[Clinical features and complications of Takotsubo syndrome in a peruvian social security referral center]. / Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana.

In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria.

Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana / Clinical features and complications of Takotsubo syndrome in a peruvian social security referral center

RESUMEN Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria.

ABSTRACT In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

The Effect of Plasma Nitriding on the Fatigue Behavior of the Ti-6Al-4V Alloy.

The Ti-6Al-4V alloy is widely used in the manufacture of components that must have low density and high corrosion resistance and fatigue strength. The fatigue strength can be improved by surface modification. The aim of this study was to determine the influence of plasma nitriding on the fatigue behavior of a Ti-6Al-4V alloy with a lamellar microstructure (Widmanstätten type). Nitriding was executed at 720 °C for 4 h in an atmosphere with N2, Ar, and H2. Microstructure characterization of the samples was carried out by X-ray diffraction analysis, optical microscopy, and scanning electron microscopy. The average roughness of the specimens was determined, and fatigue tests were executed in a bending⁻rotating machine with reverse tension cycles (R = -1). X-ray diffraction analysis of the nitrided alloy revealed the following matrix phases: α, ß, ε-Ti2N, and δ-TiN. A nitrogen diffusion layer was formed between the substrate and the titanium nitrides. Plasma nitriding resulted in an increase in low-cycle fatigue strength, whereas at high cycles of 200 MPa, both conditions exhibited similar behaviors. The fracture surface of the fatigue-tested specimens clearly revealed the lamellar microstructure. The fracture mechanism in the non-nitrided specimens appears to be due to cracking at the interface of the α and ß phases of the lamellar microstructure.

Appendix-derived Pseudomyxoma Peritonei (PMP): Molecular Profiling Toward Treatment of a Rare Malignancy.

OBJECTIVES: Pseudomyxoma peritonei (PMP) is a rare malignancy originating from the appendix, characterized by disseminated mucinous tumor implants on peritoneal surfaces. We examined the role of multiplatform molecular profiling to study biomarker-guided treatment strategies for this rare malignancy. METHODS: A total of 54 patients with appendix-derived PMP were included in the study. Tests included one or more of the following: gene sequencing (Sanger or next generation sequencing), protein expression (immunohistochemistry), and gene amplification (C/fluorescent in situ hybridization). RESULTS: Targeted sequencing of 47 genes detected variants in KRAS (81%), GNAS (74%), SMAD4 (16%), and ATM (16%). Mutations were found at low frequencies (n=1 to 2) in APC, BRAF, PIK3CA, MLH1, and TP53. GNAS and KRAS co-occurrence was found in 87%. Protein overexpression was found in epidermal growth factor receptor (83%), cyclooxygenase-2 (73%), cMET (63%), cKIT (58%), and platelet-derived growth factor receptor alpha (58%). Immune checkpoint expression was found in 36% (programmed cell death protein 1) and 18% (programmed death-ligand 1). Surrogate markers of cell proliferation were found at low rates (TLE3 23%, TOP2A 22%), consistent with the slow-growing biology of PMP. Phosophatase and tensin homolog was intact (wild type [100%]) and positive (immunohistochemistry [80%]). Patients exhibited stable microsatellite status and mismatch repair proficiency (93%). Importantly, multidrug resistance protein expression was elevated (100% BCRP, 94% MRP1, 88% PGP). Markers for gemcitabine (RRM1), fluorouracil (TS), oxaliplatin (ERCC1), and irinotecan (TOPO1) chemosensitivities were detected at favorable rates: 93%, 87%, 77% and 65%, respectively. CONCLUSIONS: Molecular profiling by multiple platforms identified potential therapies for the nontargetable KRAS-mutated population. The role of cMET-targeted therapeutics and immune checkpoint inhibitors merits further investigation. Biomarker-guided selection of cytotoxic chemotherapies may facilitate efficacy to systemic treatment.

Detection of the VP6 gene of group F and G rotaviruses in broiler chicken fecal samples from the Amazon region of Brazil.

The aim of this study was to detect rotavirus F (RVF) and rotavirus G (RVG) in fecal specimens of broiler chickens in Brazil. During 2008 and 2011, a total of 85 fecal samples were collected. The viral genome was extracted, followed by polyacrylamide gel electrophoresis (PAGE), reverse transcription polymerase chain reaction (RT-PCR), and nucleotide sequencing. Samples were screened for rotaviruses by PAGE, and RVF and RVG genome banding patterns were not seen. Using RT-PCR, it was found that 9.4 % (8/85) of the pools contained RVF, whereas 10.6 % (9/85) contained RVG. The predicted amino acid sequences of RVF and RVG from Brazilian samples were 94.4-95.7 % and 96.8-96.9 % identical, respectively, to those of prototypes from Germany. The detection of RVF and RVG in this study provides important epidemiological data about the simultaneous circulation of rotaviruses affecting broiler flocks in the Amazon region of Brazil.

PTSD-like memory generated through enhanced noradrenergic activity is mitigated by a dual step pharmacological intervention targeting its reconsolidation.

BACKGROUND: Traumatic memories have been resilient to therapeutic approaches targeting their permanent attenuation. One of the potentially promising pharmacological strategies under investigation is the search for safe reconsolidation blockers. However, preclinical studies focusing on this matter have scarcely addressed abnormal aversive memories and related outcomes. METHODS: By mimicking the enhanced noradrenergic activity reported after traumatic events in humans, here we sought to generate a suitable condition to establish whether some clinically approved drugs able to disrupt the reconsolidation of conditioned fear memories in rodents would still be effective. RESULTS: We report that the α2-adrenoceptor antagonist yohimbine was able to induce an inability to restrict behavioral (fear) and cardiovascular (increased systolic blood pressure) responses to the paired context when administered immediately after acquisition, but not 6h later, indicating the formation of a generalized fear memory, which endured for over 29 days and was less susceptible to suppression by extinction. It was also resistant to reconsolidation disruption by the α2-adrenoceptor agonist clonidine or cannabidiol, the major non-psychotomimetic component of Cannabis sativa. Since signaling at N-methyl-D-aspartate (NMDA) receptors is important for memory labilization and because a dysfunctional memory may be less labile than is necessary to trigger reconsolidation on its brief retrieval and reactivation, we then investigated and demonstrated that pre-retrieval administration of the partial NMDA agonist D-cycloserine allowed the disrupting effects of clonidine and cannabidiol on reconsolidation. CONCLUSIONS: These findings highlight the effectiveness of a dual-step pharmacological intervention to mitigate an aberrant and enduring aversive memory similar to that underlying the post-traumatic stress disorder.

Cardiac benefits of exercise training in aging spontaneously hypertensive rats.

OBJECTIVE: To evaluate the effect of low-intensity chronic exercise training (ExT) on blood pressure (BP), as well as the cardiac alterations associated with hypertension in aging hypertensive rats. METHODS: Male spontaneously hypertensive rats (SHR; 21 months old) and their normotensive control Wistar-Kyoto (WKY) rats were submitted to low-intensity training protocol for 13 weeks. BP, cardiac morphological and morphometric analysis, as well as gene expression of fibrotic and inflammatory factors were analyzed at the end of the training period. RESULTS: ExT reduced BP and heart rate in aged SHR. Left ventricle hypertrophy, collagen volume fraction and wall-to-lumen ratio of myocardium arterioles were also decreased in trained SHR. However, ExT was unable to reverse the either reduced capillary density or the cardiac myocyte hypertrophy observed in SHR as compared with WKY rats. Trained SHR showed higher metalloproteinase-2/tissue inhibitor metalloproteinase-2 (MMP-2/TIMP-2) ratio and lower levels of α-smooth muscle actin, but similar levels of connective tissue growth factor, transforming growth factor beta or IL-1 beta to that of nontrained SHR. CONCLUSION: Low to moderate-intensity chronic ExT reverses the cardiac alterations associated with hypertension: myocardial arteriole, left ventricle hypertrophy, collagen content and tachycardia. These changes could be consequence or cause of the reduction in BP observed in trained SHR. In addition, ExT does not worsen the underlying inflammatory burden associated with hypertension. Therefore, the data support a beneficial effect of ExT in aging SHR similar to that reported in young or middle-aged individuals, confirming that exercise is a healthy habit that induces cardiac improvements independently of age.

Spectroscopic and computational study of the major oxidation products formed during the reaction of two quercetin conformers with a free radical.

The goal of this research was to determine whether there are differences between the major oxidation products formed during the reaction of quercetin unhydrate (QUH) or quercetin dihydrate (QDH) with the 2,2-diphenyl-1-picrylhydrazyl free radical (DPPH), as well as to identify some properties of these products. The study was carried out employing spectroscopic and computational methods, in order to know the effect of different conformations of quercetin on the mechanism of free radical scavenging. The results demonstrated that although the same oxidation products may be formed from QUH and QDH, their properties and the predominant product were different in each. The o-quinone was the predominant oxidation product of QUH, whereas in QDH it was established an equilibrium between o-quinone and extended p-quinone.

Ventilación mecánica en trauma de tórax severo: aspectos fisiopatológicos y nuevas perspectivas de manejo / Mechanical ventilation in severe chest trauma: pathophysiological aspects and new management perspectives

El trauma severo de tórax es una patología con una alta morbilidad y mortalidad, siendo responsable aproximadamente de un 50% de las muertes en los pacientes politraumatizados. Los aspectos fisiopatológicos relacionados con el mecanismo de lesión, el estado de salud previo del paciente y el tiempo de evolución del trauma son factores importantes que determinarán el tipo de soporte ventilatorio que debe recibir el paciente que lo requiera. Los modos no convencionales de ventilación mecánica así como los dispositivos de asistencia ventilatoria se han convertido en herramientas útiles con un impacto importante en los resultados del paciente con trauma de tórax severo.

Qualitative study on WIC Program strategies to promote breastfeeding practices in Puerto Rico: what do nutritionist/dietician's think?

The purpose of this study is to better understand Nutritionist-Dietician opinions concerning WIC Program strategies to promote breastfeeding in Puerto Rico. Four groups of nutritionists-dietitians were recruited to take part in focus group discussions. Each focus group lasted for approximately 1 h and the researchers completed a debriefing sheet after each meeting. The group discussions were taped and transcribed. The participants identified hospital barriers, lack of family support and problems related to the mother as the three principal reasons that Puerto Rican mothers do not breastfeed their babies or stop breastfeeding early. An individual meeting was the most frequently mentioned WIC strategy that was meant to convince mothers to breastfeed their infants. Nevertheless, the focus group participants recognized that the effort and time available for such meetings is limited. From these groups, one theme that emerged is that the WIC Program in Puerto Rico should collaborate with hospitals to arrange for WIC-sponsored nutritionist-dietitians to visit the WIC participants during their maternity hospital stay, and in their homes.

The impact of managed care on psychiatric hospitalizations and length of stay in Puerto Rico.

The objective of this paper is to estimate the impact of managed care on psychiatric hospitalizations and length of stay of medically indigent residents in Puerto Rico. A quasi-experimental design and three waves of data from a random community sample were used. Results indicate that, after 2 years, managed care had minimal impact on the number of psychiatric hospitalizations; while the mean length of hospitalization decreased after implementation of managed care, this change was not significant. Based on the data in this study, the managed care initiative developed as part of health reform in Puerto Rico did not appear to affect rates of psychiatric hospitalization and produced only a nonsignificant reduction in the average length of psychiatric hospital stays. Additional research is needed to determine trends in mental health care provision in Puerto Rico based on more recent data.

Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria.

INTRODUCTION: Patients with diabetes complicated by hypertension and microalbuminuria have elevated cardiovascular risk, and controlling blood pressure in these patients is an urgent clinical priority. The present study aimed to examine the effects of a fixed-dose combination of antihypertensives on blood pressure and microalbuminuria. METHODS: Patients with type 2 diabetes, mild-to-moderate hypertension (diastolic blood pressure 85-105 mmHg, systolic blood pressure <160 mmHg, and 24-hour mean systolic blood pressure >130 mmHg), and microalbuminuria were randomized to 1 year of doubleblind treatment with fixed-dose manidipine/delapril (n=54) or losartan/hydrochlorothiazide (HCTZ) (n=56). RESULTS: Blood pressure was significantly reduced at 1 year in both groups (-22.2/-14.6 mmHg and -19.5/-14.3 mmHg, for systolic and diastolic blood pressure respectively, P<0.001 for each), with no significant between-group difference. Reductions in microalbuminuria occurred in both groups, with mean changes at 1 year of -3.9 mg/mmol creatinine (95% CI -5.3, -2.5) for manidipine/delapril (P<0.001 vs. baseline) and -2.7 mg/mmol creatinine (95% CI -4.0, -1.3) for losartan/HCTZ (P<0.001 vs. baseline and P=0.199 between groups). Glycemia over the 1-year study was largely unaffected; the blood glucose concentration was reduced from baseline with manidipine/delapril, although not statistically significant (mean change -0.2 mmol/L, P=0.064). Both treatments were well tolerated, with discontinuation for adverse events for one (1.9%) patient in the manidipine/delapril group and two (3.6%) in the losartan/HCTZ group. CONCLUSIONS: A fixed-dose manidipine/delapril combination represents a useful addition to the treatment options available to control hypertension complicated by diabetes and microalbuminuria.

Exploratory study: knowledge about the benefits of breastfeeding and barriers for initiation in mothers of children with spina bifida.

The aim of the study is to identify the level of knowledge on breastfeeding by mothers of infants with spina bifida and the barriers encountered in initiating breastfeeding. A non-probabilisitic sample (n=30) of mothers was used in this study. The sample was obtained in two institutions specializing in care for infants with congenital anomalies in Puerto Rico. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. Among participants, 56.7% had adequate knowledge on the benefits of breastfeeding. The most frequently encountered barriers in initiating breastfeeding were related to the neonatal intensive care unit (NICU). Problems with the medical and nursing procedures, routines, support from personnel, and adequacy of the environment were the most frequent. It is important to develop a education to encourage nurses and other health care professionals need suggest, support and encourage breastfeeding to mothers of infants with neural tube defects.

Diagnosis of foot-and mouth disease by real time reverse transcription polymerase chain reaction under field conditions in Brazil.

BACKGROUND: Foot-and-mouth disease (FMD) is an economically important and highly contagious viral disease that affects cloven-hoofed domestic and wild animals. Virus isolation and enzyme-linked immunosorbent assay (ELISA) are the gold standard tests for diagnosis of FMD. As these methods are time consuming, assays based on viral nucleic acid amplification have been developed. RESULTS: A previously described real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay with high sensitivity and specificity under laboratorial and experimental conditions was used in the current study. To verify the applicability of this assay under field conditions in Brazil, 460 oral swabs from cattle were collected in areas free of FMD (n = 200) and from areas with outbreaks of FMD (n = 260). Three samples from areas with outbreaks of FMD were positive by real-time RT-PCR, and 2 of those samples were positive by virus isolation and ELISA. Four other samples were considered inconclusive by real-time RT-PCR (threshold cycle [Ct] > 40); whereas all 200 samples from an area free of FMD were real-time RT-PCR negative. CONCLUSION: real-time RT-PCR is a powerful technique for reliable detection of FMDV in a fraction of the time required for virus isolation and ELISA. However, it is noteworthy that lack of infrastructure in certain areas with high risk of FMD may be a limiting factor for using real-time RT-PCR as a routine diagnostic tool.

Attitudes towards homosexual and lesbians among Puerto Rican Public Health graduate students.

The objective of this study is to identify the attitude toward the homosexuals and lesbians among graduate students of General Public Health and Health Education Program at School of Public Health, Medical Sciences Campus of the University of Puerto Rico. A descriptive-92 graduate students of the correlational design was used to carry out the study participated in the study General Public Health and Health Education programs. The data collection was collected through a self-administered questionnaire. Descriptive and inferential statistics (Chi-square and t-test student) were used to data analysis. The 82.6% of the participants had a prejudiced attitude toward the homosexuals and the lesbians. The 79.3% presented a low distance level. There is a significant association among the social distance, homosexual and lesbian educational exposure and the years of studies. To develop appropriate strategies to foment the acceptance and eliminate the prejudice toward the homosexuals and lesbians in the participants, what will impact in a better way of providing quality health services.

Physicians and nurses: knowledge of clinical management of sexual aggression in children based on the sexual aggression survivors manual in Puerto Rico.

OBJECTIVE: To evaluate the knowledge of health professionals about clinical the management of sexual aggression in children based on the sexual aggression survivors manual in Puerto Rico. METHOD: The study population was composed of 150 health professionals (physicians and nurses). For the collected data, a self-administered questionnaire was used. The response rate was 88.7% (n=133). Descriptive statistics, crosstabs tables and Chi-Square were used for the data analysis. RESULTS: 75.9% of the participants were unaware of physical indicators related to sexual aggression in children. Nevertheless, 66.2% of the participants recognized emotional indicators of sexual aggression. 82.7% of the participants think sexual aggression victims should be referred to the physician and nurse, followed by 20.4% that indicated the social worker. 94.7% of the participants were unaware of the correct steps to carry out in a crisis intervention with sexual aggression victims and 91.7% recognized that all information topics should be offered during the intervention. CONCLUSION: The results of this study confirm the necessity of intervention strategies to increase the knowledge of the participants about the correct clinical management of sexual aggression survivors.

Spatial relations between floodplain environments and land use - land cover of a large lowland tropical river valley: Pánuco basin, México.

Large lowland river valleys include a variety of floodplain environments that represent opportunities and constraints for human activities. This study integrates extensive field observations and geomorphic data with analysis of satellite remote sensing data to examine spatial relations between land use/land cover (LULC) and floodplain environments in the lower Pánuco basin of eastern Mexico. The floodplain of the lower Pánuco basin was delineated by combining a digital elevation model with a satellite image of a large flood event. The LULC was classified by combining a hybrid classification strategy with image stratification, applied to 15-m-resolution ASTER data. A geomorphic classification of floodplain environments was performed using a dry-stage image (ASTER data) and a 1993 Landsat image acquired during a large flood event. Accuracy assessment was based on aerial photographs (1:38,000), global positioning satellite ground-truthing, and a Landsat 7ETM(+) image from 2000, which resulted in an overall accuracy of 82.9% and a KHAT of 79.8% for the LULC classification. The geomorphic classification yielded 83.5% overall accuracy, whereas the KHAT was 81.5%. LULC analysis was performed for the entire floodplain and individually within four valley segments. The analysis indicates that the study area is primarily utilized for grazing and farming. Agriculture is primarily associated with coarse-grained (sandy/silty) natural levee and point bar units close to the river channel, whereas cattle grazing occurs in distal and lower-lying reaches dominated by cohesive fine-grained (clayey) deposits, such as backswamps. In the Pánuco valley, wetlands and lakes occur within backswamp environments, whereas in the Moctezuma segments, wetlands and lakes are associated with relict channels. This study reveals considerable variation in LULC related to spatial differences in floodplain environments and illustrates the importance of considering older anthropogenic influences on the landscape. The research design should be applicable for other large lowland coastal plain river valleys where agriculture is a major component of the floodplain landscape.

Exploratory study: breastfeeding knowledge, attitudes towards sexuality and breastfeeding, and disposition towards supporting breastfeeding in future Puerto Rican male parents.

Identify the breastfeeding knowledge, the attitudes towards sexuality and breastfeeding and the disposition towards supporting breastfeeding in future fathers were the aims of this study. A non-probabilistic sample (n = 100) of future Puerto Rican male parents was used in this study. A self-administered questionnaire was used consisting of four sections. Descriptive statistics were used for data analysis and t-test to the inferential analysis. 88.8% of the participants presented a low level of knowledge. However, 81.6% had a positive attitude toward sexuality and breastfeeding. Also, 92.0% of the participants indicated much/enough willingness to support their partners in exclusively breastfeeding. Disposition to support the breastfeeding was associated with knowledge towards breastfeeding (p = 0.04) and attitudes toward sexuality and breastfeeding (p = 0.00). The knowledge and the attitudes, in this study, are strongly related with the disposition of the father to supporting the breastfeeding in the future.

Irreversibility of chilling injury in zucchini squash (Cucurbita pepo L) could be a programmed event long before the visible symptoms are evident.

Zucchini fruits were subjected to 2.5 or 10 degrees C for 16d, followed by transfer to 20 degrees C for 24h in order to evaluate the relationship between ripening pattern, measured as CO(2) evolution and ethylene (C(2)H(4)) production, and metabolic heat production (q). Chilling injury (CI) visible symptoms were evident after 8d at 2.5 degrees C, but none were recorded on fruits kept at 10 degrees C. In fruits held at 10 degrees C, q, C(2)H(4) production, and CO(2) evolution diminished in the course of 16d, whereas in those at 2.5 degrees C CO(2) evolution showed an early burst peaking at 8d. Both C(2)H(4) production and q also showed a burst at 2.5 degrees C but they started at 4 and 8d, respectively, and peaked at 12d. The results showed that irreversibility of chilling injury in zucchini could occur long before the appearance of visible symptoms, although the metabolic activity accompanying the irreversibility process was not noticeable by isothermal calorimetry.