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Objetive: Congenital heart diseases (CHD) can be found in pregnant women. Although cardiac interventions in the catheterization laboratory are considered safe and effective, it is preferable to wait 3-6 months after delivery to correct simple, uncomplicated CHD; however, this may result in follow-up losses. The objective is to present our experience in correcting CHD during the early puerperium (EP). Materials and methods: All cases of pregnant women with CHD, including atrial septal defect (ASD), patent ductus arteriosus (PDA), and aortic coarctation (CoA) between 2017-2023, who underwent percutaneous defect correction during the EP were collected. Results: Fifteen pregnant women were included, diagnosed with ASD (5), PDA (6), and CoA (4). Five patients (33.3%) were classified as WHO risk class IV; the procedure was successful in 80% of the cases, and only 1 patient presented complications. Conclusions: In our experience, the closure of uncomplicated congenital defects during the EP did not present major complications and could be a treatment strategy to prevent follow-up losses after delivery in pregnant women with CHD.
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Objective: Several studies have demonstrated an association between frailty and worse outcomes in patients with acute coronary syndrome (ACS); however, there is a lack of evidence from Colombia. This study aims to evaluate the association between frailty and the risk of adverse outcomes in patients over 65 years old diagnosed with ACS. Materials and methods: A prospective cohort study was conducted, including patients over 65 years old who underwent coronary angiography due to an ACS diagnosis at a hospital in Medellín, Colombia. Frailty was assessed using the FRAIL scale. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included length of hospital stay and a composite outcome of in-hospital or 30-day mortality, contrast-induced nephropathy (CIN), acute heart failure, cardiogenic shock, hemorrhagic complications, and vascular complications. Results: A total of 112 patients were included. Frail patients (n=35, 31.3%) were older, had a lower socioeconomic status, higher GRACE scores, and more severely compromised coronary vessels. A significant association was observed between frailty and 30-day mortality (relative risk [RR] 19.00, 95% confidence interval [CI]: 5.04-72.61; p<0.001), the composite outcome (RR 4.57, 95% CI: 2.56-8.34; p<0.001), and longer hospital stays (9 days vs. 5 days in the non-frail group). Conclusions: A considerable number of patients over 65 years old with ACS were frail. Frailty was associated with adverse in-hospital and 30-day outcomes.
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Objective: Cryoballoon ablation for pulmonary vein isolation is a time-efficient procedure that can alleviate stress on electrophysiology lab resources. This analysis modeled the impact of cryoballoon ablation on electrophysiology lab operation using data from Latin America. Methods: Data from centers in Argentina, Mexico, Colombia, and Chile of the were used as inputs for an electrophysiology lab efficiency simulation model. The model used the assumption that either two (today's electrophysiology lab operations) or three (including electrophysiology lab operational changes) cryoballoon ablation procedures could be performed per day. The endpoints were the percentage of days that resulted in 1) overtime and 2) time left for an extra non-ablation electrophysiology procedure. Results: Data from a total of 232 procedures from six Latin American centers were included in the analysis. The average electrophysiology lab occupancy time for all procedures in Latin America was 132 ± 62 minutes. In the Current Scenario (two procedures per day), 7.4% of simulated days resulted in overtime, and 81.4% had enough time for an extra electrophysiology procedure. In the Enhanced Productivity Scenario (three procedures per day), 16.4% of days used overtime, while 67.4% allowed time for an extra non-ablation electrophysiology procedure. Conclusions: Using real-world, Latin American-specific data, we found that with operational changes, three ablation procedures could feasibly be performed daily, leaving time for an extra electrophysiology procedure on more than half of days. Thus, use of cryoballoon ablation is an effective tool to enhance electrophysiology lab efficiency in resource-constrained regions such as Latin America.
Objetivos: La ablación con criobalón para el aislamiento de venas pulmonares es un procedimiento que ahorra tiempo y puede ahorrar recursos del laboratorio de electrofisiología. Este análisis modeló el impacto de la ablación con criobalón en el funcionamiento del laboratorio de electrofisiología utilizando datos de América Latina. Métodos: Los datos de los centros de Argentina, México, Colombia y Chile del se utilizaron como datos de entrada para un modelo de simulación de la eficiencia del laboratorio de electrofisiología. El modelo partió del supuesto de que se podían realizar dos (operaciones actuales del laboratorio de electrofisiología) o tres (incluidos los cambios operativos del laboratorio de electrofisiología) procedimientos de ablación con criobalón por día. Los criterios de valoración eran el porcentaje de días en los que se producían 1) horas extraordinarias y 2) tiempo restante para un procedimiento electrofisiológico adicional no relacionado con la ablación. Resultados: Se incluyeron en el análisis los datos un total de 232 procedimientos de seis centros latinoamericanos. El tiempo medio de ocupación del laboratorio de electrofisiología para todos los procedimientos en Latinoamérica fue de 132 ± 62 minutos. En el escenario actual (dos procedimientos por día), el 7,4% de los días simulados resultaron en horas extras, y el 81,4% tuvo tiempo suficiente para un procedimiento de electrofisiología adicional. En el escenario de productividad mejorada (tres procedimientos por día), el 16,4% de los días utilizó horas extraordinarias, mientras que el 67,4% dispuso de tiempo suficiente para un procedimiento electrofisiológico extra sin ablación. Conclusiones: Utilizando datos del mundo real específicos de América Latina, descubrimos que, aplicando cambios operativos, es factible realizar tres procedimientos de ablación al día, lo que deja tiempo para un procedimiento de electrofisiología adicional en más de la mitad de los días. Por lo tanto, el uso de la ablación con criobalón es una herramienta eficaz para mejorar la eficiencia de los laboratorios de electrofisiología en regiones con recursos limitados como América Latina.
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Fibrilación Atrial , Criocirugía , Venas Pulmonares , Sistema de Registros , Humanos , Criocirugía/métodos , Venas Pulmonares/cirugía , Fibrilación Atrial/cirugía , América Latina , Factores de TiempoRESUMEN
INTRODUCTION: An infrequent yet known complication of ECMO is abdominal compartment syndrome requiring emergency laparotomy. Also, the need for prolonged enteral nutrition while on ECMO may require endoscopic gastrostomy to maintain adequate nutritional status. Here we describe our experience with emergency laparotomy and endoscopic gastrostomy in patients on ECMO support. METHODS: We retrieved patient histories from our clinical archives and performed a retrospective description of all patients taken to an emergency laparotomy or endoscopic gastrostomy while on ECMO support at our cardiovascular referral center from July 2019 through June 2024. RESULTS: During the research period of 5 years a total of 401 patients were placed on ECMO support for either cardiogenic shock or respiratory failure. A total of 27 (7%) patients required an abdominal intervention while on ECMO. 14 (3.5%) patients required emergency laparotomy and 13 (3.2%) of patients required endoscopic gastrostomy tube placement. Overall 30-day mortality of all patients requiring a general surgery procedure while on ECMO support was 33%. CONCLUSION: ECMO support can result in many complications despite its many benefits. Patients who require emergency laparotomy while on ECMO have lower survival-to-discharge and higher mortality at 30 days. Endoscopic gastrostomy however, can be safely performed on ECMO with little to no bleeding complications despite anticoagulation.
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Among mammals, bats harbour the greatest taxonomic diversity of ectoparasitic arthropods. This is mainly due to their high mobility, wide distribution range and gregarious social behaviour. In Chile, 17 species of bats have been reported; however, their ectoparasitic arthropofauna has been little studied. There are currently 12 taxa recorded, belonging to two classes and associated with only four species of bats. This study aimed to investigate the diversity of parasitic flies associated with bats in three ecoregions: Atacama Desert, Chilean Matorral and Valdivian temperate forest. During 2021, using mist nets, bats were captured in Anzota caves (Atacama Desert ecoregion), Huelquén and Alto Jahuel (Chilean Matorral ecoregion), Cherquenco and San Patricio (Valdivian temperate forest). Each bat was carefully checked during a 15-min interval for the collection of ectoparasites. The arthropods were deposited in vials with 96% ethanol. A total of 26 bats corresponding to three species (Vespertilionidae: Histiotus magellanicus Philippi, 1866, Myotis arescens (Osgood, 1943); Phyllostomidae: Desmodus rotundus (Geoffroy, 1810)) were captured from which a total of 142 ectoparasitic arthropods were collected. Bat flies were separated/identified under a stereomicroscope. Additionally, from the fieldwork, we report the presence of other ectoparasites associated with Chilean bats. In our study, we report new host-parasite associations between Trichobius parasiticus Gervais, 1844 (Diptera: Streblidae) on D. rotundus, and Basilia silvae (Brèthes, 1913) (Diptera: Nycteribiidae) in M. arescens in Chile. Our study extended the latitudinal range of distribution for B. silvae to Araucanía region, and we report for first time T. parasiticus in the country. Additionally, partial sequences of the cytochrome c oxidase I gene were obtained from these specimens. Although there is slight morphological variation in the specimens of T. parasiticus, phylogenetic analyses suggest that they correspond to the same species. The sequences generated for B. silvae represent the first for the species. Authors recommend the use of an integrative approach in the identification of ectoparasites in poorly studied ecoregions and hosts. The integration of different markers is necessary to determine more precisely the phylogenetic relationships between South American populations and species of the genera Basilia and Trichobius.
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BACKGROUND: Based on previous in vivo studies and human trials, intrathecal cell delivery is a safe and relevant therapeutic tool for improving patient's quality of life with neurological conditions. We aimed to characterise the safety profile of intrathecally delivered Mesenchymal stem cells (MSCs). METHODS: Ovid MEDLINE, Embase, Scopus, Cochrane Library, KCI-Korean Journal Database, and Web of Science. Databases were searched from their inception until April 13, 2023. Randomised Controlled Trials (RCTs) that compared intrathecal delivery of MSCs to controls in adult populations were included. Adverse events (AEs) were pooled and meta-analysed using DerSimonian-Laird random effects models with a correction factor 0.5 added to studies with zero count cells. Pooled AEs were described using Risk ratio (RR) and 95% confidence intervals (95% CI). Then, a random-effects meta-regress model on study-level summary data was performed to explore the relationship between the occurrence of AEs and covariates thought to modify the overall effect estimate. Finally, publication bias was assessed. RESULTS: 303 records were reviewed, and nine RCTs met the inclusion criteria and were included in the quantitative synthesis (n = 540 patients). MSCs delivered intrathecally, as compared to controls, were associated with an increased probability of AEs of musculoskeletal and connective tissue disorders (categorised by Common Terminology Criteria for Adverse Events-CTCAE version 5.0) (RR: 1.61, 95% CI 1.19-2.19, I2 = 0%). The random-effects meta-regress model suggested that fresh MSCs increased the probability of occurrence of AEs compared to cryopreserved MSCs (RR: 1.554; p-value = 0.048; 95% CI 1.004-2.404), and the multiple-dose, decreased the probability of AEs by 36% compared to single doses (RR: 0.644; p-value = 0.048; 95% CI 0.416-0.996); however, univariate random effects meta-regression models revealed a not significant association between the occurrence of AEs from MSCs intrathecal delivery and each covariate. CONCLUSIONS: Intrathecal delivery of MSCs was associated with a slight increase in AEs associated with musculoskeletal and connective tissue disorders, albeit without serious AEs. We conclude that intrathecal MSCs delivery is safe for patients with neurological conditions. However, further high-quality, large-scale RCTs are needed to confirm these findings.
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Inyecciones Espinales , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Enfermedades del Sistema Nervioso , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Trasplante de Células Madre Mesenquimatosas/efectos adversos , Trasplante de Células Madre Mesenquimatosas/métodos , Enfermedades del Sistema Nervioso/terapia , Células Madre Mesenquimatosas/citologíaRESUMEN
Coronary embolism (CE) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). The clinical presentation is similar to ACS, and the diagnosis is supported by Shibata criteria. Atrial fibrillation is the main reported etiology in CE cases. Management includes percutaneous intervention with thromboaspiration and anticoagulation. The following case is a description of a patient with acute chest pain and recently diagnosed atrial fibrillation (AF) with a rapid ventricular response, is described. A thrombotic lesion in the distal right coronary artery (RCA) of embolic origin, was documented. Successful mechanical thromboaspiration was performed; intravascular ultrasound (IVUS) showed no thrombus, dissection, or atherosclerotic plaque. CE is an underdiagnosed cause of ACS; diagnosis relies on Shibata criteria, and patients experience worse outcomes in follow-up.
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To ensure the best quality bread, it is important to consider the speed of digestion of starch and proteins, as well as how time fermentation and storage time influence the rate of starch digestion and the texture of the bread. This study compared the effect of fermentation time and days of storage on the texture, physicochemical, protein and starch digestibility of sourdough bread. Texture profile analysis showed that the fermentation time in recently baked sourdough bread affects hardness, chewiness, and springiness. The electrophoretic profile showed a decrease in band thickness with increase in fermentation time, consistent with a higher percentage of protein digestion. While fermentation time did not significantly affect rapidly digestible starch (RDS) and slowly digestible starch (SDS), storage time resulted in a decrease in RDS and an increase in SDS. Sourdough breads had higher levels of resistant starch (RS). The digestibility characteristics of protein and starch, as well as texture properties, are significantly influenced by fermentation and storage time. The evidence suggests that sourdough bread has the potential to improve the digestion of protein and to effectively regulate the glycemic response, which is due to its higher levels of SDS and RS.
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Pan , Almidón , Hidrólisis , Fermentación , Almidón Resistente , DigestiónRESUMEN
BACKGROUND: The study of parasites provides insight into intricate ecological relationships in ecosystem dynamics, food web structures, and evolution on multiple scales. Hepatozoon Eucoccidiorida: Hepatozoidae) is a genus of protozoan hemoparasites with heteroxenous life cycles that switch infections between vertebrates and blood-feeding invertebrates. The most comprehensive review of the genus was published 26 years ago, and currently there are no harmonized data on the epizootiology, diagnostics, genotyping methods, evolutionary relationships, and genetic diversity of Hepatozoon in the Americas. METHODS: Here, we provide a comprehensive review based on the PRISMA method regarding Hepatozoon in wild mammals within the American continent, in order to generate a framework for future research. RESULTS: 11 out of the 35 countries of the Americas (31.4%) had data on Hepatozoon, with Carnivora and Rodentia orders having the most characterizations. Bats, ungulates, and shrews were the least affected groups. While Hepatozoon americanum, H. americanum-like, H. canis, H. didelphydis, H. felis, H. milleri, H. griseisciuri, and H. procyonis correspond to the identified species, a plethora of genospecies is pending for a formal description combining morphology and genetics. Most of the vectors of Hepatozoon in the Americas are unknown, but some flea, mite, and tick species have been confirmed. The detection of Hepatozoon has relied mostly on conventional polymerase chain reaction (PCR), and the implementation of specific real time PCR for the genus needs to be employed to improve its diagnosis in wild animals in the future. From a genetic perspective, the V4 region of the 18S rRNA gene has been widely sequenced for the identification of Hepatozoon in wild animals. However, mitochondrial and apicoplast markers should also be targeted to truly determine different species in the genus. A phylogenetic analysis of herein retrieved 18S ribosomal DNA (rDNA) sequences showed two main clades of Hepatozoon: Clade I associated with small mammals, birds, and herpetozoa, and Clade II associated with Carnivora. The topology of the tree is also reflected in the haplotype network. CONCLUSIONS: Finally, our review emphasizes Hepatozoon as a potential disease agent in threatened wild mammals and the role of wild canids as spreaders of Hepatozoon infections in the Americas.
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Canidae , Quirópteros , Eucoccidiida , Animales , Gatos , Ecosistema , Filogenia , Eucoccidiida/genética , Musarañas , Animales SalvajesRESUMEN
La mucormicosis, es una patología de baja preva- lencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo opor- tunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos ma- nualmente de artículos indexados en las bases de datos MED- LINE y EBSCO a raíz de la búsqueda de los términos mu- cormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello (AU)
Mucormycosis is a low-prevalence, rapidly progres- sive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunningha- mellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral sur- gery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck
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Humanos , Mucormicosis/cirugía , Mucormicosis/diagnóstico , Mucormicosis/terapia , Signos y Síntomas , Biopsia/métodos , Factores de Riesgo , Bases de Datos Bibliográficas , Desbridamiento/métodos , Neoplasias de Cabeza y Cuello , Antibacterianos/uso terapéutico , Mucormicosis/microbiología , Mucormicosis/epidemiología , Antifúngicos/uso terapéuticoRESUMEN
Resumen La mucormicosis, es una patología de baja prevalencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo oportunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos manualmente de artículos indexados en las bases de datos MEDLINE y EBSCO a raíz de la búsqueda de los términos mucormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello.
Abstract Mucormycosis is a low-prevalence, rapidly progressive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral surgery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck.
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Resumen La fibrilación auricular es la arritmia cardíaca más frecuente del mundo y, de igual manera, es la arritmia predominante en los servicios de urgencias. Cada vez hay más prevalencia de esta enfermedad y, en consecuencia, mayores probabilidades de que los médicos en los servicios de urgencias se enfrenten a ella. Las estrategias de tratamiento estándar de la fibrilación auricular suelen ser "conservadoras" y tradicionalmente han sido el control de la frecuencia, la anticoagulación y la hospitalización. La principal motivación de este tipo de estrategia es prevenir el accidente cerebrovascular. Cuando pasa el tiempo y se produce remodelado atrial, la fibrilación auricular es cada vez más refractaria a la conversión al ritmo sinusal y cuanto más tiempo persiste y el daño cardíaco estructural aumenta, más se incrementa la duración de la fibrilación auricular. Así, en el servicio de urgencias, el manejo adecuado de un primer episodio o de una complicación, puede minimizar costos y reducir exposiciones innecesarias a terapias inadecuadas. Esta revisión aborda el manejo de la fibrilación auricular en el servicio de urgencias con base en la evidencia que se tiene disponible en el momento.
Abstract Atrial fibrillation is the most common arrhythmia, in emergency rooms and around the globe. Its frequency is constantly increasing and the likelihood of a physician encountering it at any time is high. Usual treatment approaches are "conservative", traditionally including heart rate control, anticoagulation and hospitalization. The main goal with this approach is stroke prevention. As time goes by, atrial remodeling takes place and the chance to restore sinus rhythm decreases. A longer time in atrial fibrillation leads to more structural heart disease. Thus, adequate management in the emergency room for an initial or complicated episode reduces the risk of inadequate therapies and healthcare costs. This review will focus on atrial fibrillation in the emergency room according to current evidence.
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An increase in the incidence of inflammatory arthritis after COVID-19 has been reported. Since many diseases exhibit population-specific causal effect sizes, we aimed to evaluate the incidence trends of inflammatory arthritis, including rheumatoid arthritis (RA), after COVID-19 in a large admixed Colombian population. Data analysis for this retrospective, population-based cohort study was carried out using the COOSALUD EPS registry. The following codes were selected for analyses: M059, seropositive RA, M069, unspecified RA, M060 seronegative RA, and other RA-related diagnoses: M064, M139, M068, M058, M130 and M053. The study period was limited to January 01, 2018, through December 31, 2022. Incidence rates (IRs) and incidence rate ratios (IRRs) were assessed. A Cox survival model was built to evaluate the influence of age, gender, and COVID-19 vaccination status on the development of inflammatory arthritis. A bioinformatic analysis was performed to evaluate the homology between SARS-CoV-2 and autoantigen peptides related to RA. The entire population study comprised 3,335,084 individuals. During the pandemic period (2020-2022) the total IIR for seropositive and unspecified RA were 1.60 (95% CI, 1.16-2.22) and 2.93 (95% CI, 2.04-4.19), respectively, and the IIR for overall RA-related diagnosis was 2.01 (95% CI 1.59-2.53). The age groups hazard ratios (HRs) were increased until the age group of 51-60 years (HR: 9.16; 95% CI, 7.24-11.59) and then decreased slightly in the age group 61 years or older (HR: 5.364; 95% CI, 4.24-6.78) compared to those within 18-30 years. Men were less at risk than women to develop inflammatory arthritis (HR: 0.21; 95% CI, 0.18-0.24). The greater time since COVID-19 diagnosis was associated with a lower likelihood of developing inflammatory arthritis (HR: 0.99; 95% CI:0.998-0.999). Vaccination (all types of COVID-19 vaccines included) did not prevent the development of inflammatory arthritis after COVID-19. Low identity was found between the SARS-CoV-2 ORF1ab antigen and the human antigens Poly ADP-ribose polymerase 14 and Protein mono-ADP-ribosyltransferase PARP9 isoform D (39% and 29%, respectively). In conclusion, our study confirms increased incidence of inflammatory arthritis, including RA, after COVID-19, with the greatest increase occurring before the first year post-covid. Women in their fifties were more susceptible. Further research is required to examine the effectiveness of vaccination in preventing post-COVID inflammatory arthritis and the mechanisms implicated in the development of RA after COVID-19.
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Artritis Reumatoide , COVID-19 , Masculino , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Vacunas contra la COVID-19 , Estudios de Cohortes , Incidencia , Estudios Retrospectivos , Prueba de COVID-19 , Estudios Prospectivos , COVID-19/complicaciones , COVID-19/epidemiología , SARS-CoV-2 , Artritis Reumatoide/complicaciones , Artritis Reumatoide/epidemiología , Artritis Reumatoide/diagnósticoRESUMEN
In Chile, studies of parasites from the family Sarcocystidae (Apicomplexa) have mostly been related to domestic animals. We aimed to assess the presence of Sarcocystidae taxa in cricetid rodents from Central and Southern Chile. We studied 207 rodents, encompassing six species, from 13 localities. We isolated DNA from tissue samples, amplified the Sarcocystidae 18S rRNA gene with polymerase chain reaction, and performed phylogenetic analyses using maximum likelihood and Bayesian inferences. In addition, we examined blood smears and performed histological studies in organs from Sarcocystidae DNA-positive animals. Three specimens were DNA-positive and three genotypes were retrieved and named: Sarcocystis sp. P61, related to Sarcocystis strixi, was detected in two Abrothrix olivacea. Toxoplasmatinae gen. sp. P99 was retrieved from those same two specimens, and was related to Toxoplasma and other genera, although it branched independently. Besnoitia sp. R34 was detected in one Abrothrix hirta, and was clustered with congeneric species associated with rodents. No protozoa were found during microscopic studies; thus, it was not possible to confirm parasitic interactions rather than accidental encounters. However, the close relatedness of the retrieved genotypes to parasites of rodents supports the hypothesis of host-parasite associations. All three genotypes are suggested as potential new taxa, including a putative new genus.
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Introduction: patent foramen ovale (PFO) has been associated with systemic embolic events, and evidence in favor of its closure is increasing. Our objective is to describe the main clinical outcomes and complications of percutaneous closure of patent foramen ovale. Materials and methods: patients who underwent percutaneous PFO closure from January 1, 2016, through September 1, 2021, were recorded retrospectively. Immediate outcomes (<72 hours), and early and late-onset clinical outcomes were evaluated. In-hospital and follow-up mortality were evaluated through medical chart reviews or telephone calls. Results: forty patients who underwent percutaneous PFO closure were included. There was a mean follow up of 2.3 years, the mean age was 43 ± 13.6 years, 7% were over 60 years old, 72.5% were women, 25% were hypertensive, 20% had diabetes, and 10% had a history of migraines. The mean RoPE score was 6, and 50% had a score greater than 7. Out of all the cases, three (7.5%) had serious adverse events and four had immediate complications. During follow-up, 2.5% had early-onset events consisting of atrial fibrillation and 2.5% had late-onset events due to CVA recurrence. There were no deaths from neurological causes and we reported a 100% survival. Discussion: From our experience, we highlight a low percentage of serious adverse events, and a low number of immediate, early and late-onset events, with a 100% survival, showing excellent results for percutaneous PFO closure. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2585).
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BACKGROUND: Deer species play an important role in the enzootic cycles of several Anaplasma species. While in the Northern Hemisphere ticks of genus Ixodes are well recognized vectors of these intracellular bacteria, less is known regarding the biological cycles of Anaplasma spp. in South America. METHODS: Using PCR protocols and Sanger sequencing, we assessed the presence of Anaplasma spp. in blood and ticks collected on a native deer species (Pudu puda) from southern Chile. RESULTS: Based on phylogenetic analyses of the 16S rRNA, gltA and groEL genes and calculation of average sequence divergence for groEL, our results bring to light a novel genovariant of Anaplasma phagocytophilum (named strain "Patagonia"). The strain represents a novel ecotype within the A. phagocytophilum species complex and was detected in both P. puda and their ticks. Using a larger matrix, denser taxon sampling and outgroup, our maximum-likelihood- and Bayesian-inferred phylogenies for groEL provide an accurate picture of the topology of A. phagocytophilum ecotypes and their evolutionary relationships. CONCLUSIONS: This is the first report of an ecotype of A. phagocytophilum in South America. Our results provide novel insight into the genetic diversity and ecology of this complex of bacterial lineages. Further studies should elucidate the enzootic cycle of A. phagocytophilum strain "Patagonia" and assess its pathogenic potential for pudues, domestic animals and humans in the region.
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Anaplasma phagocytophilum , Ciervos , Ixodes , Humanos , Animales , Anaplasma phagocytophilum/genética , Ciervos/microbiología , Ecotipo , Chile/epidemiología , Filogenia , ARN Ribosómico 16S/genética , Teorema de Bayes , Animales Salvajes , Ixodes/microbiología , Anaplasma/genéticaRESUMEN
INTRODUCTION: Data on extra-corporeal membrane oxygenation (ECMO) therapy for pregnant patients with Coronavirus 2019 (COVID-19) infection are limited. Here we report a case of an emergency cesarean section performed while the COVID-19 positive mother was on ECMO support. CASE REPORT: A 36-year-old COVID-19 positive patient at 26 weeks gestational age presented with respiratory failure requiring extra-corporeal membrane oxygenation therapy. Nine days later fetal distress demanded an emergency C-section. After 5 weeks on ECMO, the patient was weaned off. Both mother and child were discharged. DISCUSSION: The decision to perform an urgent C-section is one that requires meticulous thought from the attending team. Pulmonary maturation is key as pregnancy may need to be terminated at any time during ECMO. CONCLUSION: Data on ECMO support for pregnant patients with COVID-19 infection are scarce. Best results can be achieved ensuring adequate anticoagulation, meticulous choice of cannulas, continued fetal monitoring, early lung maturation, and precision timing of delivery.
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COVID-19 , Oxigenación por Membrana Extracorpórea , Insuficiencia Respiratoria , Niño , Humanos , Embarazo , Femenino , Adulto , COVID-19/terapia , Oxigenación por Membrana Extracorpórea/métodos , Cesárea , PulmónRESUMEN
Resumen Introducción: La fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano y su manejo requiere un abordaje holístico para que los resultados sean óptimos. Objetivo: Describir las características sociodemográficas y clínicas de los pacientes hospitalizados o intervenidos, con diagnóstico de fibrilación auricular, atendidos en una clínica de cuarto nivel de complejidad en Colombia. Método: Se realizó un estudio observacional, retrospectivo, a partir de registros de pacientes hospitalizados o intervenidos con diagnóstico de fibrilación auricular. Se tomó como referencia el diagnóstico de fibrilación auricular (CIE 10 I48X), durante los años 2017 y 2018. Se realizó análisis univariado y bivariado con Excel, SPSS y Epidat. Resultados: El promedio de edad de los pacientes hospitalizados fue de 69.81 años, con ligera predominancia del sexo masculino. La estancia hospitalaria fue de 6.62 en 2017 y de 5.29 días en 2018. Se encontró correlación entre los días de estancia hospitalaria y la edad de los pacientes. La comorbilidad más frecuentes en los pacientes hospitalizados fue hipertensión arterial, cardiopatía isquémica y enfermedad pulmonar obstructiva crónica. El 18.04% no tuvieron comorbilidad. Las muertes intrahospitalarias estuvieron asociadas, con mayor frecuencia, a insuficiencia cardíaca. La cardioversión eléctrica fue el procedimiento electrofisiológico más usado, seguida del aislamiento de venas pulmonares. El porcentaje de complicaciones fue menor en 2018 que en 2017. Conclusiones: Existe menor proporción de comorbilidad cuando se compara esta serie con otros reportes. Los días de estancia hospitalaria fueron superiores a los encontrados en la literatura mundial.
Abstract Introduction: Atrial fibrillation is the most frequent sustained tachyarrhythmia in humans and its management requires an integral approach in order to get optimal results. Objective: To describe the sociodemographic and clinical characteristics of patients hospitalized or on surgical procedures with a diagnosis of atrial fibrillation, managed in a Fourth level of Complexity clinic in Colombia. Method: An observational, retrospective study was conducted from records of patients hospitalized or operated with a diagnosis of atrial fibrillation. The diagnosis of atrial fibrillation (ICD-10 I48X) was taken as a reference, during the years 2017 and 2018. Univariate and bivariate analysis was performed with Excel, SPSS and Epidat. Results: The average age of hospitalized patients was 69.81 years, with a slight predominance of males. The hospital stay was 6.62 and 5.29 days, during 2017 and 2018 respectively. Correlation was found between the days of hospital stay and the age of the patients. The most frequent comorbidities in hospitalized patients were arterial hypertension, ischemic heart disease and chronic obstructive pulmonary disease. 18.04 % of patients had no comorbidities. In-hospital deaths were more frequently associated with heart failure. Electrical cardioversion was the most frequent electrophysiological procedure followed by the isolation of pulmonary veins. The percentage of complications was lower in 2018 compared to 2017. Conclusions: There are a lower proportion of comorbidities when this series is compared with other reports. The days of hospital stay were superior to those found in the world literature.
RESUMEN
The purpose of this study was to quantify the relationship between a drop in end-tidal carbon dioxide (etCO2) and occlusion of pulmonary veins (PVs) to find a delta etCO2 (ΔetCO2) able to predict occlusion during PV isolation (PVI) by cryoballoon. We designed a prospective registry. Paroxysmal atrial fibrillation patients who underwent cryoballoon PVI were included. Capnography was performed. Occlusion was tested by injection. A comparison between ΔetCO2 and occlusion was performed. Eighteen subjects (138 injections) were included. A drop of >3.5 mmHg predicted occlusion of the PV (sensitivity, 80%; specificity, 86.7%). A ΔetCO2 of ≥3.5 mmHg during inflation of the cryoballoon in each PV directly correlates with PV balloon occlusion.