Exploring the Potential of Natural Products as Antiparasitic Agents for Neglected Tropical Diseases.

Recent developments in the use of natural product-based molecules as antiparasitic agents for Malaria, leishmaniasis (LE), Chagas disease (CD), and Human African trypanosomiasis (HAT) are reviewed. The role of diverse plants in developing bioactive species is discussed in addition to analyzing the structural diversity of natural products as active agents and the diverse biological applications in CD, HAT, LE, and Malaria. This review focuses on medicinal chemistry, emphasizing the structural characteristics of natural molecules as bioactive agents against parasitic infections caused by Leishmania, Trypanosoma, and Plasmodium parasites.

Understanding time-to-recovery among Guatemalan Children before and during COVID-19.

Purpose: To understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and methods: A retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15-20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal results: There was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n = 149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major conclusions: Conducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.

COVID-19 Outbreak during Summer Courses at an Elementary School.

Due to the COVID-19 emergency, face-to-face classes were suspended. After the vaccination of teachers and to mitigate educational backwardness, the schools have begun to reopen with protocols established by the government. Here, we investigated the COVID-19 outbreak in summer courses during the reopening of a private elementary school in July 2021. We report confirmed cases of COVID-19 in staff members, students, and their families. A total community of 290 people was part of this study, and we built the contact network. The clinical features of all cases are described. We used the methodology of cases and contacts. The index case was identified by epidemiological tracking, and containment measures were activated, as well as further infection chains in the setting. We estimate the attack rate for staff members at 15.68% (95% CI 7.0-28.6), students at 12.24% (95% CI 4.6-24.8), and family members at 2.6% (95% CI 0.8-6.0). An incubation period of 48-72 h was determined. A student-teacher-student-family transmission sequence was identified. The area where the infection was identified was the school swimming pool, an area where face masks are not worn or, in some cases, inadequately used. Finally, we continue with intermittent staff testing and early detection actions, reinforcing prevention measures, environmental control, cleaning, and educational interventions with students regarding the implementation of preventive measures through classes led by school health staff.

A Feasibility Study to Examine Clinical Variables of Childhood Malnutrition in Guatemala.

Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.

Synergistic effects of natural compounds and conventional chemotherapeutic agents: recent insights for the development of cancer treatment strategies.

Cancer is one of the leading causes of death in the world. Chemotherapy is presented as an option for treatment of this disease, however, low specificity, high resistance rates, toxicity and hypersensitivity reactions, make it necessary to search for therapeutic alternatives that increase the selectivity of treatment, reduce the side effects and enhance its antitumor potential. Natural products are accessible, inexpensive and less toxic sources; in addition, they have multiple mechanisms of action that can potentiate the outcome of chemotherapeutics. In this review, we present evidence on the beneficial effect of the interaction of dietary phytochemicals with chemotherapeutical agents for cancer treatment. This effect is generated by different mechanisms of action such as, increased tumoricidal effect via sensitization of cancer cells, reversing chemoresistance through inhibition of several targets involved in the development of drug resistance and, decreasing chemotherapy-induced toxicity in non-tumoral cells by the promotion of repair mechanisms. Studies discussed in this review will provide a solid basis for the exploration of the potential use of natural products in combination with chemotherapeutical agents, to overcome some of the difficulties that arise in the management of cancer patients.

Biología comparada del conejo criollo (Sylvilagus sp.) y el conejo doméstico europeo (Oryctolagus sp.) con antecedentes de su consumo en una ciudad de Venezuela / Compared Biology of the Native Rabbit (Sylvilagus sp.) and the European Domestic Rabbit (Oryctolagus sp.) with a Background of Rabbit Consumption in a Venezuelan City

Resumen Las diferencias biológicas entre el conejo criollo Sylvilagus sp. (Lagomorpha: Leporidae) y el conejo europeo (Oryctolagus sp.) son poco conocidas entre cunicultores de Latinoamérica, bien sea porque la cunicultura es una explotación menor, comparada con las de otras especies de animales domésticos, o porque la enseñanza de esta materia en estudios universitarios es escaza. El objetivo central de esta investigación fue examinar comparativamente las diferencias existentes entre conejos Sylvilagus sp. y Oryctolagus sp., en relación con su biología, consumo y explotación comercial. Para ello se usó el sistema del metanálisis de trabajos científicos publicados sobre el tema, noticias de prensa y entrevistas realizadas a consumidores en el lapso del 2000 al 2019. Se tomaron en cuenta características morfológicas, fisiológicas, de origen genético y su comportamiento con relación al medio ambiente. Se organizaron y analizaron estas características para establecer las posibles semejanzas y diferencias entre ambos géneros. Como la familia Leporidae comprende tres géneros en Suramérica, se incluyó el género Lepus sp. solo en un cuadro comparativo de géneros. Se encontraron diferencias biológicas, genéticas y reproductivas significativas entre los géneros Sylvilagus sp. y Oryctolagus sp. que pueden ser imperceptibles para cunicultores inexpertos; por ende, se buscó hacer notar las características de cada género para su identificación práctica. Se determinó que el consumo de la carne de conejo depende de la disponibilidad que exista en el mercado.

Abstract Biologic differences between the native rabbit Sylvilagus sp. (Lagomorpha: Leporidae) and the European rabbit (Oryctolagus sp.) are quite unknown among Latin-American rabbit-breeders, either since rabbit-breeding is scarcely exploited as compared to other species of domestic animals or because this subject is taught very unusually in the college education. This research is aimed at examining comparatively the differences between Sylvilagus sp. and Oryctolagus sp. rabbits regarding their biology, consumption, and business exploitation. To do so, a meta-analysis was carried out on different scientific works dealing with this topic, news, and interviews to consumers during the term 2000 to 2019. Morphological, physiological, and genetic-origin characteristics were considered as well as how they behave in relation to the environment. These characteristics were organized and analyzed to determine the potential similarities and differences between both genuses. As the family Leporidae includes three genuses in South America, then the genus Lepus sp. was included only in a genus comparative table. Significant biologic, genetic and reproductive differences between Sylvilagus sp. And Oryctolagus sp. were found but they can be unnoticed to the unexpert rabbit-breeders. Therefore, characteristics typical to each genus were highlighted to allow a practical identification. It was determined that the consumption of rabbit meat depends on the availability in the market.

A community engagement strategy to sustain safe drinking water in Guatemala.

OBJECTIVE: We sought to examine a community engagement (CE) strategy, defined as a monetary contribution, on water filter usage DESIGN: A natural, quasi-experimental study was conducted in Guatemala following the distribution of water filters. Households in the 2014-2015 group (free water filter) were compared with households in the 2018-2019 group (CE strategy: US$5.50 for water filter) SAMPLE: One-year post-distribution, the comparison group (n = 56) and intervention group (n = 38) completed a survey on family health and water filter use RESULTS: Households in the CE group had almost five times higher odds (OR = 4.7, p = .022) of having a working water filter 1 year later. Using a multivariable logistic regression model, the single best predictor to explain working water filters was the CE strategy CONCLUSIONS: CE strategies that support ownership and dignity might sustain public health initiatives, in conjunction with collaborative international partnerships. Future research could include linking villages with local and international organizations that support safe drinking water initiatives.

Synthesis of endo-fused 5-unsubstituted Hexahydro-2H-pyrano[3,2-c]quinolinesvia Sequential Sc(OTf)3-catalyzed Cationic Imino-Diels-Alder Reaction/N-debenzylation using N-benzylanilines, 3,4-dihydro-2H-pyran and Paraformaldehyde under MW Irradiation.

BACKGROUND: Hexahydro-2H-pyrano[3,2-c]quinolines are known to have antibacterial, antifungal, and antitumor properties. Great efforts have been made to develop new synthetic methods that lead to the synthesis of valuable libraries. Extensive methodologies, low yields, excessive amounts of catalyst and expensive reactants are some of the limitations of current methodologies. AIMS AND OBJECTIVE: Developing a useful and efficient method to construct diversely substituted hexahydro-2Hpyrano[ 3,2-c]quinolines into good to excellent yields through a cationic imino-Diels-Alder/N-debenzylation methodology. METHOD: The cationic imino-Diels-Alder/N-debenzylation methodology was used for the preparation of substituted hexahydro-2H-pyrano[3,2-c]quinolines. It involves the use of Sc(OTf)3 for activation of cationic imino- Diels-Alder cycloaddition reaction of N-benzylanilines, 3,4-dihydro-2H-pyran and paraformaldehyde in MeCN; and microwave irradiation to shorten reaction time to afford new 6-benzyl-hexahydro-2H-pyrano[3,2- c]quinolines whose catalytic transfer debenzylation reactions with HCO2NH4 in the presence of Pd/C (10%) and methanol give the new 5-unsubstituted pyrano[3,2-c]quinolines in excellent yields. RESULTS: We found that optimal conditions for the preparation of hexahydro-2H-pyrano[3,2-c]quinolines were Sc(OTf)3 0.5 % and acetonitrile at 160°C for 15 min; and using paraformaldehyde obtained the 6-benzylhexahydro- 2H-pyrano [3,2-c]quinolines with excellent yields, while the N-debenzylation process using ammonium formate in the presence of Pd/C and methanol resulted in the synthesis of hexahydro-2H-pyrano [3,2-c] quinolines with quantitative yields (95-98%). CONCLUSION: We describe an efficient method to synthesize hexahydro-2H-pyrano[3,2-c]quinolines via the cationic imino-Diels-Alder/N-debenzylation methodology using Sc(OTf)3 0.5 % as Lewis Acid catalyst. Excellent yields of the products, use of MW irradiation, short times of reactions, and an efficient and highly diversified method are some of the main advantages of this new protocol.

Antibiotics in hives and their effects on honey bee physiology and behavioral development.

Recurrent honeybee losses make it critical to understand the impact of human interventions, such as antibiotic use in apiculture. Antibiotics are used to prevent or treat bacterial infections in colonies. However, little is known about their effects on honeybee development. We studied the effect of two commercial beekeeping antibiotics on the bee physiology and behavior throughout development. Our results show that antibiotic treatments have an effect on amount of lipids and rate of behavioral development. Lipid amount in treated bees was higher than those not treated. Also, the timing of antibiotic treatment had distinct effects for the age of onset of behaviors, starting with cleaning, then nursing and lastly foraging. Bees treated during larva-pupa stages demonstrated an accelerated behavioral development and loss of lipids, while bees treated from larva to adulthood had a delay in behavioral development and loss of lipids. The effects were shared across the two antibiotics tested, TerramycinR (oxytetracycline) and TylanR (tylosin tartrate). These effects of antibiotic treatments suggest a role of microbiota in the interaction between the fat body and brain that is important for honeybee behavioral development.This paper has an associated First Person interview with the first author of the article.

Epidemiological and Molecular Characterization of a Mexican Population Isolate with High Prevalence of Limb-Girdle Muscular Dystrophy Type 2A Due to a Novel Calpain-3 Mutation.

Limb-Girdle Muscular Dystrophy type 2 (LGMD2) is a group of autosomally recessive inherited disorders defined by weakness and wasting of the shoulder and pelvic girdle muscles. In the past, several population isolates with high incidence of LGMD2 arising from founder mutation effects have been identified. The aim of this work is to describe the results of clinical, epidemiologic, and molecular studies performed in a Mexican village segregating numerous cases of LGMD2. A population census was conducted in the village to identify all LGMD affected patients. Molecular analysis included genome wide homozygosity mapping using a 250K SNP Affymetrix microarray followed by PCR amplification and direct nucleotide sequencing of the candidate gene. In addition, DNA from 401 randomly selected unaffected villagers was analyzed to establish the carrier frequency of the LGMD2 causal mutation. A total of 32 LGMD2 patients were identified in the village, rendering a disease prevalence of 4.3 (CI: 2.9-5.9) cases per 1,000 habitants (1 in 232). Genome wide homozygosity mapping revealed that affected individuals shared a 6.6 Mb region of homozygosity at chromosome 15q15. The identified homozygous interval contained CAPN3, the gene responsible for LGMD2 type A (LGMD2A). Direct sequencing of this gene revealed homozygosity for a novel c.348C>A mutation (p.Ala116Asp) in DNA from all 20 affected subjects available for genetic screening, except one which was heterozygous for the mutation. In such patient, a heterozygous c.2362AG>TCATCT deletion/insertion was recognized as the second CAPN3 mutation. Western blot and autocatalytic activity analyses in protein lysates from skeletal muscle biopsy obtained from a p.Ala116Asp homozygous patient suggested that this particular mutation increased the autocatalytic activity of CAPN3. Thirty eigth heterozygotes of the p.Ala116Asp mutation were identified among 401 genotyped unaffected villagers, yielding a population carrier frequency of 1 in 11. This study demonstrates that a cluster of patients with LGMD2A in a small Mexican village arises from a novel CAPN3 founder mutation. Evidence of allelic heterogeneity is demonstrated by the recognition of an additional CAPN3 mutation in a single affected. Our study provides an additional example of genetic isolation causing a high prevalence of LGMD and of successful molecular characterization of the disease by means of homozygosity mapping. The identification of a very high carrier frequency of the LGMD2-causing mutation has implications for more rational genetic counseling in this community.

Building alliances for improving newborn health in Latin America and the Caribbean / Alianzas para mejorar la salud de los recién nacidos en América Latina y el Caribe

The regional Latin American and Caribbean (LAC) Neonatal Alliance and national neonatal alliances in Bolivia, El Salvador, and Peru were studied through in-depth interviews and a review of publications. Findings were analyzed to distill successful strategies, structures, and tools for improving neonatal health by working through alliances that can be replicated at the regional or national level. The studies found the following factors were the most critical for successful outcomes from alliance work: inclusion of the Ministry of Health as a leader or primary stakeholder; a committed, diverse, technically expert, and horizontal membership; the presence of champions for neonatal health at the national level; development of a shared work plan based on feasible objectives; the use of shared financing mechanisms; the use of informal and dynamic organizational structures; and a commitment to scientific evidence-based programming. The relationship between the regional and national alliances was found to be mutually beneficial.

Se estudiaron la Alianza de Salud Neonatal para América Latina y el Caribe a escala regional, y las alianzas nacionales de salud neonatal de Bolivia, El Salvador y Perú, mediante entrevistas exhaustivas y un análisis de las publicaciones. Se analizaron los resultados para extraer las estrategias, las estructuras y las herramientas eficaces para mejorar la salud neonatal trabajando mediante alianzas que puedan repetirse a escala regional o nacional. Los estudios descubrieron que los factores más decisivos para obtener resultados exitosos del trabajo mediante alianzas fueron los siguientes: la inclusión de los ministerios de salud como líderes o interesados directos principales; una afiliación comprometida, diversa, técnicamente experta y horizontal; la presencia de promotores de la salud neonatal a escala nacional; la formulación de un plan de trabajo compartido basado en objetivos factibles; la utilización de mecanismos de financiamiento compartido; el uso de estructuras organizativas informales y dinámicas; y un compromiso con la programación científica basada en datos probatorios. Se observó que la relación entre las alianzas regionales y nacionales resultaba mutuamente beneficiosa.

An epidemiological investigation of a Forkhead box protein E3 founder mutation underlying the high frequency of sclerocornea, aphakia, and microphthalmia in a Mexican village.

PURPOSE: To investigate the molecular epidemiological basis for the unusually high incidence of sclerocornea, aphakia, and microphthalmia in a village in the Tlaxcala province of central Mexico. METHODS: A population census was performed in a village to identify all sclerocornea, aphakia, and microphthalmia cases. Molecular analysis of the previously identified Forkhead box protein E3 (FOXE3) mutation, c.292T>C (p.Y98H), was performed with PCR amplification and direct DNA sequencing. In addition, DNA from 405 randomly selected unaffected villagers was analyzed to establish the carrier frequency of the causal mutation. To identify the number of generations since the mutation arose in the village, 17 polymorphic markers distributed in a region of 6 Mb around the mutated locus were genotyped in the affected individuals, followed by DMLE software analysis to calculate mutation age. RESULTS: A total of 22 patients with sclerocornea, aphakia, and microphthalmia were identified in the village, rendering a disease prevalence of 2.52 cases per 1,000 habitants (1 in 397). The FOXE3 homozygous mutation was identified in all 17 affected subjects who consented to molecular analysis. Haplotype analysis indicated that the mutation arose 5.0-6.5 generations ago (approximately 106-138 years). Among the 405 unaffected villagers who were genotyped, ten heterozygote carriers were identified, yielding a population carrier frequency of approximately 1 in 40 and a predicted incidence of affected of 1 in 6,400 based on random marriages between two carriers in the village. CONCLUSIONS: This study demonstrates that a cluster of patients with sclerocornea, aphakia, and microphthalmia in a small Mexican village is due to a FOXE3 p.Y98H founder mutation that arose in the village just over a century ago at a time when a population migrated from a nearby village because of land disputes. The actual disease incidence is higher than the calculated predicted value and suggests non-random marriages (i.e., consanguinity) within the population. We can now offer the community more informed genetic counseling based on an accurate genetic test, thus increasing the likelihood of a better outcome for the families.

Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents.

PURPOSE: The present work documents an outbreak of epidemic keratoconjunctivitis among ophthalmology residents, its influence in the presentation of the community cases, the use of molecular techniques for its diagnosis, and the implementation of successful control measures for its containment. METHODS: Isolation of the etiologic agent was achieved using cultured African green monkey kidney epithelial cells (VERO). Through molecular tests, such as polymerase chain reaction (PCR) and DNA sequencing, the genotype of the isolated virus was identified. The sequences obtained were aligned with data reported in the NCBI GenBank. A scheme of outbreak control measures was designed to enforce correct sanitary measures in the clinic. The statistical program, Epi info 2002, and openepi were used to determine the attack rate. The Excel Microsoft program was used to elaborate the endemic channel. RESULTS: Nine of the ten samples studied were isolated from the culture and identified by Adenovirus-specifc PCR. Sequencing allowed identification of Ad8 as the agent responsible for the outbreak. The attack rate was 24.39 cases per 100. The epidemic curve allowed identification of a disseminated source in the Institute of Ophthalmology "Conde de Valenciana." It was not possible to calculate the incubation periods among the cases. The endemic channel showed the presence of an epidemic keratoconjunctivitis among the patients that had been cared for at the out-patient services of the institute. CONCLUSIONS: One outbreak of a disseminated source caused by Ad8 was detected in the institute among its medical residents, probably associated with relaxation of the habitual sanitary measures during an epidemic of hemorrhagic conjunctivitis among the patients cared for at the institute. The proposed scheme to control the outbreak allowed for its containment and controlled the epidemic of associated cases.

Intraluminal aortoplasty vs. surgical aortic resection in congenital aortic coarctation. A clinical random study in pediatric patients.

BACKGROUND: Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated. METHODS: A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05. RESULTS: There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant. CONCLUSIONS: Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.

Types of obstructions in double-chambered right ventricle: mid-term results.

BACKGROUND: The double-chambered right ventricle (DCRV) is increasingly recognized as a distinct obstruction entity. The nature of the obstruction is not well defined. METHODS: Patients with DCRV were prospectively studied during the last 4 years according to the following criteria: 1) pressure gradient by echo Doppler and cardiac catheterization within the right ventricle; 2) angiographic demonstration, and 3) surgical confirmation. RESULTS: From March 1997 to March 2001, 10 new cases were included. Age ranged from 2 to 14 years (mean 9.5 +/- 4.4 years), weight ranged from 9.9 to 75 kg (mean 23 +/- 13.6 kg), and height from 0.85 to 1.48 m (mean 114 +/- 19 cm). Systolic gradient by echo Doppler ranged from 20 to 135 mmHg (mean 86 +/- 44 mmHg) and by cardiac catheterization, 18 to 130 mmHg (mean 78 +/- 35 mmHg). In terms of angiographic findings, in six patients the right ventriculogram showed an oblique and low obstruction; in four patients the obstruction was high and horizontal. With regard to surgical findings, angiographic findings were confirmed by the surgeon except in one patient, in whom both types of obstruction were present. No mortality was observed. With follow-up 4 to 40 months after surgery (mean 24 +/- 15 months), 8 of 10 patients were evaluated; all corresponded to class I NYHA. Systolic gradient by echo Doppler ranged from 0 to 11 mmHg (mean 4 +/- 6 mmHg). CONCLUSIONS: DCRV IS PRODUCED BY THE FOLLOWING THREE TYPES OF MUSCULAR OBSTRUCTIONS: low and oblique obstruction; high and horizontal obstruction, and mixed obstruction. Mid-term surgical results are satisfactory.

Estenosis mitral congénita: experiencia 1991-2001 / Congenital mitral stenosis 1991-2001 experience

Objetivo: Describir la experiencia en estenosis mitral congénita en 10 años. Material y métodos: Se revisaron los casos de enero 1991-2001. Los sobrevivientes fueron evaluados mediante ecocardiografía. Resultados: Fueron 16 enfermos con media de 3 ñ 3.08 (0 a 10 años). Tipos de obstrucciones: fusión de comisuras y cuerdas tendinosas (45 por ciento), válvula mitral en paracaídas 37 por ciento, anillo supravalvular mitral uno, fusión directa de los músculos papilares a las valvas uno y doble orificio mitral otro. Datos hemodinámicos (en mmHg): presión en cuña 18.4 ñ 4, arteria pulmonar sistólica 61 ñ 21, diastólica 34 ñ 15 y media 47 ñ 18, gradiente transmitral (GTM) 12.9 ñ 7.3 y URP 5.5 ñ 3.8. Cuatro enfermos recibieron tratamiento médico. Resultados quirúrgicos. Reparación mitral en 6 enfermos. Implante de prótesis mitral en 4 enfermos (2 con reparación previa). La mortalidad global fue de 2 (12.5 por ciento). El seguimiento global fue de 3.5 ñ 3 años. Cuando se comparó el GTM antes, 22.6 ñ 11.5 y después, 4.75 ñ 1.5 de reparación mitral o implantación de prótesis (12 ñ 2.3 vs 6 ñ 1.15), la diferencia fue significativa P < 0.05. Conclusiones: La mayoría de los enfermos son susceptibles de reparación mitral. A mediano plazo un tercio de éstos requerirá prótesis.

Catéter subclavio como acceso vascular transitorio para hemodiálisis / Subclavian catheter how transitory vascular access for hemodialysis

Se estudió en forma restrospectiva un período de tres años en la utilización del catéter subclavio de doble lumen (CS) como acceso vascular transitorio para hemodiálisis (HD). La población comprendió a 20 pacientes (14 de sexo femenino y 6 de sexo masculino) en los que se colocaron 29 CS. Tres de ellos fueron excluidos por no permanecer 24 horas en su sitio de inserción o por no permitir la realización de una sesión de HD. Los restantes 26 componen el grupo que finalmente se estudia. Uno fue colocado en una paciente con insuficiencia cardíaca refractaria a tratamiento médico. Trece se utilizaron en pacientes con insuficiencia renal crónica (IRC) y 12 en pacientes con insuficiencia renal aguda (IRA). La efectividad en el funcionamiento (CS funcionante hasta disponer un acceso definitivo o hasta terminar el requerimiento de HD del paciente) fue de 69,23%y 66,66%respectivamente. En pacientes con inestabilidad hemodinámica (5 CS) y en diabéticos (7CS) la efectividad fue del 100%. Las complicaciones infecciosas fueron tardías, provocando una de ellas la muerte por sepsis de un paciente que se encontraba recibiendo tratamiento inmunodepresor por una glomerulonefritis rápidamente evolutiva. El resto curó con la extracción del CS. Los pacientes que recibieron antibióticos (ATB) por diferentes causas durante la permanencia del CS tuvieron mayor perdurabilidad del mismo y menor porcentaje de complicaciones infecciosas. No se registraron complicaciones graves durante las canulaciones. Hubo un solo caso de trombosis de la vena subclavia con manifestación clínica y posterior certificación radiológica, que no comprometió el funcionamiento de la FAV homolateral. Se concluye que el CS resulta de primera elección en pacientes con inestabilidad hemodinámica y en diabéticos que requieren acceso vascular transitorio. Consideramos su uso relativamente contraindicado en pacientes bajo tratamiento inmunosupresor. Parecería, además, que el uso de ATB durante la permanencia del CS prolonga su vida útil y disminuye las complicaciones infecciosas

Catéter subclavio como acceso vascular transitorio para hemodiálisis / Subclavian catheter how transitory vascular access for hemodialysis

Se estudió en forma restrospectiva un período de tres años en la utilización del catéter subclavio de doble lumen (CS) como acceso vascular transitorio para hemodiálisis (HD). La población comprendió a 20 pacientes (14 de sexo femenino y 6 de sexo masculino) en los que se colocaron 29 CS. Tres de ellos fueron excluidos por no permanecer 24 horas en su sitio de inserción o por no permitir la realización de una sesión de HD. Los restantes 26 componen el grupo que finalmente se estudia. Uno fue colocado en una paciente con insuficiencia cardíaca refractaria a tratamiento médico. Trece se utilizaron en pacientes con insuficiencia renal crónica (IRC) y 12 en pacientes con insuficiencia renal aguda (IRA). La efectividad en el funcionamiento (CS funcionante hasta disponer un acceso definitivo o hasta terminar el requerimiento de HD del paciente) fue de 69,23%y 66,66%respectivamente. En pacientes con inestabilidad hemodinámica (5 CS) y en diabéticos (7CS) la efectividad fue del 100%. Las complicaciones infecciosas fueron tardías, provocando una de ellas la muerte por sepsis de un paciente que se encontraba recibiendo tratamiento inmunodepresor por una glomerulonefritis rápidamente evolutiva. El resto curó con la extracción del CS. Los pacientes que recibieron antibióticos (ATB) por diferentes causas durante la permanencia del CS tuvieron mayor perdurabilidad del mismo y menor porcentaje de complicaciones infecciosas. No se registraron complicaciones graves durante las canulaciones. Hubo un solo caso de trombosis de la vena subclavia con manifestación clínica y posterior certificación radiológica, que no comprometió el funcionamiento de la FAV homolateral. Se concluye que el CS resulta de primera elección en pacientes con inestabilidad hemodinámica y en diabéticos que requieren acceso vascular transitorio. Consideramos su uso relativamente contraindicado en pacientes bajo tratamiento inmunosupresor. Parecería, además, que el uso de ATB durante la permanencia del CS prolonga su vida útil y disminuye las complicaciones infecciosas

Catéter subclavio como acceso vascular transitorio para hemodiálisis / Subclavian catheter how transitory vascular access for hemodialysis

Se estudió en forma restrospectiva un período de tres años en la utilización del catéter subclavio de doble lumen (CS) como acceso vascular transitorio para hemodiálisis (HD). La población comprendió a 20 pacientes (14 de sexo femenino y 6 de sexo masculino) en los que se colocaron 29 CS. Tres de ellos fueron excluidos por no permanecer 24 horas en su sitio de inserción o por no permitir la realización de una sesión de HD. Los restantes 26 componen el grupo que finalmente se estudia. Uno fue colocado en una paciente con insuficiencia cardíaca refractaria a tratamiento médico. Trece se utilizaron en pacientes con insuficiencia renal crónica (IRC) y 12 en pacientes con insuficiencia renal aguda (IRA). La efectividad en el funcionamiento (CS funcionante hasta disponer un acceso definitivo o hasta terminar el requerimiento de HD del paciente) fue de 69,23%y 66,66%respectivamente. En pacientes con inestabilidad hemodinámica (5 CS) y en diabéticos (7CS) la efectividad fue del 100%. Las complicaciones infecciosas fueron tardías, provocando una de ellas la muerte por sepsis de un paciente que se encontraba recibiendo tratamiento inmunodepresor por una glomerulonefritis rápidamente evolutiva. El resto curó con la extracción del CS. Los pacientes que recibieron antibióticos (ATB) por diferentes causas durante la permanencia del CS tuvieron mayor perdurabilidad del mismo y menor porcentaje de complicaciones infecciosas. No se registraron complicaciones graves durante las canulaciones. Hubo un solo caso de trombosis de la vena subclavia con manifestación clínica y posterior certificación radiológica, que no comprometió el funcionamiento de la FAV homolateral. Se concluye que el CS resulta de primera elección en pacientes con inestabilidad hemodinámica y en diabéticos que requieren acceso vascular transitorio. Consideramos su uso relativamente contraindicado en pacientes bajo tratamiento inmunosupresor. Parecería, además, que el uso de ATB durante la permanencia del CS prolonga su vida útil y disminuye las complicaciones infecciosas