Histological and Mechanical Behavior of INC 01 and 02 Bare Metal Stents Against a Commercial Stent: A Preclinical Study in a Porcine Model.

BACKGROUND: PCI is an expensive procedure in our population and it implies a huge cost for the institutions and National Health Service. AIM OF THE STUDY: The main objective was to evaluate the technical and biological success of two stents designed in Mexico. METHODS: Ten York pigs, 4-6 months of age, underwent implantation of the bare metal INC-01 (10 stents) and INC-02 (6 stents) coronary stent in addition to a conventional commercial stent (10 stents). Technical success was evaluated immediately with angiography and Intravascular Ultrasound IVUS, continued by a mean follow-up of 4 month and a final angiographic, IVUS and histological evaluation. RESULTS: Initial technical success, angiography and IVUS between the three stents were not significant. One stent presented restenosis in follow-up (commercial stent), but all other stents presented excellent clinical outcome, satisfactory angiographic and IVUS results. Inflammation, proliferation and endothelialization between the stents had no major differences in histological analysis in a mean of 4 months follow-up. CONCLUSIONS: In this pig model, the INC 01 and INC 02 stents showed the same delivering technical success, angiographic and IVUS features, biological and histological response compared to commercial last generation stents.

Estado actual del tratamiento de resincronización cardiaca en Cataluña: resultados del estudio prospectivo multicéntrico TRC-CAT / Status of cardiac resynchronization therapy in Catalonia, Spain: Results of the prospective multicentric study TRC-CAT

Introducción y objetivos: Los resultados del tratamiento de resincronización cardiaca (TRC) han sido extensamente publicados. Sin embargo, hay datos limitados en poblaciones no seleccionadas. El objetivo del estudio fue analizar la eficacia y la seguridad del TRC en Cataluña. Métodos: Se analizó prospectivamente una serie de pacientes consecutivos a los que se les implantó durante un año un dispositivo de TRC en 7 hospitales universitarios de Cataluña, los cuales representan el 90% del total de dispositivos implantados. Se definió como remodelado ecocardiográfico inverso el aumento de 5 puntos de la fracción de eyección del ventrículo izquierdo, y respondedores clínicos los pacientes que a los 12 meses habían aumentado > 10% la distancia recorrida en la prueba de caminar 6 minutos o un punto la clase de laNew York Heart Association. El seguimiento de los pacientes fue por un año y se analizaron los ingresos hospitalarios y la mortalidad. Resultados: De los 200 pacientes incluidos en el estudio, el 99% cumplía las indicaciones de las guías clínicas actuales de TRC y el 68% recibió TRC con desfibrilador automático implantable. La tasa de complicaciones fue del 12,5%. Durante el seguimiento 16 pacientes (8%) murieron. El 52% (104) de la población fue respondedor clínico y un 62% (124) presentó remodelado ecocardiográfico. En comparación con el año previo al implante los ingresos hospitalarios se redujeron un 82%, lo que resultó en una diferencia estadísticamente significativa (p < 0,001). Conclusiones: En una población no seleccionada de Cataluña observamos que el TRC fue eficaz y redujo el número de hospitalizaciones (AU)

Introduction and objectives: Results of cardiac resynchronization therapy (CRT) have been extensively published. However, there is limited data in unselected populations. The objective of the study was to analyse the efficacy and safety of CRT in Catalonia. Methods: A prospective study was performed of consecutive patients implanted with CRT over one year in 7 university hospitals in Catalonia, representing 90% of the implanted patients. Echocardiographic reverse remodelling was defined as 5 points improvement in left ventricular ejection fraction and clinical responders were defined as patients with an increase > 10% of six-minute walk test or one point of New York Heart Association functional class at 12 months. Patients were followed up for one year and hospital admissions and mortality were analyzed. Results: Of the 200 patients included in the study, 99% met the indications of the current CRT clinical guidelines and 68% received CRT with implantable cardioverter-defibrillator. The rate of complications was 12.5%. During follow-up 16 patients (8%) died. Fifty-two percent (104) of the population was considered to respond clinically and 62% (124) presented improved echocardiographic parameters. Compared to the year prior to implant, hospital admissions decreased by 82% (P < .001). Conclusions: In an unselected population of Catalonia, we observe that CRT was effective and decreased the number of hospital admissions (AU)

[Status of cardiac resynchronization therapy in Catalonia, Spain: Results of the prospective multicentric study TRC-CAT]. / Estado actual del tratamiento de resincronización cardiaca en Cataluña: resultados del estudio prospectivo multicéntrico TRC-CAT.

INTRODUCTION AND OBJECTIVES: Results of cardiac resynchronization therapy (CRT) have been extensively published. However, there is limited data in unselected populations. The objective of the study was to analyse the efficacy and safety of CRT in Catalonia. METHODS: A prospective study was performed of consecutive patients implanted with CRT over one year in 7 university hospitals in Catalonia, representing 90% of the implanted patients. Echocardiographic reverse remodelling was defined as 5 points improvement in left ventricular ejection fraction and clinical responders were defined as patients with an increase>10% of six-minute walk test or one point of New York Heart Association functional class at 12 months. Patients were followed up for one year and hospital admissions and mortality were analyzed. RESULTS: Of the 200 patients included in the study, 99% met the indications of the current CRT clinical guidelines and 68% received CRT with implantable cardioverter-defibrillator. The rate of complications was 12.5%. During follow-up 16 patients (8%) died. Fifty-two percent (104) of the population was considered to respond clinically and 62% (124) presented improved echocardiographic parameters. Compared to the year prior to implant, hospital admissions decreased by 82% (P<.001). CONCLUSIONS: In an unselected population of Catalonia, we observe that CRT was effective and decreased the number of hospital admissions.

[Quality care in an intensive therapy unit at private hospital]. / Calidad de atención en una unidad de terapia intensiva del sector privado.

BACKGROUND: The aim of this article is to evaluate the quality of care in intensive care, with international quality indices. METHODS: It was a descriptive study in an intensive care private care in Mexico. 2012 indicators are analyzed in a total of 446 hospital patients. The quality indicators were in line with international recommendations. The severity was determined by the scale SAPS III. RESULTS: Indicator of ventilation associated pneumonia was below the recommended standard (11.7 vs. 12 per thousand), bacteremia related central venous catheter in accepted ranges (5.7 vs. 4 per thousand). The ulcer prophylaxis, prevention of pulmonary embolism and prevention of falls in high compliance proportions (> 90, > 95 % and 0 falls). The rates of unplanned extubation and re-intubation below indicators (< 1 per thousand days intubation and < 12 %). While indicators varied by classification of severity of the condition, the goals were met. Mortality was lower than that estimated by gravity. CONCLUSION: In this therapy the implementation of internationally recommended actions has helped maintain an adequate quality of care. The effort has impacted not only the patients with acute conditions of admission, but also patients with high mortality or Hazard.

Introducción: el objetivo es evaluar la calidad de la atención en una unidad de terapia intensiva con índices internacionales de calidad. Métodos: estudio descriptivo, en una unidad de cuidados intensivos de atención privada en México. Se analizan los indicadores de 2012 con un total de 446 pacientes hospitalizados. Los indicadores de calidad fueron acordes a recomendaciones internacionales. La gravedad fue determinada por la escala SAPS III. Resultados: el indicador de neumonías asociadas a ventilación se encontró por debajo del estándar recomendado (11.7 frente a 12 por mil); la bacteremia relacionada a catéter venoso central en rangos aceptados (5.7 frente a 4 por mil). Las acciones de profilaxis de úlceras, prevención de tromboembolia pulmonar y prevención de caídas en altas proporciones de cumplimiento (> 90, > 95 % y 0 caídas). Las tasas de extubación no programada y reintubaciones estuvieron por debajo de los indicadores (< 1 por mil días intubación y < 12 %). La mortalidad fue menor a la estimada por la gravedad. Conclusión: En esta terapia la implementación de acciones recomendadas a nivel internacional ha permitido mantener una adecuada calidad de atención. El esfuerzo a impactado no solo a los pacientes con condiciones agudas de ingreso, sino también a pacientes con alto riesgo de mortalidad.

A fatal case of Nocardia otitidiscaviarum pulmonary infection and brain abscess: taxonomic characterization by molecular techniques.

We report on a rare case of pulmonary Nocardiosis and brain abscess caused by Nocardia otitidiscaviarum in an elderly woman with chronic obstructive pulmonary disease. Taxonomic identification involved phenotypic testing, restriction fragment length polymorphism (RFLP), and complete 16S rRNA gene sequencing.

[Hyperglycemia controlled with GIK solution in non-diabetic patients subjected to heart surgery]. / Control de la hiperglucemia con la solución de glucosa-insulina-potasio en pacientes no diabéticos en cirugía cardíaca.

UNLABELLED: We prospectively compared, the glucose-insulin-potassium (GIK) solution 1,000 mL 10% glucose, 20 units of fast acting insulin and 60 mEq of potassium chloride, against a GIK solution with 1,000 mL of glucose, 40 units of fast acting insulin an 120 mEq of chloride, in the hyperglycemic control of non-diabetic patient subjected to cardiac surgery. We divided 40 patients in four groups ten patients each. Group A was the control they received 1,000 mL of 10% glucose in water, 20 units of fast acting insulin and 60 mEq of potassium chloride in a drops/ hour dose without an infusion pump. Group B received the same solution in a 50 mL/hour dose. Group C received 1,000 mL of 10% glucose in water, 40 units of fast acting insulin plus, 120 mEq of potassium chloride at the same infusion rate as Group A. Group D 2 1,000 mL of 10% of glucose in water, 40 units of fast acting insulin in the same rate as Group B. The GIK solution was started after anesthesia induction and maintained all along the extracorporeal circulation, the study continued until the patient was transferred to the intensive care unit. We measured blood glucose, circulating insulin and seric levels of potassium three times; basal before the anesthetic induction, during the extracorporeal circulation and at the intensive care unit arrival. The data were analyzed with measure of central tendency, dispersion and multivariate analysis. RESULTS: Among the four groups no statistically significant differences existed in demographic data. In Group A, glucose and potassium levels were higher as compared with the rest of the groups (p <0.05) in all measurements; Group D was less hyperglycaemic as compared with Groups A, B, and C. CONCLUSION: The solution with low insulin dose does useful plasmatic insulin levels in the hyperglycemia in non diabetic patients subjected to cardiac surgery.

Control de la hiperglucemia con la solución de glucosa-insulina-potasio en pacientes no diabéticos en cirugía cardíaca / Hyperglycemia controlled with GIK solution in non-diabetic patients subjected to heart surgery

We prospectively compared, the glucose-insulin-potassium (GIK) solution 1,000 mL 10% glucose, 20 units of fast acting insulin and 60 mEq of potassium chloride, against a GIK solution with 1,000 mL of glucose, 40 units of fast acting insulin an 120 mEq of chloride, in the hyperglycemic control of non-diabetic patient subjected to cardiac surgery. We divided 40 patients in four groups ten patients each. Group A was the control they received 1,000 mL of 10% glucose in water, 20 units of fast acting insulin and 60 mEq of potassium chloride in a drops/ hour dose without an infusion pump. Group B received the same solution in a 50 mL/hour dose. Group C received 1,000 mL of 10% glucose in water, 40 units of fast acting insulin plus, 120 mEq of potassium chloride at the same infusion rate as Group A. Group D 2 1,000 mL of 10% of glucose in water, 40 units of fast acting insulin in the same rate as Group B. The GIK solution was started after anesthesia induction and maintained all along the extracorporeal circulation, the study continued until the patient was transferred to the intensive care unit. We measured blood glucose, circulating insulin and seric levels of potassium three times; basal before the anesthetic induction, during the extracorporeal circulation and at the intensive care unit arrival. The data were analyzed with measure of central tendency, dispersion and multivariate analysis. RESULTS: Among the four groups no statistically significant differences existed in demographic data. In Group A, glucose and potassium levels were higher as compared with the rest of the groups (p <0.05) in all measurements; Group D was less hyperglycaemic as compared with Groups A, B, and C. CONCLUSION: The solution with low insulin dose does useful plasmatic insulin levels in the hyperglycemia in non diabetic patients subjected to cardiac surgery.

Oriented immobilisation of anti-pneumolysin Fab through a histidine tag for electrochemical immunosensors.

Orientation of reagents is a key step in the construction of immunosensors. When the immunoreagent is a recombinant protein, this can be achieved by employing hexahistidine tags. The orientation of recombinant histidine-tagged Fab fragments of monoclonal anti-pneumolysin antibodies on gold films is evaluated. Using histidine as a chelator of Ni or employing an anti-polyhistidine antibody for capturing the His6 residue is considered. Measurements are based in the signal of indigo, which comes from the hydrolysis of 3-indoxylphosphate by alkaline phosphatase (AP). The attachment of the enzyme occurs through the interaction of biotin with AP-labelled streptavidin or employing AP-conjugated immunoreagents. In the case of the interaction Ni-histidine, for the study of the self-assembling process a His-tagged and biotinylated protein (His6-GST-B) was employed. General conditions were studied and non-specific adsorption was avoided with the use of 1-hexanethiol. Improvements of the signal compared with the direct adsorption were only achieved by the use of histidine capturing antibodies. With an optimised ratio anti-polyhis:His6-Fab the signal increases approximately a 100%. Precision is adequate and the response is linear with the concentration of pneumolysin between 0.1 and 10 ng/mL.

[Oxygen carriers in cardiac surgery]. / Transportadores de oxígeno en cirugía cardíaca.

Artificial oxygen carriers may be grouped into two categories: Hemoglobin-based solutions and perfluoro-chemical based emulsions. Allogenic erythrocyte transfusions represent a limited resource and are associated with adverse events such as acute transfusion reactions, transmission of infectious diseases, immunosuppression and postoperative infections. Although "artificial blood" is not yet a clinical reality, several temporary "artificial oxygen carriers" are in late stage clinical development.

Transportadores de oxígeno en cirugía cardíaca / Oxygen carriers in cardiac surgery

Artificial oxygen carriers may be grouped into two categories: Hemoglobin-based solutions and perfluoro-chemical based emulsions. Allogenic erythrocyte transfusions represent a limited resource and are associated with adverse events such as acute transfusion reactions, transmission of infectious diseases, immunosuppression and postoperative infections. Although [quot ]artificial blood[quot ] is not yet a clinical reality, several temporary [quot ]artificial oxygen carriers[quot ] are in late stage clinical development.

Streptomyces albus isolated from a human actinomycetoma and characterized by molecular techniques.

A Streptomyces albus forearm actinomycetoma that could not be identified by culture was properly identified at the species level by study of an internal fragment of the heat shock protein gene, comparative sequence analysis of 16S ribosomal DNA (rDNA), and the hypervariable gamma-region of the 16S rDNA.

[Risk stratification in heart surgery]. / Estratificación del riesgo en cirugía cardiaca.

Risk scores have been important in patient assessment, such as, age, severity of heart disease, and comorbidity in patients undergoing heart surgery. Several risk scores have been developed to predict mortality after heart surgery. This paper analyzes data of the world, cardiac surgery reporting system, which contains information on cardiac preoperative risk factors, and postoperative complications.

Hemofiltración en cirugía cardiaca / Hemofiltration in cardiac surgery

Durante los procedimientos quirúrgicos con circulación extracorpórea el método de hemoconcentración por el principio de ultrafiltración sanguínea fue empleado para controlar hemodilución en 250 pacientes. Un dispositivo de fibra hueca y un hemoconcentrador especial fue empleado. La cantidad de ultrafiltrado recibido de un paciente varió entre 2600 ml, con una media de 1825 ñ 800 ml. La hemoconcentración por el principio del método de ultrafiltración es relativamente simple, seguro, y efectivo para el control de la hemodilución durante la circulación extracorpórea. El empleo de este método no se acompaña por alteraciones significativas en la homeostasis. Este método puede ser recomendado para uso de rutina en operaciones a corazón abierto que ameriten circulación extracorpórea

Glucosa-potasio-insulina en revascularización coronaria / Glucose-potasium-insulin containing solution in coronary artery by-pass

Se estudiaron 20 pacientes para cirugía de puentes aortocoronarios, los cuales fueron divididos en dos grupos: Grupo I (10 pacientes; 8 masculinos y 2 femeninos), los cuales recibieron una solución conteniendo glucosa-potasio-insulina. El grupo II (control, 10 pacientes, 8 masculinos y 2 femeninos), los cuales recibieron una solución Hartman Todos fueron monitorizados con electrocardiograma (derivación DII - V5), línea arterial, catéter en arteria pulmonar y en el seno coronario, frecuencia cardiaca, presión arterial media, gasto cardiaco y sus derivadas. Así mismo electrolitos, glucosa sanguínea y lactos en el seno coronario; efectuándose mediciones: basal, 5, 15, 30 y 60 minutos después de iniciada la infusión. Los cambios fueron analizados para detectar cualquier cambio usando la prueba de Wilcoxon y t de student pareada. Encontrándose cambios significativos en el grupo 1 al aumentar el gasto cardiaco, índice cardiaco, v menor producción de lactatos en el seno coronario, comparadas al grupo control. En conclusión de acuerdo a los resultados obtenidos en este estudio creemos que la solución polarizante puede ser usada en el paciente coronario con efectos benéficos hemodinámicos y sin complicaciones

Evaluación pre-operatoria del paciente cardiopata para cirugía no cardiaca / Preoperative assesment of cardiac patients for non-cardiac surgery

Actualmente existe un incremento en el número de pacientes cardiópatas sometidos a cirugía no cardiaca. Sin embargo, la evaluación con la finalidad de poder predecir con mayor seguridad el riesgo a que estos se encuentran sometidos. Una exitosa evaluación y tratamiento del paciente cardiopata llevado a cirugía no cardiaca, requiere de un cuidadoso trabajo en equipo y comunicación entre el paciente, médico de primer contacto, anestesiólogo y cirujano. En esta revisión, se encuentran descritos ciertos factores y predictores de riesgo, así como también algunos algoritmos recientes, basados en los datos observacionales colectados y la opinión de los expertos más calificados, todo ello con la finalidad de involucrar al anestesiólogo en el cuidado preoperatorio, transoperatorio y postoperatorio del paciente con enfermedad cardiaca sometido a cirugía no cardiaca

Esmolol en fibrilación auricular rápida secundaria a estenosis mitral / Utility of esmolol in rapid auricular flutter secondary to mitral stenoses

Se estudiaron 40 pacientes portadores de estenosis mitral, confirmada por cateterismo cardiaco y/o ecocardiografía transtorácica, programados para remplazo valvular mitral, los cuales semonitorizaron con electrocardiograma (DII), línea arterial, así comocatéter de flotación en arteria pulmonar. Registrándose las siguientes constantes hemodinámicas: Frecuencia Cardiaca (FC), presión arterial media (PAM), presión arterial pulmonar (PAP), presión capilar pulmonar (PCP), presión venosa central (PVC) y Gasto Cardiaco (GC), calculándoce Volumen Latido (VL), Indice sistólico (IS), Resistencias Vasculares Sistémicas (VS), Indice Trabajo Ventricular Izquierdo (ITVI), Resistencias Vasculares Pulmonares (RVP) y Producto presión-frecuencia (PPF). Se estímulo de ninguna índole se administró clorhidrato de esmolol en infusión a dosis de 450 µg/kg/min durante 15 min, tiempo en el cual se realizaron las mediciones antes mencionadas; básales (sin esmolol) y a los 3, 5, 10 y 15 minutos de iniciada la infusión, obteniéndose resultados significativos en el gasto cardiaco, índice cardiaco, frecuencia cardiaca, volumen latido,índice sistólico e índice de trabajo de ventricular izquierdo así como en las resistencias vasculares sistémicas y producto presión-frecuencia

Alfentanyl en pacientes con cardiopatías congénitas / Alfentanyl in patients with congenital cardiopathies

Se estudiaron 39 pacientes con diferentes cardiopatías congénitas programados para corrección total de la misma bajo circulación extracorporea, administrándose anestesia balanceada con halogenado e infusión de clorhidrato alfentanyl en diferentes tiempos durante el acto anestésico quirúrgico, monitorizandose electrocardiograma de superficie, presión arterial invasiva, presión venosa central, tomándose muestras sanguíneas arteriales para verificar concentraciones plasmáticas de alfentanyl así mismo las variables hemodinámicas para correlacionar dichas muestras; dichos tiempos de medición fueron control, 3 min, incisión de piel, esternotomía, circulación extracorporea, cierre de esternón y fin de la cirugía; concluyéndose que las dosis administradas provee adecuada anestesia, así mismo se conserva estabilidad hemodinámica. Obteniéndose concentraciones plasmáticas adecuadas de anestesia cuando dichos niveles fueron de 192-303 ng/ml