"Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

BACKGROUND: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

Spatial analysis and risk mapping of Fasciola hepatica infection in dairy cattle at the Peruvian central highlands.

This study aimed to develop maps for Fasciola hepatica infection occurrence in dairy cattle in the districts of Matahuasi and Baños in the Peruvian central highlands. For this, a model based on the correlation between environmental variables and the prevalence of infection was constructed. Flukefinder® coprological test were performed in samples from dairy cattle from 8 herds, during both the rainy and wet season. Grazing plots were geo-referenced to obtain information on environmental variables. Monthly temperature, monthly rainfall, elevation, slope, normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), normalized difference water index (NDWI), distance to rivers, urban areas and roads were obtained by using remote sensor images and ArcGIS®. Multilayer perceptron Artificial Neural Networks modeling were applied to construct a predictive model for the occurrence of fasciolosis, based on the relationship between environmental variables and level of infection. Kappa coefficient (k > 0.6) was used to evaluate concordance between observed and forecasted risk by the model. Coprological results demonstrated an average prevalence from 20% to 100%, in Matahuasi, and between 0 and 87.5%, in Baños. A model with a high level of concordance between predicted and observed infection risk (k = 0.77) was obtained, having as major predicting variables: slope, NDWI, NDVI and EVI. Fasciolosis risk was categorized as low (p < 20%), medium (20% < p < 50%) and high (p ≥ 50%) level. Using ArcGIS 10.4.1, risk maps were developed for each risk level of fasciolosis. Maps of fasciolosis occurrence showed that 87.2% of Matahuasi area presented a high risk for bovine fasciolosis during the dry season, and 76.6% in the wet season. In contrast, 21.9% of Baños area had a high risk of infection during the dry season and 12.1% during the wet season. In conclusion, our model showed areas with high risk for fasciolosis occurrence in both districts during both dry and rainy periods. Slope, NDWI, NDVI and EVI were the major predictors for fasciolosis occurrence.

"Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

Background: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

Changing Management of Type B Aortic Dissections.

The purpose of this manuscript is to review recent trends in the management of acute type B aortic dissection. Due to its efficacy and low morbidity, thoracic endografting has rapidly been adopted as the treatment of choice for most patients with malperfusion or rupture as a consequence of acute aortic dissection. This technology is increasingly applied to patients without rupture or malperfusion, so-called "uncomplicated" dissections, to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta. A variety of techniques have been proposed, including intentional rupture of the dissection membrane to obliterate the false lumen as well as the candy-plug technique to eliminate retrograde flow in the false lumen.

[Cardiac progression of systemic light chain amyloidosis]. / Progresión cardiaca de amiloidosis sistémica de cadera ligera.

Systemic light chain amyloidosis is a disease characterized by the accumulation of amyloid protein in multiple organs and systems. We present the case of a 52-year-old male patient with a diagnosis of systemic light chain amyloidosis associated with cardiac and renal involvement. A renal biopsy showed the presence of renal amyloidosis associated with proteinuria, and the patient was referred for cardiovascular evaluation. The baseline electrocardiogram showed micro voltage in frontal leads that were discordant with the left ventricular hypertrophy evidenced in the transthoracic echocardiogram (TTE). Cardiac magnetic resonance imaging (CMR) confirmed the presence of cardiac amyloid infiltration with a pattern of extensive ventricular late-gadolinium enhancement. Despite being referred and receiving specific systemic chemotherapy treatment, the evolution was not favorable after four months of follow-up with worsening cardiac infiltration, increasing values of biomarkers, and progression of dyspnea. The TTE was useful in revealing the unfavorable evolution and worsening of diastolic function parameters and increased wall thickness in the context of infiltration. The electrocardiogram and echocardiogram were easily accessible tools that allowed the monitoring of the response to treatment.

Sintomatología depresiva y trastornos neurocognitivos en pacientes con VIH adherentes y no adherentes a TARAA: estudio transversal analítico / Depressive symptomatology and neurocognitive disorders in haart-adherent and non-adherent hiv patients: a cross-sectional analytical study

Introducción: Las personas portadoras del virus de inmunodeficiencia humana (VIH) presentan mayor comorbilidad de trastornos neurocognitivos y del ánimo que la población general. La introducción de los antirretrovirales ha disminuido significativamente la demencia asociada a VIH, relacionado a la adherencia a la terapia antirretroviral altamente activa (TARAA). Diversos estudios han demostrado la coexistencia de otros factores para explicar dicho trastorno cognitivo, tales como enfermedad neurológica previa, enfermedad psiquiátrica, consumo de drogas, nivel educativo, reserva cognitiva, entre otras. Objetivo: Determinar el grado de sintomatología depresiva, deterioro cognitivo y su relación con la adherencia a TARAA y otros factores de curso clínico en pacientes portadores de VIH en control ambulatorio. Métodos: Estudio transversal. Se incluyeron pacientes que viven con VIH adscritos al programa de infectología del Hospital Dr. Gustavo Fricke, Viña del mar, Chile. Se utilizaron datos sociodemográficos, clínicos y se aplicaron las escalas Depression in the Medicaly III Questionary, Montreal Cognitive Assesment y Morysky Green Levin Test. Resultados: Se incluyeron 29 participantes, en su mayoría hombres (86,2%) y con escolaridad técnica o profesional (86.2%). No hubo diferencias entre variables biodemográficas, depresivas ni subdimensiones cognitivos. Entre pacientes adherentes y no adherentes se encontró diferencias significativas respecto a la presencia de algún deterioro cognitivo. Conclusiones: Los resultados deben ser interpretados con cautela, dado su alcance limitado. Futuros estudios traslacionales debieran incorporar mediciones más certeras del nivel de adherencia al TARAA.

Introduction: Human immunodeficiency virus (HIV) carriers present more neurocognitive and mood disorders than the general population. The introduction of antiretrovirals has significantly lowered the incidence of HIV associated dementia, and this is related to adherence to highly active antiretroviral therapy (HAART). Several studies have shown the coexistence of other factors that could explain the cognitive disorder, such as a pre-existing neurological disease, psychiatric disease, drug consumption, level of education, cognitive reserve, and others. Objective: To determine the degree of depressive symptomatology and cognitive impairment and their relation to adherence to HAART and other factors of the clinical course of HIV carriers in outpatient supervision. Methods: Cross-sectional study. We included HIV patients in the infectious diseases program, Dr Gustavo Fricke Hospital, Viña del Mar, Chile. We used sociodemographic and clinical data and we applied the Depression in the Medically Ill questionnaire, Montreal Cognitive Assessment, and the Morysky Green Levin Test. Results: 29 patients participated, mainly men (86.2%) with technical or professional education (86.2%). There were no significant differences in sociodemographic, depressive, or cognitive subdomain variables. There were significant differences in cognitive impairment between adherents and non-adherents. Conclusions: Care should be taken with interpreting the results, given their limited scope. Future cross-sectional studies should incorporate more accurate measurements of HAART adherence.

Contrast-associated acute kidney injury following peripheral angiography.

Contrast-associated acute kidney injury (CA-AKI) is a well-known complication following angiography. Peripheral angiograms have been delayed or canceled for fear of worsening renal function leading to dialysis dependence. With the emergence of preventive measures, it is hypothesized that the risk of CA-AKI may be lower than previously observed. We performed a retrospective chart review of a single surgeon's 118 cases who underwent angiographic procedures from September 2019 through August 2020, recording patient characteristics and serum creatinine values. This cohort was comprised of 65 (55%) men and had a median age of 69 years [quartile 1 = 60, quartile 3 = 75]; 55 (47%) had diabetes mellitus and the median estimated glomerular filtration rate was 64 [45, 84] mL/min/1.73 m2. We observed a statistically significant decrease in paired serum creatinine (-0.02 mg/dL) following the procedure, and only 4 patients (3.4%) developed CA-AKI, with older age and elevated baseline creatinine being associated with reduced kidney function. We did not detect an adverse relationship between contrast volume and CA-AKI. While CA-AKI continues to be a concern for patients who require peripheral angiographic procedures, this study found the overall risk to be low. This may be partly attributable to the use of pre- and postprocedure hydration protocols and lower contrast volumes.

Disability and COVID-19: ensuring no one is left behind.

The United Nations' Sustainable Development Agenda calls for targeted attention to the needs and rights of the most vulnerable populations to ensure a life of dignity and human security for all. In this paper, we argue that persons with disabilities are in a disproportionately vulnerable situation in public health emergencies. By using the example of Coronavirus disease 2019 (Covid-19), we explain why that is and call for the systematic consideration of the needs and rights of persons with disabilities during the response to the outbreak and during the recovery phase. Otherwise, equity will continue to be merely an aspiration during this COVID-19 emergency - as it will in future health emergencies.

The Vici venous stent for treatment of renal vein entrapment.

The nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta. We present the first reported case of symptomatic left renal vein compression treated with balloon angioplasty and stenting with the Vici stent system.

Direct access of ascending aorta for endograft delivery in the descending thoracic aorta.

First-line therapy for aneurysm, dissection, or rupture of the descending thoracic aorta is now by the endovascular approach. Retrograde insertion of the endograft, through access from the femoral arteries, is the preferred approach. This case presents a new, innovative technique for delivery of an endoprosthesis into the descending thoracic aorta when hostile anatomy prevents delivery from the femoral arteries, iliac arteries, or infrarenal abdominal aorta in a patient not suitable for open repair.

Ascending aortic thrombus with multiple emboli associated with COVID-19.

Coronavirus disease 2019 (COVID-19) initiates a hypercoagulable state and causes thrombotic complications. A presentation of multiple thromboembolic events without an underlying source should raise suspicion for COVID-19 hypercoagulability. We describe a patient with an ascending aortic thrombus resulting in multiple emboli treated by multiple modalities.

Recurrencia de fibrilación auricular posablación de venas pulmonares. Identificación de factores predictores / Atrial fibrillation recurrence post pulmonary vein ablation. Identification of predictive factors / Recorrência da fibrilação atrial pós-ablação das veias pulmonares. Identificação de fatores preditivos

Resumen: La ablación de la fibrilación auricular mediante el aislamiento de las venas pulmonares, es una estrategia ampliamente utilizada en la actualidad. La recurrencia posablación es un problema frecuente. Se han investigado varios predictores de recurrencia con el fin de optimizar la elección del paciente que más se beneficia del procedimiento. Actualmente la evidencia es controvertida, siendo necesarios más estudios al respecto.

Summary: The ablation of atrial fibrillation based on pulmonary veins isolation, is a widely used strategy nowadays. Post ablation recurrence is a frequent problem. Several recurrence predictors have been researched, with the purpose of choosing the patient that would benefit the most from this procedure. Current evidence is controversial and more research is needed.

Morphological and Immunohistochemical Description of a Lymphoma in a Two-Month-Old Lamb Using MUM1/IRF4, CD79a, CD3, CD10 and Ki67 Markers / Descripción morfológica e inmunohistoquímica de un linfoma en un cordero de dos meses de edad usando los marcadores MUM1/IRF4, CD79a, CD3, CD10 y Ki67 / Descrição morfológica e imuno-histoquímica de um linfoma em um cordeiro de dois meses de idade usando os marcadores MUM1/IRF4, CD79a, CD3, CD10 e Ki67

Abstract This article contains a morphological description of a case of early presentation lymphoma in a lamb, characterised by its unusual clinical history and advanced lesions. The primary tumour was located in the skin in the carpal region, and metastases were observed in the brain, right eye, all the pulmonary lobes, the myocardium and endocardium of the heart, left adrenal gland, abdominal portion of the vagal nerve, serosa of the rumen, the body of lumbar vertebra L3, and the submandibular, mediastinal and mesenteric lymph nodes. Histopathological examination revealed that it was a large cell lymphoma. Immunohistochemical analysis was carried out with antibodies for MUM1/IRF4, CD79a, CD3, CD10 and Ki67, used here for the first time as markers to characterise a lymphoma in this species. The result revealed that it was a B-cell lymphoma.

Resumen En este artículo se describe morfológicamente un caso de linfoma de presentación temprana en la especie ovina, el cual se caracterizó por lo inusual de su historia clínica y lo avanzado de las lesiones. El tumor primario se localizó en la piel del carpo y se observaron metástasis en el cerebro, el ojo derecho, todos los lóbulos pulmonares, el miocardio y endocardio del corazón, la glándula adrenal izquierda, el nervio vago en su porción abdominal, la serosa del rumen, el cuerpo vertebral lumbar L3, los linfonodos submandibulares, mediastínicos y mesentéricos. El examen histopatológico reveló un linfoma no Hodgkin de células grandes. El análisis inmunohistoquímico se realizó con anticuerpos para MUM-1/IRF-4, CD79a, CD3, CD10 y Ki-67, los cuales se usaron por primera vez como marcadores para caracterizar un linfoma en esta especie. El resultado reveló que se trató de un linfoma de células-B.

Resumo Neste artigo descreve-se morfologicamente um caso de linfoma de apresentação precoce na espécie ovina, caracterizado pela historia clínica incomum e as lesões avançadas. O tumor primário foi encontrado na pele do carpo e metástase foi observada no cérebro, olho direito, todos os lobos pulmonares, miocárdio e endocárdio do coração, a glándula adrenal esquerda, nervo vago na porção abdominal, a serosa do rúmen, o corpo vertebral lombar L3, linfonodos submandibulares, mediastinos e mesentéricos. O exame histopatológico revelou linfoma não-Hodgkin de células grandes. A análise imuno-histoquímica foi realizada com anticorpos para MUM-1/IRF-4, CD79a, CD3, CD10 e Ki-67, os quais usaram-se por primeira vez como marcadores para caracterizar um linfoma nessa espécie. O resultado revelou que se tratou de linfoma de células-B.

Remodelado reverso de la aurícula izquierda posablación de venas pulmonares en la fibrilación auricular: una serie de casos / Reverse remodeling of left atrium post pulmonary veins ablation in atrial fibrillation: case series / Remodelação reversa do átrio esquerdo pós-ablação de veias pulmonares na fibrilação atrial: uma série de casos

Resumen: El aislamiento de las venas pulmonares usando sistemas de navegación en tercera dimensión (3D) es una técnica de uso universal que ha demostrado tasas de éxito significativas en la ablación de la fibrilación auricular (FA). Sin embargo, el remodelado que sufre la aurícula izquierda (AI) posterior a la ablación ha sido escasamente evaluado. Ocho pacientes fueron sometidos a ablación de las venas pulmonares con sistema de mapeo electroanatómico entre marzo de 2016 y marzo de 2017. Se evaluó la AI con ecocardiograma preprocedimiento, y uno y tres meses luego de este, utilizando las siguientes variables: volumen auricular izquierdo en biplano, fracción de eyección de AI (FEAI) y strain reservorio de AI en pared lateral. Para determinar la existencia de recurrencia se realizó Holter de 24 horas e interrogatorio telefónico a los tres y seis meses posablación. Se evidenció remodelado reverso estructural y funcional de la AI en seis pacientes. Aquellos con recurrencia de FA no presentaron remodelado reverso y mostraron mayor deterioro de la función auricular previo a la ablación. Estos hallazgos permiten plantearnos algunas hipótesis a investigar sobre los predictores de recurrencia.

Summary: Electrical isolation of the pulmonary veins using third dimension navigation systems is a universal technique that has showed a significant success in atrial fibrillation ablation. Nevertheless, the reverse remodeling suffered by the left atrium after ablation has been scarcely evaluated. Eight patients underwent the ablation of the pulmonary veins with electroanatomic map system, between March 2016 to March 2017. The left atrium was evaluated by echocardiogram pre procedure, and one and three months after ablation, using the following variables: left atrial volume in biplane, ejection fraction of the left atrium and reservoir strain of the left atrium in the lateral wall. To determine the existence of recurrence, Holter of 24 hours was applied and phone calls three and six months after were made. There was evidence of a reverse remodeling structural and functional of the left atrium in six patients. Those with recurrence of atrial fibrillation did not show reverse remodel and showed higher deterioration of the auricular function prior to the ablation. These findings let us make some hypotheses and investigate about recurrence predictors.

Resumo: O isolamento das veias pulmonares, utilizando sistemas de navegação em terceira dimensão, é uma técnica de uso universal que tem sucesso significativo na ablação de fibrilação atrial. No entanto, o remodelamento do átrio esquerdo após a ablação tem sido pouco avaliado. Oito pacientes foram submetidos a ablação de veias pulmonares utilizando mapeamento eletro-anatômico entre março de 2016 e março de 2017. O átrio esquerdo foi avaliado com ecocardiograma no pré-procedimento, e um e três meses após o mesmo, usando as seguintes variáveis: volume do átrio esquerdo em biplano, fração de ejeção do átrio esquerdo e tensão do reservatório do átrio esquerdo na parede lateral. Para determinar a existência de recorrência, Holter de 24 horas e interrogatório por telefone foram realizados três e seis meses após a ablação. A remodelação reversa estrutural e funcional do átrio esquerdo foi observado em seis pacientes. Aqueles com recidiva de fibrilação atrial não apresentaram remodelamento reverso e mostraram maior deterioração da função atrial antes da ablação. Estas descobertas permitem propor algumas hipóteses para investigar sobre os preditores de recorrência.

INTELLECTUAL PROPERTY IN SPORTS: TRENDS IN PATENTS OF THE INTERNATIONAL AND COLOMBIAN SPORTS INDUSTRY / PROPRIEDADE INTELECTUAL NO ESPORTE: TENDÊNCIAS DE PATENTES NA INDUSTRIA ESPORTIVA INTERNACIONAL E COLOMBIANA / PROPIEDAD INTELECTUAL EN EL DEPORTE: TENDENCIAS EN PATENTES DE LA INDUSTRIA DEPORTIVA INTERNACIONAL Y COLOMBIANA

La propiedad intelectual en el deporte es un tema poco estudiado, por lo que se carece de información robusta para describir el panorama global de la innovación de la industria deportiva. El presente artículo tiene como propósito identificar las tendencias de la industria deportiva internacional y la realidad colombiana sobre la protección de la innovación en el mercado de patentes. Mediante un estudio exploratorio, se caracterizaron los indicadores bibliométricos para patentes en los últimos 20 años. Los resultados muestran un aumento notable desde 2007 en registros de patentes, siendo China el país más innovador, y el mercado de aparatos para el entrenamiento físico el de mayor crecimiento a nivel global. En Colombia se registran 17 familias de patentes y seis segmentos estratégicos para el desarrollo de productos altamente innovadores.

Propriedade intelectual e inovação no esporte são tópicos poucos estudados, portanto, há uma falta de informação robusta para descrever o panorama da inovação da indústria do esporte. O presente artigo tem como objetivo identificar as tendências da indústria do esporte internacional e a realidade colombiana sobre a proteção da inovação no mercado de patentes. Através de um estudo exploratório, os indicadores bibliométricos para patentes nos últimos 20 anos foram caracterizados. Os resultados revelam um aumento marcante no registro de patentes desde o 2007, sendo a China o país mais inovador, o mercado de aparelhos para o treinamento físico é o de maior crescimento global. Na Colômbia, se cadastram 17 famílias de patentes e seis segmentos estratégicos para o desenvolvimento de produtos altamente inovadores.

Intellectual property in sports is a little studied subject, therefore, there is a lack of relevant information to describe the global panorama of innovation in the sports industry. This article aims to identify the trends in the international sports industry and the Colombian reality about the protection of innovation in the patent market. Through an exploratory study, bibliometric indicators were characterized for patents in the last 20 years. The results show a remarkable increase since 2007 in patent registrations being China the most innovative country; the market of the devices for physical training devices presents the greater growth at a global level. In Colombia, 17 patent families and six strategic segments are registered for the development of highly innovative products.

Biofiltration of trimethylamine in biotrickling filter inoculated with Aminobacter aminovorans

Background: Trimethylamine (TMA) is the main responsible for the odor associated with rotting fish and other annoying odors generated in many industrial activities. Biofiltration has proved to be efficient for treating odorous gaseous emissions. The main objective of this work was to determine the removal capacity of TMA of a biotrickling filter inoculated with Aminobacter aminovorans and to evaluate the effect of H2S on its performance. Results: The maximumspecific growth rate ofA. aminovorans in a liquid culture was 0.15 h -1 , witha TMAto biomass yield of 0.10 (g g -1) and a specific consumption rate of 0.062 g·g-1·h-1 . The initial specific consumption rate of TMA was highly influenced by the presence of H2S in liquid culture at concentrations of 20 and 69 ppm in heading space oftheflasks.ABTF inoculatedwithA. aminovorans showedremoval efficiencieshigher than98%ina range ofloading rate of 0.2 to 8 g·m-3·h-1 at empty bed residence time (EBRT) of 85 and 180 s. No effect on the elimination capacity and efficiency was detected when H2S was added at 20 and 50 ppm to the inlet gaseous emission, though the fraction of A. aminovorans measured by qPCR in the biofilm decreased. Conclusions:Abiotrickling filter inoculated with A. aminovorans can remove efficiently the TMA in a gaseous stream. The elimination capacity of TMA can be negatively affected by H2S, but its effect is not notorious when it is forming part of a biofilm, due to its high specific consumption rate of TMA.

Case Report: An Innovative Endovascular Technique for Repair of Descending Thoracic Aortic Aneurysm following an Open Coarctation Repair.

It was once postulated that open surgical repair of coarctation of the aorta during childhood patients was cured. However, long-term follow-up has been significant for late problems such as an aneurysm. The incidence of such aneurysm after open surgical coarctation repair is 11-24%. If such an aneurysm is left untreated, patients are at a high risk of morbidity and mortality. Prior to the endovascular era, patients would require a redo open repair which in itself is a highly morbid operation. Currently, thoracic endovascular aortic repair (TEVAR) has been reported as a feasible and safe alternative to open surgical reprocedures in this context. However, TEVAR might be challenging due to the proximity of the pathology to supraaortic vessels and the ongoing presence of the coarctation. We are reporting a unique case of a 48-year-old male undergoing TEVAR due to aortic aneurysm after previous surgical coarctation treatment and successful closure of the coarctation with a vascular plug device.

58. Seguridad y eficacia de la ablación de la fibrilación auricular con mapeo electroanatómico en nuestro medio

Antecedentes: la fibrilación auricular (FA) es la arritmia más frecuente y asocia una alta morbilidad y mortalidad. La ablación de la misma mediante aislamiento de las venas pulmonares (AVP) utilizando mapeo electroanatómico (MEA) se ha convertido en el tratamiento de elección para el control de ritmo y mejorar los síntomas cuando la farmacoterapia antiarrítmica ha fallado. La tasa de éxito y seguridad del procedimiento varían en las distintas cohortes publicadas. Objetivos: Objetivo primario: determinar la eficacia del procedimiento en esta población. Objetivo secundario: analizar la seguridad del procedimiento y describir la evolución de los síntomas posperíodo de blanqueo de 3 meses. Material y método: se incluyó una cohorte retrospectiva de 25 pacientes, 17 con FA paroxística y 8 con FA persistente, sometidos a AVP con sistema de MEA Ensite Navx entre 2015 y 2017. La eficacia se evaluó con el número de venas pulmonares con aislamiento eléctrico y anatómico exitoso. La tasa de recurrencia se evaluó con Holter de 24 horas luego de los tres meses del procedimiento. La seguridad se evaluó con el análisis de las complicaciones periprocedimiento. Se utilizó test de Student para la comparación de las medias y se consideró como significativo una p<0,05. Cabe destacar que el equipo actuante tenía experiencia en este tipo de procedimiento pero sin MEA. Resultados: el porcentaje de éxito fue de 72%, con una franca mejoría de los síntomas (escala ERHA), tanto en el grupo de recurrencia como en el que no recurrió, con diferencias estadísticamente significativas. La seguridad fue similar a la de los registros internacionales. Se observó disminución progresiva en tiempo de radioscopía. La población que recurrió tenía mayor área auricular izquierda, mayor tiempo desde el diagnóstico de FA hasta la ablación y mayor prevalencia de FA persistente, sin diferencias estadísticamente significativas. Se adjunta tabla de resultados y gráfica de tendencia del uso de radioscopía. Conclusiones: la tasa de éxito y seguridad así como la mejoría sintomática de este procedimiento en nuestro centro es similar a las grandes series publicadas, lo que puede explicarse por la cuidadosa selección de pacientes, la experiencia del equipo en este tipo de procedimientos y la metodología de seguimiento utilizada.

14. Serie de casos: remodelado reverso de la aurícula izquierda posablación de venas pulmonares en la fibrilación auricular. un posible predictor de recurrencia

Antecedentes: la ablación de las venas pulmonares con reconstrucción anatómica en 3D usando sistemas de navegación es una técnica nueva prometedora para lograr mayor tasa de éxito en la ablación de la FA. Sin embargo, el remodelado que sufre la aurícula izquierda posterior a la ablación ha sido escasamente evaluado. Objetivo: describir los cambios a corto plazo que sufre la aurícula izquierda posterior a la ablación de venas pulmonares con radiofrecuencia y en forma secundaria evaluar la relación entre estos hallazgos y la recurrencia de FA. Material y método: prospectivamente se incluyeron ocho pacientes sometidos a ablación de las venas pulmonares con sistema de mapeo electroanatómico, entre marzo del 2016 y marzo del 2017. Se evaluó la aurícula izquierda preprocedimiento, uno y tres meses luego del mismo. Variables estudiadas: volumen auricular izquierdo en biplano, fracción de eyección de aurícula izquierda (FEAI) y strain reservorio de aurícula izquierda en pared lateral. Para determinar la existencia de recurrencia se realizó Holter de 24 horas y llamadas telefónicas a los tres y seis meses posablación. Resultados: se logró aislamiento anatómico y eléctrico de las cuatro venas pulmonares en los ocho pacientes. Cuatro de ellos disminuyeron su volumen AI en más del 15%. La FEAI no presentó cambios significativos en esta serie. El strain reservorio mejoró al mes posablación. 2 de los 8 pacientes tuvieron recurrencia temprana de la FA. En estos dos pacientes, el volumen auricular y el strain reservorio no tuvieron cambios significativos, además su strain reservorio basal (previo a ablación) fue menor a 10 en ambos casos. Conclusiones: se evidenció remodelado reverso estructural y funcional de la aurícula izquierda en la mayoría de los pacientes. Aquellos con recurrencia de FA no presentaron remodelado reverso y mostraron mayor deterioro de la función auricular previo a la ablación. Estos hallazgos permiten plantearnos algunas hipótesis a investigar sobre los predictores de recurrencia.

9. Denervación parasimpática supraventricular en la enfermedad del nodo sinusal por estado hipervagotónico

Historia clínica: mujer de 47 años sin antecedentes patológicos a destacar, historia de diez años de evolución de astenia y mareo. Consultó por episodio presincopal. Examen físico: frecuencia cardíaca (FC) 36 l/min, resto normal. Pruebas complementarias: radiografía de tórax normal, ECG: bradicardia sinusal a 36 lpm, sin evidencia de bloqueos en la conducción, resto normal. ETT y paraclínica sanguínea: normal. Holter 24 h: FC mínima: 27 lpm. FC máxima: 86 lpm. FC media: 41 lpm. Pausa máxima de 2,5 s, SDNN de 338 ms. Evolución clínica: se descartaron causas reversibles de bradicardia sinusal, se realizó planteo de hiperactividad parasimpática confirmándose con test de atropina positivo. Del estudio electrofisiológico (EEF) se destacó un tiempo de recuperación del nodo sinusal (TRNS) de más de 8.000 ms. Se procedió a la ablación por radiofrecuencia (RF) de los cuerpos neuronales posganglionares parasimpáticos supraventriculares a nivel endocárdico. Al final del procedimiento la FC fue de 62 lpm. Holter en la evolución: FC media fue de 56 lpm, SDNN de 135 ms, asintomática durante el estudio. Diagnóstico: enfermedad del nodo sinusal presinusal por estado hipervagotónico. Discusión: la denervación parasimpática supraventricular con catéter de ablación por RF endocárdica es una alternativa segura y eficiente para el tratamiento de la bradicardia sinusal sintomática por vagotonía supraventricular. Es una opción terapéutica que evita los efectos desfavorables de la estimulación cardíaca artificial (marcapasos).