Comparison of electrogram characteristics in persistent atrial fibrillation.

INTRODUCTION: Multiple analysis techniques evaluate electrograms during atrial fibrillation (AF), but none have been established to guide catheter ablation. This study compares electrogram properties recorded from multiple right (RA) and left atrial (LA) sites. METHODS: Multisite LA/RA mapping (281 ± 176/239 ± 166 sites/patient) was performed in 42 patients (30 males, age 63 ± 9 years) undergoing first (n = 32) or redo-AF ablation (n = 10). All electrogram recordings were visually reviewed and artifactual signals were excluded leaving a total of 21 846 for analysis. Electrogram characteristics evaluated were cycle length (CL), amplitude, Shannon's entropy (ShEn), fractionation interval, dominant frequency, organizational index, and cycle length of most recurrent morphology (CLR ) from morphology recurrence plot analysis. RESULTS: Electrogram characteristics were correlated to each other. All pairwise comparisons were significant (p < .001) except for dominant frequency and CLR (p = .59), and amplitude and dominant frequency (p = .38). Only ShEn and fractionation interval demonstrated a strong negative correlation (r = -.94). All other pairwise comparisons were poor to moderately correlated. The relationships are highly conserved among patients, in the RA versus LA, and in those undergoing initial versus redo ablations. Antiarrhythmic drug therapy did not have a significant effect on electrogram characteristics, except minimum ShEn. Electrogram characteristics associated with ablation outcome were shorter minimum CLR , lower minimum ShEn, and longer mimimum CL. There was minimal overlap between the top 10 sites identified by one electrogram characteristic and the top 10 sites identified by the other 10 characteristics. CONCLUSION: Multiple techniques can be employed for electrogram analysis in AF. In this analysis of eight different electrogram characteristics, seven were poorly to moderately correlated and do not identify similar locations. Only some characteristics were predictive of ablation outcome. Further studies to consider electrogram properties, perhaps in combination, for categorizing and/or mapping AF are warranted.

Electrogram morphology recurrence guided catheter ablation for repeat ablation of persistent atrial fibrillation.

BACKGROUND: There are no standard mapping approaches for patients with persistent atrial fibrillation (PeAF), particularly after failed prior catheter ablation (CA). In this study, we assess the feasibility of using Electrogram Morphology Recurrence (EMR) to guide ablation. METHODS: Ten patients with recurrent PeAF after prior CA underwent detailed mapping of both atria during PeAF using the PentaRay (4 mm interelectrode spacing) and 3D mapping with CARTO. At each site, 15 s recordings were made. Custom software identified each electrogram and cross-correlation was used to identify the most recurrent electrogram morphology from which the % recurrence and cycle length of the most repeatable morphology (CLR) was calculated. Sites of shortest CLR and sites within 5 ms of shortest CLR with recurrence ≥ 80% were used to inform CA strategy. RESULTS: A mean of 342.9 ± 131.9 LA and 328.6 ± 91.5 RA sites were recorded per patient. Nine had PV reconnection. Shortest CLR sites guided ablation in 6/10 patients while 1 patient failed to fulfill shortest CLR criteria, and another 3 did not undergo CA guided by shortest CLR due to operator preference. On 12-month follow-up, all 4 patients without shortest CLR guided CA had recurrent PeAF. Of the 6 patients with shortest CLR guided CA, 5 patients did not have recurrent PeAF (p = 0.048), although 1 had paroxysmal AF and 2 had atypical atrial flutter. CONCLUSION: EMR is a feasible, novel technique to guide CA in patients with PeAF. Further evaluation is needed to provide an electrogram-based method for mapping guided targeted ablation of key areas.

Electrogram Morphology Recurrence for Mapping Persistent Atrial Fibrillation: Initial vs Redo Catheter Ablation.

BACKGROUND: Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (AF) quantifies consistency of activation and is expected to be high and rapid near AF drivers. OBJECTIVES: The purpose of this study was to compare EMR in left atria (LA) and right atria (RA) in patients undergoing first vs redo ablation for persistent AF. METHODS: Multisite LA/RA mapping (LA: 281 ± 176 sites/patient; RA: 239 ± 166 sites/patient) before persistent AF ablation was performed in 42 patients (30 males, age 63 ± 9 years) undergoing first (Group 1, n = 32) or redo ablation (Group 2, n = 10). After cross-correlation of each automatically detected EGM with every other EGM per recording, the most recurrent electrogram morphology was identified and its frequency (Rec%) and recurrence cycle length (CLR) were computed. RESULTS: In Groups 1 and 2, minimum CLR was 172.8 ± 26.0 milliseconds (LA: 178.2 ± 37.6 milliseconds, RA: 204.4 ± 34.0 milliseconds, P = 0.0005) and 186.5 ± 28.3 milliseconds (LA: 196.1 ± 38.1 milliseconds vs RA: 199.0 ± 30.2 milliseconds, P = 0.75), with Rec% 94.7% ± 10% and 93.8% ± 9.2%. Group 2 minimum CLR was not different from Group 1 (P = 0.20). Shortest CLR was in the LA in 84% of Group 1 and 50% of Group 2 patients (P = 0.04). Only 1 of 10 patients in Group 2 had the shortest CLR in the pulmonary veins (PVs) compared with 19 of 32 in Group 1 (P = 0.01). Most sites (77.6%) had Rec% <50%. CONCLUSIONS: EMR identified the shortest CLR sites in the PVs in 59% of patients undergoing initial persistent AF ablation, consistent with reported success rates of ∼50% for PV isolation. The majority of sites have low recurrence and may reflect bystander sites not critical for maintaining AF. EMR provides a robust new method for quantifying consistency and rapidity of activation direction at multiple atrial sites.

Evaluación del riesgo y estado ponderal en adultos mayores institucionalizados de la ciudad de Guayaquil-Ecuador / Nutritional risk and weight status in older adults institutionalized of Guayaquil-Ecuador

FUNDAMENTOS: Los adultos mayores requieren de evaluaciones periódicas para determinar su estado de salud. El objetivo fue evaluar el estado ponderal y riesgo nutricional de adultos mayores que se encontraban en centros gerontológicos de Guayaquil, Ecuador, en febrero de 2018. MÉTODOS: El análisis de riesgo nutricional se realizó a 479 personas a quienes se les aplicó la herramienta Nutrition Screening Initiative Checklist, mientras que el análisis de estado ponderal incluyó a 465 personas a través de la medición del índice de masa corporal (IMC). Las pruebas se realizaron en 3 centros gerontológicos. RESULTADOS: Un total de 77% hombres y 81% mujeres se encontraban en un estado de riesgo nutricional grave por sus hábitos alimenticios, y un 61% de hombres y 45% de mujeres presentaron un estado ponderal normal. CONCLUSIONES: Los adultos mayores de la ciudad de Guayaquil requieren más atención por parte de los distintos gestores encargados de su salud para reducir el estado de riesgo grave en el que se encuentran actualmente, esto también tendrá incidencia para mejorar el estado nutricional que, si bien se encuentra controlado, no deja de ser un posible problema en el futuro

BACKGROUND: Older adults require periodic evaluations to determine their health status. The objectives were to evaluate the weight status and nutritional risk of elderly people in gerontological centers located in Guayaquil, Ecuador, in February 2018. METHODS: For the nutritional risk analysis 479 people were used to whom the Nutrition Screening Initiative Checklist tool was applied, while for the weight status analysis 465 people were used through the measurement of body mass index (BMI), the tests They were carried out in 3 centers. RESULTS: A total of 77% men and 81% women are in serious risk from their eating habits, and 61% men and 45% women have a normal weight status. CONCLUSIONS: Elderly people in Guayaquil require more attention from different managers in charge of their health, to reduce the serious risk that they're currently facing, this will also have an incidence improving the weight status that, even though is controlled, it's a possible problem in the future

Photodynamic therapy using ultradeformable liposomes loaded with chlorine aluminum phthalocyanine against L. (V.) braziliensis experimental models.

Ultradeformable liposomes (UDLs) containing sodium cholate as edge activator could be an appropriate skin drug-delivery system for chloroaluminum phthalocyanine (ClAlPc) during photodynamic therapy (PDT) against cutaneous leishmaniasis (CL). The aim of this work was to study cell internalization, reactive oxygen species (ROS) production, and toxicity/genotoxicity and transdermal delivery of UDL-ClAlPc, and to determine whether PDT was able to induce anti-leishmanial activity in Leishmania (Viannia) braziliensis experimental models. Prepared liposomes had an average size of 118.39 nm, zeta potential of -37.83 mV, and polydispersity index of 0.15. Liposomal internalization (red fluorescence inside cells), ROS generation (green fluorescence by 2,7-dichlorodihydrofluorescein diacetate [DCFH-DA] cleavage) and non-specific DNA damage (photo-comets) were observed after PDT. Transdermal delivery of ClAlPc, measured by in vitro diffusion experiments through BALB/c skin, showed that UDL-ClAlPc was able to deliver very low quantities of ClAlPc (<1%) to deep skin layers. PDT using UDL-ClAlPc induced photodamage in mammalian cells (J774, THP-1, and NIH-3T3), promastigotes, and intracellular amastigotes without a selective response against amastigotes (selective index ≥1). Topical once-daily ClAlPc-UDL plus visible-light irradiation (20 J/cm2) twice weekly for 3 weeks was ineffective against L. (V.) braziliensis-infected BALB/c mice, whereas miltefosine 30 mg/kg/day orally for 10 days healed the lesions and scars, without parasites observed on the slides. Even though UDLs preserved ClAlPc photoactivities and were able to deliver ClAlPc to dermis, they were unable to result in healing of CL-infected mice after PDT. Experiments using different CL animal models and liposomes with increased skin permeability abilities are recommended.

Biodiversity loss along a gradient of deforestation in Amazonian agricultural landscapes.

Assessing how much management of agricultural landscapes, in addition to protected areas, can offset biodiversity erosion in the tropics is a central issue for conservation that still requires cross-taxonomic and landscape-scale studies. We measured the effects of Amazonia deforestation and subsequent land-use intensification in 6 agricultural areas (landscape scale), where we sampled plants and 4 animal groups (birds, earthworms, fruit flies, and moths). We assessed land-use intensification with a synthetic index based on landscape metrics (total area and relative percentages of land uses, edge density, mean patch density and diversity, and fractal structures at 5 dates from 1990 to 2007). Species richness decreased consistently as agricultural intensification increased despite slight differences in the responses of sampled groups. Globally, in moderately deforested landscapes species richness was relatively stable, and there was a clear threshold in biodiversity loss midway along the intensification gradient, mainly linked to a drop in forest cover and quality. Our results suggest anthropogenic landscapes with high-quality forest covering >40 % of the surface area may prevent biodiversity loss in Amazonia.

Síndrome de guillian Barré: su evolución en una sala de cuidados intensivos

Se realizó un estudio retrospectivo-prospectivo desde el año 1984 sobre la evolución de 25 pacientes pediátricos en la sala de Cuidados Intensivos del Hospital Escuela, el porcentaje de pacientes que necesitaron ventilación mecánica durante ese período fué del 13%, el grupo de edad más afectado fué el de 1-2 años de edad, el 100% de los pacientes ingresa dos tenían parálisis simétrica, la mayoría de los pacientes (17 de 25) presentaron un cuadro de evolución rápidamente progresiva hasta la parálisis, pocos fueron los pacientes que necesitaron ventilación mecánica y que tenían un cuadro de más de 10 días de evolución. La incidencia de fenómenos neurovegetativos fué de un 60% (15 de 25 pacientes) y fueron más frecuentes en el grupo de 1-2 años de edad, en el grupo de pacientes muertos la incidencia de fenómenos neurovegetativos fue de 85.5% frente a un 50% de incidencia en los sobrevivientes, esto parece indicar que la incidencia de estos fenómenos es un factor de mal pronóstico, tambien se comprobó que en el 92% de los pacientes a quienes se les practicó espirometría, tenían una reducción significativa de su volumen tidal, 6 de 8 paciente que no recuperaron su volumen tidal al final de la tercer semana murieron, hecho clínico relevante que puede ser considerado otro factor de mal pronóstico. De los 25 pacientes ingresados a UCI, 7 pacientes murieron mortalidad inferior a la reportada por otros países del área en este tipo de pacientes, la mortalidad global del Sindrome es de 4%. Se analizan las causas de muerte encontrando que la mayoría de ellas estan relaciconadas con el compromiso respiratorio y trastornos neurovegetativos