A comprehensive study from the micro- to the nanometric scale: Evaluation of chilling injury in tomato fruit (Solanum lycopersicum).

Tomato fruit is susceptible to chilling injury (CI) during its postharvest handling at low temperature. The symptoms caused by this physiological disorder have been commonly evaluated by visual inspection at a macro-observation scale on fruit surface; however, the structure at deeper scales is also affected by CI. This work aimed to propose a descriptive model of the CI development in tomato tissue under the micro-scale, micro-nano-scale and nano-scale approaches using fractal analysis. For that, quality and fractal parameters were determined. In this sense, light microscopy, Environmental Scanning Electron Microscopy (ESEM) and Atomic Force Microscopy (AFM) were applied to analyse micro-, micro-nano- and nano-scales, respectively. Results showed that the morphology of tomato tissue at the micro-scale level was properly described by the multifractal behaviour. Also, generalised fractal dimension (Dq=0) and texture fractal dimension (FD) of CI-damaged pericarp and cuticle were higher (1.659, 1.601 and 1.746, respectively) in comparison to non-chilled samples (1.606, 1.578 and 1.644, respectively); however, FD was unsuitable to detect morphological changes at the nano-scale. On the other hand, lacunarity represented an appropriate fractal parameter to detect CI symptoms at the nano-scale due to differences observed between damaged and regular ripe tissue (0.044 and 0.025, respectively). The proposed multi-scale approach could improve the understanding of CI as a complex disorder to the development of novel techniques to avoid this postharvest issue at different observation scales.

Target Strength and swimbladder morphology of Mueller's pearlside (Maurolicus muelleri).

In the last few years, there has been increasing interest in the commercial exploitation of mesopelagic fish and a trawl-acoustic methodology has been recommended to make estimates of abundance of these resources. This study provides relevant information on the scattering properties of a key mesopelagic fish species in the Bay of Biscay, Mueller's pearlside (Maurolicus muelleri), necessary to convert the acoustic density into numerical abundance. The target strength (TS) of pearlside was estimated for the first time at five frequencies commonly used in acoustic surveys. A high-density filter was applied to reduce the bias derived from overlapping echoes erroneously assigned to single targets. Its relationship with fish length (b20) was also determined (-65.9 ± 2, -69.2 ± 3, -69.2 ± 2, -69.5 ± 2.5 and -71.5 ± 2.5 dB at 18, 38, 70, 120 and 200 kHz, respectively). Biomass estimates of pearlside in the Bay of Biscay during the four years of study (2014-2017) are given using the 38 kHz frequency. Morphological measurements of the swimbladder were obtained from soft X-ray images and used in the backscattering simulation of a gas-filled ellipsoid. Pearlside is a physoclist species, which means that they can compensate the swimbadder volume against pressure changes. However, the best fit between the model and the experimental data showed that they lose that capacity during the trawling process, when the swimbladder volume is affected by Boyle's law.

Reembarazo en la adolescencia: análisis de la población perteneciente a la Red del Hospital Padre Hurtado, entre los años 2005-2015 / Teenage pregnancy: analysis of the population belonging to the Padre Hurtado Hospital Network, between 2005-2015

OBJETIVO PRINCIPAL: Evaluar prevalencia de adolescentes multíparas >2, en la población atendida en Hospital Padre Hurtado. MATERIALES Y MÉTODO: Estudio de cohorte retrospectivo, con información extraída de la ficha electrónica de partos e intervenciones, realizados entre 2005-2015 HPH. Los datos fueron tabulados en Microsoft Excel y luego analizados en el paquete estadístico IBM SPSS versión 22. RESULTADOS: Se atendieron 62.656 partos y hubo 5.770 eventos gestacionales que requirieron alguna intervención, de éstas, 14.030 (20,5%) ocurrieron en pacientes menores de 20 años y 356 (0,52%) en menores de 15 años. El número de multíparas fue de 940 (10,3% de mujeres con embarazo adolescente). En el caso de primigestas <15 años, 68 presentaron más de un embarazo durante su adolescencia (19,3% de embarazadas). El período intergestacional tuvo una mediana en 3 años (rango 1 - 6 años). Cuando una adolescente <15 años se embaraza por primera vez, tiene un OR de 2,25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) de volver a embarazarse durante su adolescencia, en relación a las adolescentes que se embarazan por primera vez después de los 15 años. En cuanto a intervenciones, al comparar ambos grupos, las menores de 15 años tienen un OR 2,75 de que al embarazarse, requieran cirugía. CONCLUSIÓN: La frecuencia de embarazo adolescente evaluada, es superior a la nacional y mundial. Cuando el primer embarazo ocurre <15 años, éstas tienen mayor riesgo de presentar un segundo embarazo durante la adolescencia. Una medida de prevención secundaria, es la utilización de MAC en el puerperio inmediato, idealmente LARCs.

OBJECTIVE: To evaluate the prevalence of multiparous adolescents, in the population that had their births at Hospital Padre Hurtado. METHODS: Retrospective cohort study, with information taken from the electronic database of the center, Birth data and Interventions, between 2005 and 2015. The data was tabulated in Microsoft Excel and the analysis was done with IBM SPSS 22 version. RESULTS: It occurred 62,656 deliveries and 5,770 pregnancies that ended in an intervention, from the total, 14,030 (20.5%) occurred in girls under 20 years and 356 (0.52%) under 15 years old (yo). The number of multiparous was 940 (10.3% of all of the adolescent pregnancies). For first time pregnants under 15 yo, 68 had a reiterative pregnancy among their adolescence (19.3% of pregnant <15 yo). The median time between pregnancies was 3 years (range 1- 6 years). When a girl <15 yo gets pregnant for the first time, she has an OR of 2.25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) of getting pregnant again during adolescence compared to girls that get pregnant between 15-18 yo. About interventions, the group under 15yo had an OR 2.75 (in Chile all forms of abortions are illegal) compared with the group above 15 years, of requiring surgery when pregnant. CONCLUSIONS: The frequency of adolescent pregnancy analized, is above the national and international publications. Plus, if the pregnancy occurs under 15 yo, they have a greater chance of having another teenage pregnancy. An effective secondary prevention could be administration of contraception during immediate postpartum, ideally LARCs.

Bronchoscope insertion route and patient comfort during flexible bronchoscopy.

SETTING: Diagnostic flexible bronchoscopy performed in hospitalised and ambulatory patients in a tertiary care academic hospital in Monterrey, Mexico. OBJECTIVE: To determine the effect of the route of insertion of the bronchoscope (oral or nasal) on patient comfort, vocal cord visualisation, local anaesthetic and sedation requirements and possible complications. DESIGN: Prospective study carried out in patients aged ⩾ 18 years with an indication for flexible bronchoscopy. The route of insertion was randomly assigned. Symptoms related to the procedure were evaluated using a questionnaire. RESULTS: Sixty-three patients were included: 32 in the oral insertion group and 31 in the nasal insertion group. There was no statistically significant difference in patient discomfort (1.91 ± 2.95 vs. 2.39 ± 3.56 points on a scale of 1 to 10, P = 0.74) or procedural complications (4 vs. 0 events, P = 0.12) between study groups. Oral insertion was associated with less time to vocal cord visualisation (25.5 ± 156 s vs. 56 ± 61 s, P < 0.01), lower requirement for lidocaine (15 ± 7.50 vs. 16 ± 4 ml, P = 0.01) and fewer insertion failures (0 vs. 6 cases, P < 0.01). CONCLUSIONS: With intravenous sedoanalgesia, route of insertion did not affect patient comfort. However, the oral route was associated with faster vocal cord visualisation, less use of lidocaine and no insertion failure.

Large mesopelagic fishes biomass and trophic efficiency in the open ocean.

With a current estimate of ~1,000 million tons, mesopelagic fishes likely dominate the world total fishes biomass. However, recent acoustic observations show that mesopelagic fishes biomass could be significantly larger than the current estimate. Here we combine modelling and a sensitivity analysis of the acoustic observations from the Malaspina 2010 Circumnavigation Expedition to show that the previous estimate needs to be revised to at least one order of magnitude higher. We show that there is a close relationship between the open ocean fishes biomass and primary production, and that the energy transfer efficiency from phytoplankton to mesopelagic fishes in the open ocean is higher than what is typically assumed. Our results indicate that the role of mesopelagic fishes in oceanic ecosystems and global ocean biogeochemical cycles needs to be revised as they may be respiring ~10% of the primary production in deep waters.

School-based individualised lifestyle intervention decreases obesity and the metabolic syndrome in Mexican children.

BACKGROUND: Currently, there is limited evidence about effective strategies to manage childhood obesity and the metabolic syndrome in school settings. The present study aims to analyse changes in the prevalence of being overweight/obese and having the metabolic syndrome in relation to a 10-month lifestyle intervention based on individualised face-to-face sessions and parental education in school settings. METHODS: The study sample comprised a cross-sectional sample of 96 overweight/obese Mexican children aged 6-12 years from eight schools. Clinical, anthropometric measurements and 24-h recalls were obtained during each of 13 visits. Laboratory measurements were determined at the beginning and end. The energy-reduced diet was based on dietary recommended intakes. Individualised structured daily meals and a physical activity plan, tailored-made for each child, were provided every 3 weeks at the schools. Parental attendance was required. Student's t-test, McNemar and Shapiro-Wilk tests and simple linear regression were used for the statistical analysis. RESULTS: The prevalence of metabolic syndrome fell significantly from 44% to 16% (P < 0.01), high blood pressure fell from 19% to 0%, hypertrigliceridaemia fell from 64% to 35%, high-density lipoprotein-cholesterol ≤ 40 fell from 60% to 41%, hyperglycaemia fell from 1% to 0%, and waist circumference ≥90th percentile fell from 72% to 57%. There was a 2.84 [95% confidence interval (CI) = -4.10 to -1.58; P < 0.01] significant decrease in body mass index percentile and in body-fat percentage (95% CI = -3.31 to -1.55; P < 0.01). Of the overweight children, 32% achieved normal-weight, whereas 24% of the obese ones converted to overweight and 1% reached normal-weight. Physical activity increased 16 min/day(-1) (P = 0.02) and 2 days/week(-1) . CONCLUSIONS: A school-setting lifestyle intervention led to a decreased prevalence of being overweight/obese and to a striking reduction in the prevalence of the metabolic syndrome in a sample of Mexican children.

[Lumbar herniated disks treated with a dynamic interspacer]. / Hernias discales lumbares tratadas con interespaciador dinámico.

UNLABELLED: Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. MATERIAL AND METHODS: The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. RESULTS: The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. CONCLUSION: Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

Role of steps in the dissociative adsorption of water on rutile TiO2(110).

The water-TiO(2) interaction is of paramount importance for many processes occurring on TiO(2), and the rutile TiO(2)(110)-(1×1) surface has often been considered as a test case. Yet, no consensus has been reached whether the well-studied surface O vacancies on the terraces are the only active sites for water dissociation on rutile TiO(2)(110)-(1 × 1), or whether another channel for the creation of H adatoms exists. Here we use high-resolution scanning tunneling microscopy and density functional theory calculations to tackle this long-standing question. Evidence is presented that a second water dissociation channel exists on the surfaces of vacuum-annealed TiO(2)(110) crystals that is associated with the ⟨111⟩ step edges. This second water dissociation channel can be suppressed by blocking of the ⟨111⟩ step edges using ethanol.

Reduced step edges on rutile TiO2(110) as competing defects to oxygen vacancies on the terraces and reactive sites for ethanol dissociation.

The rutile TiO2(110) surface is the most studied surface of titania and considered as a prototype of transition metal oxide surfaces. Reactions on flat TiO2(110)-(1×1) surfaces are well studied, but the processes occurring on the step edges have barely been considered. Based on scanning tunneling microscopy studies, we here present experimental evidence for the existence of O vacancies along the [11¯1](R) step edges (O(S) vac.'s) on rutile TiO(2)(110). Both the distribution of bridging O vacancies on the terraces and temperature-programed reaction experiments of ethanol-covered TiO(2)(110) point to the existence of the O(S) vac.'s. Based on experiments and density functional theory calculations, we show that O(S) vac.'s are reactive sites for ethanol dissociation via O-H bond scission. Implications of these findings are discussed.

Direct evidence for ethanol dissociation on rutile TiO2(110).

We have studied the interaction of ethanol with reduced TiO(2)(110)-(1 × 1) by high-resolution scanning tunneling microscopy (STM) measurements and density functional theory calculations. The STM data revealed direct evidence for the coexistence of molecularly and dissociatively adsorbed ethanol species on surface Ti sites. In addition, we found evidence for dissociation of ethanol at bridge-bonded O vacancies. The density functional theory calculations support these findings and rationalize the distinct diffusion behaviors of molecularly and dissociatively adsorbed ethanol species, as revealed in time-lapsed STM images.

Pharmacological evaluation of the immunomodulatory FL-6 in induced chronic hepatitis in Wistar rats.

The aim of this study was to evaluate the pharmacological effect of FL-6, a new immunomodulatory drug, in chronic hepatitis immunologically induced in rats via porcine-serum (PS) administration. Thirty-two male Wistar rats (150 g) were divided into 4 experimental groups: (1) Control (PBS 0.5 ml 3-times per week for 8-week); (2) FL-6 (50 ng/kg 3-times per week for 4-week); (3) Hepatitis (PS 373 mg/kg twice per week for 8-week); and (4) Hepatitis + FL-6 (doses as above). Rats were sacrificed at the end of treatment. ALT, AST, ALP and gamma-GT activities, as well as IL-6 and IL-10 levels, were evaluated in serum samples. Glutathione and malondialdehyde were also analyzed. A morphological analysis of liver tissue was carried out. The hepatitis group showed an increase in ALT (1.44-fold), AST (1.28-fold), ALP (1.83-fold), gamma-GT (3.91-fold), IL-6 (2.6-fold) and IL-10 (7.1-fold) levels when compared with controls (p < 0.05). Histopathological analysis revealed an inflammatory response characterized by inflammatory infiltrates and liver damage, which was accompanied by a reduction of 74.8% in glutathione levels (p < 0.05). However, animals with hepatitis treated with FL-6 had a reduction of ALT activity (17.74%), as well as a reduction in IL-6 (24.21%) and IL-10 (30.91%) levels (p < 0.05). These animals showed a reduction in inflammatory response characterized by a decrease in inflammatory infiltrate at the hepatic parenchyma and portal structures; livers showed less damage and a reduction of necrotic and apoptotic hepatocytes. In conclusion, the treatment with FL-6 improved liver function and reduced the inflammatory marker in rats with chronic hepatitis induced by PS-administration.

Induction of DNA synthesis in Anopheles albimanus tissue cultures in response to a Saccharomyces cerevisiae challenge.

DNA synthesis was detected by the incorporation of 5-bromo-2' deoxy-uridine (BrdU) in adult Anopheles albimanus organs in culture in response to a challenge with Saccharomyces cerevisiae. Abdomens of mosquitoes inoculated with Roswell Park Memorial Institute medium (RPMI, control) or yeast were cultivated in RPMI plus ConA and BrdU for 5 days. DNA was obtained by phenolic extraction and the incorporated BrdU was quantified by ELISA using anti-BrdU peroxidase-labeled antibodies. Abdomen tissues of mosquitoes inoculated with yeast showed higher DNA synthesis than controls. Organs from untreated mosquitoes cultured in the presence of zymosan also synthesized DNA but at a lower level than tissues from yeast-inoculated mosquitoes. In similar experiments, DNA synthesis was inhibited by the addition of colchicine. DNA synthesis, evidenced by epifluorescence using an anti-BrdU fluorescein-labeled antibody, occurred in fat body, epithelial cells in pleural membranes, and the dorsal vessel. Pleural membranes showed the highest number of labeled cells. These tissues were also labeled with anti-PCNA (proliferating cell nuclear antigen) antibodies, two of which were able to produce polytene chromosomes under yeast stimulation. These results demonstrate that different An. albimanus tissues undergo DNA synthesis in response to foreign particles.

[Ventricular tachycardia associated with isolated right ventricular dysfunction as indicator of arrhythmogenic dysplasia of the right ventricle]. / Taquicardia ventricular asociada a disfunción del ventrículo derecho aislada como indicador de displasia arritmogénica del ventrículo derecho.

We report the case of a 21 year-old patient with arrhythmogenic right ventricular dysplasia manifested by episodes of QRS tachycardia greater than 0.12 sec and isolated dysfunction of the right ventricle. The patient treated with amiodarone however, the tachycardia episodes persisted. The surface electrocardiogram showed left branch block with the axis down, which suggested a right ventricle origin, and was therefore considered an arrhythmogenic dysplasia. Echocardiography and cardioangiography showed alterations in the anatomy of the outflow tract of the right ventricle. A myocardial gammagraphy revealed no perfusion alterations. The endomyocardial biopsy showed perivascular fibrosis. An electrophysiology study was performed, stimulating the outflow tract of the right ventricle, which induced two types of ventricular tachycardias, one of them identical to that recorded clinical. The patient was treated with sotalol, and has been being free of ventricular tachycardia episodes for 18 months of follow-up. We consider that this entity should be studied in a systematic way in those patients with ventricular tachycardia originated in the outflow of the right ventricle and with primary cardiac illness.

[Peak expiratory flow rate in 4- to 15-year-old children. Comparison of 3 measuring models]. / Pico de flujo espiratorio en escolares de 4 a 15 años de edad. Comparación de tres modelos de medidor.

OBJECTIVE: a) To establish the possible differences between three different models of PEF-meter, including PF-Control for the first time; b) to build a normogram for each of the three models, as a function of different variables (age, height, and inspiratory and espiratory thoracic circumference); c) to search for differences between both sexes, and d) to study the mathematical correlation between the results yielded by the different models. METHODS: PEF was measured in a sample of 476 school-children, in the range of 4 and 15 years (233 boys, 243 girls), with a mean age of 9,3 years and a height range between 96,8 cm and 178,8 cm (mean 137,9). PEF value was recorded as the best of three attempts when the difference them was less than 10%. Three devices of each model were used (Vitalograph, Mini-Wright, PF-Control). The utilisation was always done in a rotatory fashion at school time (15-17 hours) in the children's school. RESULTS: We found significant differences between the three models (p < 0,0004). The best predictive variable for PEF is height, with an r = 0,90-0,92 (depending on the model) when the exponential model is considered. Independently of the device, there were significant differences between sexes. CONCLUSIONS: a) The variable that expresses PEF the better is height; b) PEF values are different between girls and boys; c) there were significant differences between the various models; d) Monitoring of a given child must be done with the same model of PEF-meter, and e) The best correlation is obtained with the exponential model, although differences with the lineal model were not statistically significant.

Pico de flujo espiratorio en escolares de 4 a 15 años de edad. Comparación de tres modelos de medidor / Peak espiratory flow rate in school-children 4-15 years old. Comparison between three different devices

OBJETIVO: a) Establecer las posibles diferencias entre tres modelos de medidor, incluyendo por vez primera el PF-Control; b) determinar el normograma del pico de flujo espiratorio (PEF) para cada modelo de medidor, en función de la edad, talla, perímetro torácico inspiratorio y espiratorio; c) establecer las posibles diferencias en razón del sexo, y d) estudiar la correlación matemática entre los resultados obtenidos con los distintos modelos de medidor. MÉTODOS: Se midió el PEF en una muestra de 476 escolares, de edades comprendidas entre 4 y 15 años (233 varones y 243 mujeres), con una media de 9,3 años. La talla menor fue 96,8 cm y la mayor 178,8 cm, con una media de 137,95 cm. Se consideró como valor de PEF al mejor de tres intentos, con una diferencia menor del 10 por ciento entre ellos. Se utilizaron 3 aparatos de cada modelo (Vitalograph, Mini-Wright, PF-Control). Su uso fue siempre rotatorio, y el horario de 15 a 17 horas, en el propio centro escolar. RESULTADOS: Existen diferencias significativas en razón del modelo de medidor. La variable que mejor se ajusta al PEF es la talla, con una r = 0,90-0,92 (según el modelo considerado) para el modelo exponencial. El factor sexo establece diferencias significativas en los valores del PEF, con los tres modelos de medidor. CONCLUSIÓN: a) La variable que mejor expresa los resultados del PEF es la talla; b) los valores del PEF de varones y mujeres son distintos, con significación estadística; c) existen diferencias significativas en razón del modelo de medidor utilizado; d) la monitorización del PEF en un sujeto determinado debe hacerse con el mismo modelo de medidor, y e) el modelo de regresión exponencial consigue un mejor ajuste (AU)

Indice de gravedad simplificado en trauma abdominal penetrante / Abridged severity index in penetrating abdominal trauma

El índice de trauma abdominal penetrante, PATI, es un excelente medio para cuantificar y establecer un pronóstico, tanto vital como de complicaciones, sin embargo, su uso no se ha generalizado en nuestro medio, por ser quizás un poco engorroso su cálculo. Basándonos en él diseñamos uno que nos parece de más fácil manejo, reduciendo a 3 los 5 grados lesionales. Revisamos 212 fichas de paciente operados por esta patología y consignamos fundamentalmente las complicaciones y mortalidad. El número de complicaciones es proporcional al valor del índice. Por otra parte, valores mayores de 25 son incompatibles con la vida. Los resultados son estadísticamente significativos. Logramos correlacionar nuestro índice abreviado con el original, por lo que proponemos su uso, considerando que es de utilidad pra predecir el pronóstico del paciente y comparar distintas series

Ecocardiografia fetal doppler y color / Doppler fetal echocardiography and color

Se hace una breve revision bilbiografica sobre la utilidad de los estudios con doppler en adicion a la imagen bidimensional durante la ecocardiografia fetal, mostrando como estos brindan una importante valoracion hemodinamica y fisiologica del corazon del feto, asi como alteraciones patologicas. Con este metodo se puede estudiar la velocidad y direccion del flujo en las diferentes camaras y valvulas cardiacas; tractos de salida y grandes arterias, pudiendo calcular gradientes de presion, gasto cardiaco, direccion de los cortocircuitos, etc. Ademas con el Doppler color es posible visualizar objetivamente la direccion y magnitud del flujo sanguineo, asi como su caracter laminar o turbulento

Informe practica de administracion de enfermeria en el area rural de la unidad local de San Juan de Rioseco / Report of nursing administration practice in the rural area of the local unit from San Juan de Rioseco

Informe de la practica de pregrado en administracion de servicios de enfermeria en areas rurales realizada en San Juan de Rioseco (Cundinamarca), aplicando el "proceso de enfermeria" describe el estado de la salud de la region, la organizacion de los servicios de salud, y los programas de salud para la comunidad, y analizando los aspectos positivos y negativos de cada uno de ellos formula el diagnostico de enfermeria: deficiencia en el sistema de educacion en salud a la comunidad, resultando en uso inadecuado de los servicios ofertados manifestado por bajos porcentajes de cobertura y bajos indices ocupacionales. Propone un programa de acciones y actividades de enfermeria, presenta el cronograma de implementacion y la evaluacion del mismo. Anexa el registro de actividades realizadas durante la practica.

Tumores cardiacos metastasicos. Revision de las autopsias efectuadas en el Hospital Gorgas en un periodo de diez anos. / Metastatic tumors to the heart. Review of the autopsies carried out at the Hospital Gorgas in a period of 10 years

42 casos de pacientes con metastasis cardiacas se encontraron en 260 pacientes que murieron a consecuencia de neoplasias malignas, al revisar un total de 1856 autopsias realizadas en el Hospital Gorgas en un periodo de 10 anos. Se presta atencion especial a los sintomas clinicos principales a fin de encontrar una correlacion clinico-patologica. Estos sintomas son en orden de frecuencia: cambios electrocardiograficos, insuficiencia cardiaca, cardiomegalia (debida a hemopericardio o a derrame pericardico), disnea y soplos cardiacos