[Percutaneous intervention in the correction of congenital heart deffects (DCC): experience in as UMAE]. / El intervencionismo percutáneo en la corrección de defectos cardíacos congénitos (DCC): experiencia en una UMAE.

INTRODUCTION: Congenital heart defects are common in infants and adults, affecting quality of life if not corrected. Unlike open surgery, percutaneous intervention allows correction with a high success rate and speedy recovery. In Mexico, there are not enough studies to describe their efficacy and safety. METHODS: A cohort study was conducted in the Hospital "Manuel Avila Camacho", in Puebla, Mexico, including 149 patients with congenital heart defects repaired by percutaneous intervention, recording data from clinical records. The following were documented: post-guided fluoroscopy, hemodynamic changes, cardiac catheterization drilling anatomical changes, and complications six months later such as infection or bleeding at the puncture site, device migration, endocarditis, or death. SPSS was used, using descriptive and inferential statistics. RESULTS: The patients' congenital heart defects treated were ductus arteriosus, atrial septal defect, and aortic coarctation, with ductus arteriosus being recorded as the most frequent congenital heart defect. Primary angioplasties were performed in 75% and stenting in the rest. Anatomical corrections of congenital defects were successful in 96.4% of patients (p < 0.01), with minimal adverse effects (p < 0.01). CONCLUSIONS: We conclude that our hospital has good efficacy and safety in percutaneous intervention, comparable to published reports.

Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico.

In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients)--mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients)--left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients)--signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.

Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico

In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7 percent. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients) - mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients) - left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients) - signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.

[Combined fixed doses therapy in systemic hypertension]. / Tratamiento combinado con dosis fijas de la hipertensión arterial.

OBJECTIVE: A single blind clinical trial was conducted to assess the concept that initial treatment in stage I and II of hypertension with fixed doses of two antihypertensives that have different modes of action and additive effects, in a 24-week period with bisoprolol (B), an cardioselective beta blocker, that does not have intrinsic sympathomimetic activity, associated to hydrochlorothiazide (HCTZ). MATERIAL AND METHODS: Thirty-one patients (22 females and 9 male) were included, with an age range between 20 and to 70 years (mean 52.45 +/- 12.10). After a two-weeks wash out period and a similar placebo phase, patients were assigned to receive a once-daily dosing of B 5 mg and 6.25 mg of HCTZ, during eight-weeks. Those patients that did not reduce their blood pressure below 90 mm Hg received a double dose of the beta blocker until the end of the study. RESULTS: After twenty-fourth weeks period of the study, the mean systolic/diastolic blood pressures reduction was 23.9/20.1 mm Hg, compared to basal levels (p < 0.001). The adverse effects were rare. No clinically significant changes from baseline in laboratory parameters were observed. CONCLUSION: This study demonstrates that fixed doses combination therapy with B/HCTZ (5 mg plus 6.25 mg) is effective and well tolerated, with a sustained hypotensive effect. Combined therapy with fixed doses, is an alternative in the initial treatment of mild to moderate hypertension.

Estudio comparativo entre bisoprolol y metoprolol, asociados a hidroclorotiazida, como terapia antihipertensiva / Comparative study between bisoprolol and metoprolol/hydrochlorothiazide in anti-hypertensive therapy

El objetivo de este estudio fue el de comparar la eficacia y seguridad del bisoprolol (B), un nuevo betabloqueador cardioselectivo (desprovisto de actividad simpaticomimético intrínseca) y del metoprolol (M) asociados a hidroclorotiazida (HCTZ) en el tratamiento de la hipertensión arterial (HTA) leve a moderada. En un estudio doble ciego, aleatorizado, controlado con placebo fueron evaluados 62 pacientes (47 mujeres y 15 hombres), con edades entre 20 y 70 años (media 52.5 ñ 10.4). Después de un periodo de lavado y una fase de placebo de 2 semanas cada uno, los enfermos fueron asignados recibir B (10 mg) más 6.25 mg de HCTZ o M (100 mg) más 6.25 mg de HCTZ, durante 4 semanas. Al término de este periodo, aquellos enfermos en los cuales no se había reducido la presión arterial diastólica (PAD) por abajo de 90 mmHg la dosis del betabloqueador fue duplicada. Después de ocho semanas de tratamiento, la disminución promedio en la presión arterial sistólica (PAS) y PAD en relación a los valores basales fueron: 31.8 mmHg/21.2 mmHg y 28.0 mmHg/20.6 mmHg para B/HCTZ y M/HCTZ, respectivamente (p < 0.0001). No se encontraron modificaciones significativas en los parámetros de laboratorio, al concluir el estudio en ninguno de los dos grupos. La disminución de la presión arterial (PA) con B/HCTZ se encuentra relacionada con un perfil de eventos adversos y cambios metabólicos semejante a los observados con otras drogas.