: In patients with persistent atrial fibrillation, long-term preservation of sinus rhythm under chronic amiodarone treatment may be anticipated when the arrhythmia lasts 12 months or less and/or its reversion is obtained pharmacologically. We may confidently assume that these two factors have a beneficial additive influence on the outcome.

Diseño de una estructura curricular por competencias / The design of a competency based curricular structure

En educación, el currículo ocupa un lugar esencial; en él se especifican los lineamientos normativos y académicos que orientan la formación profesional. El sistema escolarizado diseña sus currículos considerando los factores y recursos intra y extrainstitucionales relacionados con los contenidos y los resultados esperados. Sin embargo, la débil relación entre empresas e instituciones educativas se manifiesta en problemas educativos y de desempeño cuando el egresado se enfrenta al ámbito laboral. A pesar de los mecanismos de interacción entre unas y otras, persiste la inclinación por responder a las demandas empresariales mediante una oferta de estudios formal, rígida y conforme a modelos con tiempos y secuencias de acreditación fijos. Existe consenso en considerar que la educación requiere de cambios radicales; no obstante, los currículos permanecen inamovibles y prácticamente sin cambios, originando que la mayoría de los alumnos promovidos prácticamente no logren alcanzar los propósitos establecidos y su desempeño sea deficiente. Proponemos una estructura cu-rricular basada en competencias profesionales que se organiza a partir de las necesidades sociales y que se sustenta en la pedagogía de la problematización, la andragogía, la didáctica crítica, la administración estratégica, la planificación innovadora, la motivación, el modelamiento y la evaluación formativa. Los propósitos que se persiguen consisten en que el alumno logre una competencia para la vida y demuestre un desempeño acorde con su realidad sociolaboral, y que la acción-reflexión permita al mismo proceso educativo modificar el currículo dependiendo de las necesidades presentes y futuras.

Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia

To assess the effect of a high monoinsaturated fatty acids (MFA) diet on serum lipids, 30 healthy adultt normolipidemic volunteers and 37 adult patients with mild hypercholesterolemia (5.4 - 9.3 mmol/l), 15 of them also with hypertriglyceridemia (2.3 - 4.8 mmol/l), were studied. Fifteen healthy and 30 hypercholesterolemic subjects (15 of them with associated type 2 diabetes mellitus) received an avocado enriched diet (2000 Kcal, lipids 53 percent MFA 49 g saturated/unsaturated ratio 0.54), and seven non-diabetic hypercholesterolemic individuals received an isocaloric control diet (MFA 34 g, saturated/unsaturated ratio 0.7). Serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride concentrations were measured before and after a 7-day diet period. In healthy individuals a 16 percent decrease of serum total cholesterol level followed the high MFA diet, while it rose after the control diet (p<0.001 between diets). In hypercholesterolemic subjects a significant (p<0.01) decrease of serum total cholesterol (17 percent), LDL-cholesterol (22 percent) and triglycerides (22 percent), and increase of HDL-cholesterol (11 percent) levels occurred with the avocado diet, while no significant changes were noticed with the control diet. High lipid, high MFA-avocado enriched diet can improve lipid profile in healty and especially in mild hypercholesterolemic patients, even if hypertriglyceridemia (combined hyperlipidemia) is present