Complex ADHD Challenging Case: Managing Co-Occurring Attention-Deficit Hyperactivity Disorder and Congenital Heart Disease with a Limited Medication Formulary: A Case from Mexico.

CASE: DL is an 8-year-old Mexican boy with a posterior atrial septal defect and partial anomalous pulmonary venous return of the right lower pulmonary vein with resultant right heart dilation with normal right ventricular systolic and diastolic function and no arrhythmias. Surgical repair was deferred, and DL's condition was being medically managed with furosemide 0.5 mg/kg BID and spironolactone 0.5 mg/kg BID.DL presents for developmental assessment due to poor performance in school following a lifting of COVID-19 pandemic restrictions and return to in-person classes. He has been attending full-time classes for 3 months without improvements in math, reading, and writing skills. Current attentional concerns at school include an inability to complete tasks without getting distracted by minimal stimuli and highly impulsive behavior.At the first assessment, DL was performing below grade expectations (e.g., reading by syllable without text comprehension, demonstrating preoperational addition and subtraction skills, inability to take dictation)-all of which was viewed as negatively impacted by attentional deficits. DL met DSM-5 criteria for ADHD, predominantly inattentive type. He was started on 10-mg immediate-release methylphenidate PO at 8 am with breakfast and a second dose of 10-mg immediate-release methylphenidate PO 4 hours after the first dose.After a month, at the first follow-up consultation, improvement in attention span, impulsivity, and school performance were observed, including reading skills and math proficiency. However, DL's mother raised concerns about circumoral cyanosis and acrocyanosis in the fingers of both hands after playing outside. These signs were not previously observed. During physical examination at the same visit, heart rate, blood pressure, and oximetry were within baseline ranges and his cardiac examination was unchanged. DL's dosage of methylphenidate was lowered to 10-mg immediate-release methylphenidate PO QD in the mornings with breakfast (8 am).DL did not return to clinic for another 2 months, having discontinued the medication after 2 months of treatment given financial limitations. His mother reported that DL's exertional circumoral cyanosis and acrocyanosis resolved while he was off medication. However, she observed an increase in inattentive symptoms and impulsivity and decline in his academic skills. She asked if our team was able continue the treatment despite the drug side effects, since she believed the benefits outweighed the disadvantages.Given these concerns, the team requested an updated cardiology assessment. The Cardiologist recommended discontinuation of methylphenidate and recommended follow-up with cardiothoracic surgery for reassessment of the surgical timeline.Given the limited treatment options in Mexico, what would you do next as the treating developmental-behavioral clinician…?

Efectividad de la colecistectomía laparoscópica de puerto único asistida con imanes bajo anestesia espinal

Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

Conocimientos, actitudes y prácticas sobre Leishmaniasis visceral en tres comunas de Neiva, Huila / Knowledge, attitudes and practices about Visceral leishmaniasis in three communes of Neiva, Huila

Introducción: La leishmaniasis visceral es una enfermedad zoonótica, transmitida por vectores del género Lutzomyia, de distribución en 98 países, incluyendo Colombia y que puede ocasionar un cuadro clínico grave, que en ausencia de tratamiento puede ser fatal. Objetivo: Determinar los conocimientos, actitudes y prácticas (CAP) adquiridas sobre vectores, reservorios y características de la Leishmaniasis visceral en las comunas 8, 9 y 10 de Neiva (Huila) en 2019. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en el período de junio a diciembre de 2019, en el que se muestrearon tres comunas (8, 9 y 10), en un total de 30 barrios de la ciudad de Neiva-Huila. Se aplicaron 385 encuestas tipo CAP, con un margen de error de 5 % y una confiabilidad de 95 %. Se incluyeron personas adultas de 18 años o más (267 mujeres y 117 hombres), que voluntariamente desearon participar, con previo consentimiento informado. Resultados: Según la información analizada, se determinó que 77 % de los encuestados no conoce la leishmaniasis visceral, 52 % no la identifican como una enfermedad zoonótica, 82 % no conocen el agente causal y 44 % no tienen claridad sobre los síntomas que se presentan en humanos. Conclusiones: Aunque se han realizado campañas preventivas en las comunas afectadas, el nivel de conocimiento sobre la enfermedad, el vector, el reservorio y las prácticas preventivas específicas para contrarrestar la leishmaniasis visceral son poco conocidos en la población de estudio, a pesar de que las prácticas y actitudes identificadas son positivas.

Introduction: Visceral leishmaniasis is a zoonotic disease transmitted by vectors of the Lutzomyia genus, distributed in 98 countries, including Colombia, which can cause a serious clinical picture that, in the absence of treatment, can be fatal. Objective: To determine the knowledge, attitudes, and practices (KAP) acquired on vectors and reservoirs, as well as the characteristics of visceral Leishmaniasis in communes 8, 9 and 10 of the city of Neiva in 2019. Material and Methods: A descriptive cross-sectional study was carried out from June to December 2019. Three communes (8, 9 y 10) were sampled from a total of 30 neighborhoods of the city of Neiva - Huila. In addition, 385 CAP-type surveys were applied, with a margin of error of 5% and a reliability of 95%. People aged 18 years or older (267 women and 117 men) who voluntarily wished to participate, with prior informed consent, were included. Results: According to the analyzed information, it was determined that the majority of the surveyed population did not know about visceral leishmaniasis (77%), did not identify it as a zoonotic disease (52%), nor did they know who the causative agent is (82%); furthermore, they were not clear about the symptoms that occur in humans, nor the treatment used to manage them. Conclusions: Although preventive campaigns have been carried out in the affected communes, the level of knowledge about the disease, the vector, the reservoir, and the specific preventive practices to counteract visceral leishmaniasis are little known in the study population, despite the fact that the identified practices and attitudes are positive.

May Measurement Month 2017-2019: an analysis of blood pressure screening results from Dominican Republic.

Arterial hypertension is the main risk factor that contributes to cardiovascular disease and represents a leading cause of morbidity and mortality globally. May Measurement Month (MMM) is a global screening campaign with the aim of improving awareness of hypertension at the individual and population level, an initiative that has been supported in the Dominican Republic (DR) since 2017. Adults (≥18 years) were recruited by sampling in different places in the DR, three blood pressure (BP) readings were performed per participant, and data on risk factors and comorbidities were collected. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥ 90 mm Hg (mean of second and third readings), and/or taking antihypertensive medication. Multiple imputation was used to estimate participants' mean BP when three readings were not available. Of 3693 participants, 2134 (57.8%) had hypertension, of whom 1646 (77.1%) were taking medication, but only 38.6% of those on treatment had their BP under control(<140/90 mmHg). The remaining 61.4% of the participants received inadequate treatment. A total of 66% of treated patients were taking a single antihypertensive drug. MMM provides an important platform for the standardized compilation of BP data and the creation of awareness of hypertension in the DR and other nations of the world. The data generated from the 2017-2019 MMM campaigns highlight the importance of adequate detection, knowledge, and control of BP.

Characterizing the Genetic Architecture of Parkinson's Disease in Latinos.

OBJECTIVE: This work was undertaken in order to identify Parkinson's disease (PD) risk variants in a Latino cohort, to describe the overlap in the genetic architecture of PD in Latinos compared to European-ancestry subjects, and to increase the diversity in PD genome-wide association (GWAS) data. METHODS: We genotyped and imputed 1,497 PD cases and controls recruited from nine clinical sites across South America. We performed a GWAS using logistic mixed models; variants with a p-value <1 × 10-5 were tested in a replication cohort of 1,234 self-reported Latino PD cases and 439,522 Latino controls from 23andMe, Inc. We also performed an admixture mapping analysis where local ancestry blocks were tested for association with PD status. RESULTS: One locus, SNCA, achieved genome-wide significance (p-value <5 × 10-8 ); rs356182 achieved genome-wide significance in both the discovery and the replication cohorts (discovery, G allele: 1.58 OR, 95% CI 1.35-1.86, p-value 2.48 × 10-8 ; 23andMe, G allele: 1.26 OR, 95% CI 1.16-1.37, p-value 4.55 × 10-8 ). In our admixture mapping analysis, a locus on chromosome 14, containing the gene STXBP6, achieved significance in a joint test of ancestries and in the Native American single-ancestry test (p-value <5 × 10-5 ). A second locus on chromosome 6, containing the gene RPS6KA2, achieved significance in the African single-ancestry test (p-value <5 × 10-5 ). INTERPRETATION: This study demonstrated the importance of the SNCA locus for the etiology of PD in Latinos. By leveraging the demographic history of our cohort via admixture mapping, we identified two potential PD risk loci that merit further study. ANN NEUROL 2021;90:353-365.

Comparative Growth Inhibition of Bread Spoilage Fungi by Different Preservative Concentrations Using a Rapid Turbidimetric Assay System.

Bread and intermediate moisture bakery products are mainly spoiled by yeasts and filamentous fungi. The inoculum load and preservation system used determines their shelf life. To extend the shelf life of such commodities, the use of chemical preservatives is the most common way to try and control the initiation of mold spoilage of bread. This study has utilized a rapid turbidimetric assay system (Bioscreen C) to examine the temporal efficacy of calcium propionate (CP) and potassium sorbate (PS) for controlling the growth of important bread spoilage fungi. The objectives were to compare the temporal growth of strains of three important spoilage fungi Hyphopichia burtonii (HB17), Paecilomyces variotii (PV11), and Penicillium roqueforti (PR06) isolated from visibly molded bread to (a) different concentrations of CP and PS (0-128 mM), (b) temperatures (25°C, 30°C), (c) water activity (aw; 0.95, 0.97), and (d) pH (5.0, 5.5). All three abiotic factors, pH, aw, and temperature, and preservative concentrations influenced the relative growth of the species examined. In general, PS was more effective than CP in inhibiting the growth of the strains of these three species. In addition, the Time to Detection (TTD) for the efficacy of the preservatives under the interacting abiotic factors was compared. The strain of Paecilomyces variotii (PV10) was the most tolerant to the preservatives, with the shortest TTD values for both preservatives. P. roqueforti was the most sensitive with the longest TTD values under all conditions examined. These results are discussed in the context of the evolution of resistance to food-grade preservatives by such spoilage fungi in bakery products.

Overview of Fungi and Mycotoxin Contamination in Capsicum Pepper and in Its Derivatives.

Capsicum products are widely commercialised and consumed worldwide. These substrates present unusual nutritional characteristics for microbial growth. Despite this, the presence of spoilage fungi and the co-occurrence of mycotoxins in the pepper production chain have been commonly detected. The main aim of this work was to review the critical control points, with a focus on mycotoxin contamination, during the production, storage and distribution of Capsicum products from a safety perspective; outlining the important role of ecophysiological factors in stimulating or inhibiting mycotoxin biosynthesis in these food commodities. Moreover, the human health risks caused by the ingestion of peppers contaminated with mycotoxins were also reviewed. Overall, Capsicum and its derivative-products are highly susceptible to contamination by mycotoxins. Pepper crop production and further transportation, processing and storage are crucial for production of safe food.

Synthesis of Polyheterocyclic Pyrrolo[3,4-b]pyridin-5-ones via a One-Pot (Ugi-3CR/aza Diels-Alder/N-acylation/aromatization/SN2) Process. A Suitable Alternative towards Novel Aza-Analogues of Falipamil.

We describe the one-pot synthesis of twenty polyheterocyclic pyrrolo[3,4-b]pyridin-5-ones via a cascade process (Ugi-3CR/aza Diels-Alder/N-acylation/aromatization) in 20 to 95% overall yields, as well as four pharmacologically promising analogues via an improved cascade process (Ugi-3CR/aza Diels-Alder/N-acylation/aromatization/SN2): two piperazine-linked pyrrolo[3,4-b]pyridin-5-ones in 33 and 34%, and a couple of Falipamil aza-analogues in 30 and 35% overall yields. It is worth highlighting the good substrate scope found, because final products are furnished with alkyl, aryl, and heterocyclic substituents. The use of chain-ring tautomerizable isocyanides (as key reagents for the Ugi-type three component reaction) allowed for a rapid and efficient assembly of the polysubstituted oxindoles, which were used in situ toward the complex products, conferring features like robustness, sustainability, and the one-pot approach to this synthetic methodology.

Synthesis of Structurally Diverse Emissive Molecular Rotors with Four-Component Ugi Stators.

The use of the multicomponent Ugi reaction to rapidly prepare a library of dumbbell-like molecular rotors is highlighted here. The synthetic strategy consisted of the atom-economic access to 15 bulky and structurally diverse iodinated stators, which were cross-coupled to the 1,4-diethynylphenylene rotator. From those experiments, up to six rotors 1a-c and 1l-n were obtained, with yields ranging from 35 to 69% per coupled C-C bond. In addition to the framework diversity, five of these compounds showed aggregate-enhanced emission properties thanks to their conjugated 1,4-bis(phenylethynyl)benzene cores, a property that rises by increasing the water fraction (fw) in their THF solutions. The results highlight the significance of the diversity-oriented synthesis of rapid access to new molecular fluorescent rotors.

Assessment of fractional excretion of urea for early diagnosis of cardiac surgery associated acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine, but it is not widely used in clinical practice. Fractional excretion of urea (FeU) has been referred to as a useful tool to discriminate between prerenal and established AKI. The aim of our study is to evaluate the sensitivity and specificity of FeU, in the early diagnosis of AKI in patients undergoing CS. METHODS: We performed a prospective study on adults undergoing CS. AKI was defined by AKIN criteria. Individuals suffering from CKD, were excluded. Sensitivity and specificity of FeU, fractional excretion of sodium (FeNa) and urine NGAL, measured at 1, 6 and 24 h following CS, were assessed. RESULTS: We included 66 patients (26% female) aging 68 ± 11 years. AKI prevalence was 24% and mortality was 3.28%. Patients with AKI had a significantly lower FeU compared to those without AKI (23.89 ± 0.67% vs. 34.22 ± 0.58%; p < 0.05) 6 h after CS, but not at the 1- and 24-h time points. NGAL was also statistically significant between both groups. FeU showed a 75% sensitivity and 79.5% specificity; the AUC was 0.786. ROC analysis of FeU and NGAL yielded similar values (p = NS). CONCLUSION: FeU is useful as an early biomarker to predict AKI after CS and it is comparable to the new biomarker NGAL.

Population genetic structure of traditional populations in the Peruvian Central Andes and implications for South American population history.

Molecular-based characterizations of Andean peoples are traditionally conducted in the service of elucidating continent-level evolutionary processes in South America. Consequently, genetic variation among "western" Andean populations is often represented in relation to variation among "eastern" Amazon and Orinoco River Basin populations. This west-east contrast in patterns of population genetic variation is typically attributed to large-scale phenomena, such as dual founder colonization events or differing long-term microevolutionary histories. However, alternative explanations that consider the nature and causes of population genetic diversity within the Andean region remain underexplored. Here we examine population genetic diversity in the Peruvian Central Andes using data from the mtDNA first hypervariable region and Y-chromosome short tandem repeats among 17 newly sampled populations and 15 published samples. Using this geographically comprehensive data set, we first reassessed the currently accepted pattern of western versus eastern population genetic structure, which our results ultimately reject: mtDNA population diversities were lower, rather than higher, within Andean versus eastern populations, and only highland Y-chromosomes exhibited significantly higher within-population diversities compared with eastern groups. Multiple populations, including several highland samples, exhibited low genetic diversities for both genetic systems. Second, we explored whether the implementation of Inca state and Spanish colonial policies starting at about ad 1400 could have substantially restructured population genetic variation and consequently constitute a primary explanation for the extant pattern of population diversity in the Peruvian Central Andes. Our results suggest that Peruvian Central Andean population structure cannot be parsimoniously explained as the sole outcome of combined Inca and Spanish policies on the region's population demography: highland populations differed from coastal and lowland populations in mtDNA genetic structure only; highland groups also showed strong evidence of female-biased gene flow and/or effective sizes relative to other Peruvian ecozones. Taken together, these findings indicate that population genetic structure in the Peruvian Central Andes is considerably more complex than previously reported and that characterizations of and explanations for genetic variation may be best pursued within more localized regions and defined time periods.

Possible positive selection for an arsenic-protective haplotype in humans.

BACKGROUND: Arsenic in drinking water causes severe health effects. Indigenous people in the South American Andes have likely lived with arsenic-contaminated drinking water for thousands of years. Inhabitants of San Antonio de los Cobres (SAC) in the Argentinean highlands generally carry an AS3MT (the major arsenic-metabolizing gene) haplotype associated with reduced health risks due to rapid arsenic excretion and lower urinary fraction of the monomethylated metabolite. OBJECTIVES: We hypothesized an adaptation to high-arsenic living conditions via a possible positive selection for protective AS3MT variants and compared AS3MT haplotype frequencies among different indigenous groups. METHODS: Indigenous groups we evaluated were a) inhabitants of SAC and villages near Salta in northern Argentina (n = 346), b) three Native American populations from the Human Genome Diversity Project (HGDP; n = 25), and c) five Peruvian populations (n = 97). The last two groups have presumably lower historical exposure to arsenic. RESULTS: We found a significantly higher frequency of the protective AS3MT haplotype in the SAC population (68.7%) compared with the HGDP (14.3%, p < 0.001, Fisher exact test) and Peruvian (50.5%, p < 0.001) populations. Genome-wide microsatellite (n = 671) analysis showed no detectable level of population structure between SAC and Peruvian populations (measure of population differentiation FST = 0.006) and low levels of structure between SAC and HGDP populations (FST < 0.055 for all pairs of populations compared). CONCLUSIONS: Because population stratification seems unlikely to explain the differences in AS3MT haplotype frequencies, our data raise the possibility that, during a few thousand years, natural selection for tolerance to the environmental stressor arsenic may have increased the frequency of protective variants of AS3MT. Further studies are needed to investigate this hypothesis.

Hipertensos primarios: evolución de la remodelación cardiaca según tratamiento / Primary hypertensive patients: evolution of cardiac remodeling according to treatment

Fundamento: La hipertensión arterial es un problema prioritario de salud a nivel mundial que afecta eminentemente a las sociedades desarrolladas y es extraordinariamente prevalente. Objetivo: Valorar, después del tratamiento farmacológico, la evolución de la remodelación cardiaca en pacientes hipertensos primarios. Método: Se realizó un estudio observacional, analítico transversal en tres áreas de salud del municipio Camagüey a 178 pacientes hipertensos primarios, mayores de 18 años, diagnosticados con remodelación del ventrículo izquierdo en el año 2004. Al grupo de estudio se le indicó tratamiento antihipertensivo en sus respectivos consultorios del médico de la familia. En el año 2006 se le realizaron a estos pacientes ecocardiografías, se practicaron las mediciones diastólicas del ventrículo izquierdo y se clasificaron los patrones geométricos. Las mediciones ecocardiográficas se compararon con las del 2004 y se determinó la evolución de los cambios del patrón geométrico. Resultados: Después del tratamiento farmacológico, normalizaron el patrón geométrico el 12,4 por ciento, la remodelación concéntrica y la hipertrofia excéntrica disminuyeron hasta un 11,8 y un 23,6 por ciento de los pacientes, respectivamente y la hipertrofia concéntrica aumentó a un 52,2 por ciento. Se demostró que el 80,5 por ciento de los pacientes con remodelación concéntrica evolucionó desfavorablemente. El 56,1 por ciento de los pacientes con hipertrofia ventricular concéntrica, se mantuvieron con evolución estable. La hipertrofia ventricular excéntrica tuvo un 74 por ciento con evolución favorable. Conclusiones: Antes y después del tratamiento farmacológico existió un predominio de la hipertrofia concéntrica.

Background: The arterial hypertension is a worldwide high-priority health problem that eminently affects developed societies and it is extraordinarily prevaling. Objective: To assess, after the pharmacological treatment, the evolution of cardiac remodeling in primary hypertensive patients. Method: An observational, cross-sectional analytic study in three health areas of Camagüey municipality to 178 primary hypertensive patients was conducted, older than 18 years, diagnosed with remodeling of the left ventricle in the year 2004. To the study group was indicated antihypertensive treatment in their respective family doctor´s offices. In the year 2006 were performed to these patients echocardiographies, it were practiced the diastolic mensurations of the left ventricle and the geometric patterns were classified. The echocardiographic mensurations were compared with those of the 2004 and the evolution of the geometric pattern's changes was determined. Results: After the pharmacological treatment, they normalized the geometric pattern 12,4 percent, the concentric remodeling and the eccentric hypertrophy diminished until a 11,8 and 23,6 percent of patients respectively and the concentric hypertrophy increased to 52,2 percent. It was demonstrated that 80,5 percent of patients with concentric remodeling evolved unfavorably. The 56,1 percent of patients with concentric ventricular hypertrophy, stayed with stable evolution. The eccentric ventricular hypertrophy had 74 percent with favorable evolution. Conclusions: Before and after the pharmacological treatment a prevalence of the concentric hypertrophy existed.

Mitochondrial DNA and the peopling of South America.

The initial peopling of South America is largely unresolved, in part because of the unique distribution of genetic diversity in native South Americans. On average, genetic diversity estimated within Andean populations is higher than that estimated within Amazonian populations. Yet there is less genetic differentiation estimated among Andean populations than estimated among Amazonian populations. One hypothesis is that this pattern is a product of independent migrations of genetically differentiated people into South America. A competing hypothesis is that there was a single migration followed by regional isolation. In this study we address these hypotheses using mtDNA hypervariable region 1 sequences representing 21 South American groups and include new data sets for four native Peruvian communities from Tupe, Yungay, and Puno. An analysis of variance that compared the combined data from western South America to the combined data from eastern South America determined that these two regional data sets are not significantly different. As a result, a migration from a single source population into South America serves as the simplest explanation of the data.

Valores de lipidos en una población normal adulta de la ciudad de Santo Domingo, República Dominicana / Levels of lipids in a healthy adult population of Santo Domingo, Dominican Republic

Se encuestaron 1857 personas de 14 barrios de la ciudad de Santo Domingo, seleccionados por muestreo sistemático previa visita a las casas por encuestadores sociales. Se determinaron en ayunas colesterol total, HDL, triglicéridos, ácido úrico y glicemia y los pacientes fueron sometidos a un cuestionario, ex físico, etc. El 74.2 por ciento resultó del sexo femenino y 23.8 por ciento sexo masculino. El promedio de colesterol total fue de 179 +- 46 mg/dL, colesterol HDL 43 +- 12 mg/dL y TG 113 +- 65 mg/dL. El colesterol total fue mas alto en las mujeres y el colesterol HDL también fue más bajo en los hombres. En la clase baja el promedio de colesterol total fue de 173 mg/dL y en la clase alta 203 mg/dL. Según el consenso europeo el 19.49 por ciento tenían un colesterol por encima de los 200 mg/dL y entre 250 y 300 mg/dL el 4,25 por ciento , en tanto que la hipertrigliceridemia fue de 6.40 por ciento . Se establecen por 1ra. vez en Santo Domingo valores de referencia para los adultos por encima de los 20 años en cuanto a lípidos se refiere

Isquemia miocardíaca silente: concepto y fisiopatología

Tenemos que asumir que la presencia de isquemia miocárdica silente es un elemento importante en la valoración clínica de nuestros pacientes, de tal manera que podamos establecer a tiempo el riesgo que esto implica y contribuir al estudio integral de ellos. Es necesario señalar, que a pesar de los avances en los últimos años con el objetivo de dilucidar los mecanismos exactos que intervienen en el desarrollo de la isquemia miocárdica silente, aún es necesario profundizar las investigaciones pára establecer de manera evidente los diversos elementos que participan en el desencadenamiento de dicho fenómeno

Efectos antilipidémicos de un preparado de aceite de hígado de bacalao en 40 pacientes con dislipidemias

Estudiamos el efecto de un preparado nacional de aceite de hígado de bacalao a dosis de 14G. por día, en 40 pacientes con dislipidemias, y comparamos con un placebo en un estudio simple ciego abierto durante dos meses de tratamiento. El efecto sobre los lípidos plasmáticos se documentó luego de un mes de una dieta estándard tipo II de la AHA. El colesterol disminuyó en el grupo tratado solamente en 3%, en tanto que los triglicéridos se redujeron en un 28%. El colesteroL HDL aumentó 15% con el tratamiento. Estos resultados se obtuvieron luego dela reducción que produjo la administración de la dieta, la cual también provocó disminuciones que variaron entre un 6-15% para el colestero y los triglicéridos respectivamente. La tolerancia al preparado administrado en forma de suspensión fue excelente en la mayoría de los pacientes