Photodynamic Inactivation of Foodborne Bacteria: Screening of 32 Potential Photosensitizers.

The development of novel antimicrobial technologies for the food industry represents an important strategy to improve food safety. Antimicrobial photodynamic disinfection (aPDD) is a method that can inactivate microbes without the use of harsh chemicals. aPDD involves the administration of a non-toxic, light-sensitive substance, known as a photosensitizer, followed by exposure to visible light at a specific wavelength. The objective of this study was to screen the antimicrobial photodynamic efficacy of 32 food-safe pigments tested as candidate photosensitizers (PSs) against pathogenic and food-spoilage bacterial suspensions as well as biofilms grown on relevant food contact surfaces. This screening evaluated the minimum bactericidal concentration (MBC), minimum biofilm eradication concentration (MBEC), and colony forming unit (CFU) reduction against Salmonella enterica, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas fragi, and Brochothrix thermosphacta. Based on multiple characteristics, including solubility and the ability to reduce the biofilms by at least 3 log10 CFU/sample, 4 out of the 32 PSs were selected for further optimization against S. enterica and MRSA, including sunset yellow, curcumin, riboflavin-5'-phosphate (R-5-P), and erythrosin B. Optimized factors included the PS concentration, irradiance, and time of light exposure. Finally, 0.1% w/v R-5-P, irradiated with a 445 nm LED at 55.5 J/cm2, yielded a "max kill" (upwards of 3 to 7 log10 CFU/sample) against S. enterica and MRSA biofilms grown on metallic food contact surfaces, proving its potential for industrial applications. Overall, the aPDD method shows substantial promise as an alternative to existing disinfection technologies used in the food processing industry.

Trombólisis intraarterial en paciente COVID-19 con isquemia aguda en extremidadinferior / Intraarterial thrombolysis in a COVID-19 patient with acute lower limb ischemia

La trombólisis dirigida por catéter es un procedimiento considerado de elección y aceptado, con muy buenos resultados en los casos de trombosis arteriales del lecho distal. Los pacientes con infección por COVID-19 y trombosisarteriales representan una subpoblación de pacientes críticos que condiciona el uso de determinadas técnicasquirúrgicas de revascularización.

Catheter-directed thrombolysis is an accepted procedure with very good results in cases of arterial thrombosis ofthe distal territory, being considered of choice. Patients with COVID-19 infection and arterial thrombosis representa subpopulation of critically ill patients that conditions the use of certain revascularization surgical techniques.

Toward Understanding of Suicidality in a Spanish Clinical Population: Validation of the European Spanish Version of the Interpersonal Needs Questionnaire.

INTRODUCTION: Suicidal ideation (SI) represents one of the most prominent predictors of suicidal behavior (SB). The Interpersonal Needs Questionnaire (INQ) was developed from the Interpersonal Theory of Suicide (ITS) to assess the 2 core drivers of SI proposed by the theory. Despite the relevance of suicide-related ideations and ITS, there is a lack of psychometric measures validated in clinical Spanish population that adequately evaluate SI components of ITS. Thus, the main aim of the study was to validate INQ-10 in a Spanish clinical sample including the genuine cultural and linguistic characteristics of European Spanish. METHODS: 315 participants were included in the analyses; 149 of them consulted mental health services for the presence of suicide-related behaviors. A series of exploratory and confirmatory factor analyses were carried out to identify the factor solution. Bivariate and multivariate analyses were used to analyze psychometric properties. Finally, sensitivity and specificity properties were explored through receiver-operating characteristic analyses which also provided the cut-off values of the questionnaire. RESULTS: An 8-item version demonstrated a good fit to the 2-factor solution. Likewise, this 8-item version showed good psychometric properties. Sensitivity and specificity indices of the version validated as well as the calculated cut-off points were excellent. CONCLUSIONS: The current results demonstrate the utility of an 8-item INQ European Spanish version as a valid measure of the current SI in Spanish clinical population. In addition, the validated form reflects the theoretical framework on which it was built.

"Grandes respondedores y recuperación". Tratamiento con clozapina asociado a factor estimulante de colonias de granulocitos / "Great responders and recovery." Treatment with clozapine associated with granulocyte colony stimulating factor

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Metabolomic responses of mussel Mytilus galloprovincialis to fluoranthene exposure under different nutritive conditions.

Biomarkers are useful tools to assess biological effects of pollutants that are extensively used in monitoring programs to assess ecosystem health. However, they are strongly affected by mussel physiological state, especially nutritive status, which has led to the search of new biological indicators of chemical pollutants exposition. Environmental metabolomics is an approach for examining the metabolic responses (measurement of low molecular weight endogenous metabolites) of an organism to both natural and anthropogenic stressors that can occur in its environment. The aim of the present work was to assess the effect of the polycyclic aromatic hydrocarbon fluoranthene (FLU) exposure on the metabolomic profiles of mussel digestive glands under different nutritive conditions. To achieve this objective, mussels were reared, for a period of 56 days, under three different food rations in order to obtain a gradient of nutritive status (negative, zero and positive energy balance), and after that, they were exposed, during 3 weeks, to a nominal concentration of 3 µg FLU L-1. A total of 43 metabolites, including aminoacids (Ala, Val, Leu, Ile, etc.), energy metabolism related metabolites (ATP, AMP, etc.), organic osmolytes (taurine, etc.), redox metabolism (GSH, NADP+) and nucleotides, were identified and quantified in the digestive glands of the mussels. Principal Component Analysis (PCA) defined two principal components (PC1 and PC2) that explained 55.6% of the total variance, although the first component explains more than 80% of this variance, this being related to the mussel nutritive condition. The effect of the toxicant, explained by the PC2, is similar to that produced under conditions of food restriction, which masks the effect of the toxicant under these conditions. As the feeding conditions are more favorable, the toxic effect becomes more apparent. Therefore, the great influence of nutritive condition on mussel metabolome implies a handicap for the use of metabolomic biomarkers, as previously demonstrated for biochemical and other molecular biomarkers, in large-scale monitoring programs in which several food conditions coexist with pollution levels.

Infección arterial causada por Listeria monocytogenes: a propósito de dos casos. Eficacia del abordaje combinado precoz y tratamiento supresivo oral / Arterial infection caused by Listeria monocytogenes: Report of two cases. The efficacy of an early combined approach and oral suppressive treatment

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Metabolomic responses in caged clams, Ruditapes decussatus, exposed to agricultural and urban inputs in a Mediterranean coastal lagoon (Mar Menor, SE Spain).

The Mar Menor is a coastal lagoon affected by the growth of intensive agriculture and urban development in the surrounding area. Large amounts of chemical pollutants from these areas are discharged into El Albujón, a permanent water-course flowing into the lagoon. Biomarkers such as the activity of acetylcholinesterase or antioxidant enzymes have been previously tested in this lagoon demonstrating the presence of neurotoxicity and oxidative stress in clams transplanted in sites affected by the dispersion of the effluent from El Albujón. To complete this traditional toxicology work, a metabolomic profiling of these transplanted organisms has been carried out for the detection of metabolic biomarkers induced by agricultural/urban pollutants. More than 70 metabolites have been quantified using a targeting metabolomics platform based on HPLC-MS. The intracellular metabolic pattern was analyzed by PCA from the digestive gland of clams after 7 and 22 days of transplantation. Results showed a different profile of metabolite between organisms collected from control and exposed sites. At the shorter exposure time, there was an increase in several metabolites in the latter when compared with those from control sites, whereas metabolic profiling at 22 days showed that those metabolites were drastically diminished, with even lower levels than at control sites. These metabolites included: (i) 12 amino acids from the 21 proteogenic and HomoSer, (ii) osmotic protectants such as γ-butyrobetaine and taurine and (iii) nucleotides such as ITP. Regarding sulfur-containing molecules, taurine could be highlighted as a potential biomarker since its concentration was reduced by more than 30 times after 22 days of exposure, whereas the antioxidant glutathione remained constant in the organisms from both control and exposed sites. Although targeted metabolomics has been shown as an early technique of pollutant effect detection, the two-phase pattern could highlight a more complicated metabolite response to pollutants than classical biomarkers.

Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. METHOD: WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers. RESULTS: Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (ß = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks. CONCLUSION: The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

Systematic production of inactivating and non-inactivating suppressor mutations at the relA locus that compensate the detrimental effects of complete spot loss and affect glycogen content in Escherichia coli.

In Escherichia coli, ppGpp is a major determinant of growth and glycogen accumulation. Levels of this signaling nucleotide are controlled by the balanced activities of the ppGpp RelA synthetase and the dual-function hydrolase/synthetase SpoT. Here we report the construction of spoT null (ΔspoT) mutants obtained by transducing a ΔspoT allele from ΔrelAΔspoT double mutants into relA+ cells. Iodine staining of randomly selected transductants cultured on a rich complex medium revealed differences in glycogen content among them. Sequence and biochemical analyses of 8 ΔspoT clones displaying glycogen-deficient phenotypes revealed different inactivating mutations in relA and no detectable ppGpp when cells were cultured on a rich complex medium. Remarkably, although the co-existence of ΔspoT with relA proficient alleles has generally been considered synthetically lethal, we found that 11 ΔspoT clones displaying high glycogen phenotypes possessed relA mutant alleles with non-inactivating mutations that encoded stable RelA proteins and ppGpp contents reaching 45-85% of those of wild type cells. None of the ΔspoT clones, however, could grow on M9-glucose minimal medium. Both Sanger sequencing of specific genes and high-throughput genome sequencing of the ΔspoT clones revealed that suppressor mutations were restricted to the relA locus. The overall results (a) defined in around 4 nmoles ppGpp/g dry weight the threshold cellular levels that suffice to trigger net glycogen accumulation, (b) showed that mutations in relA, but not necessarily inactivating mutations, can be selected to compensate total SpoT function(s) loss, and (c) provided useful tools for studies of the in vivo regulation of E. coli RelA ppGpp synthetase.

Metabolic profiling of insect cell lines: Unveiling cell line determinants behind system's productivity.

Baculovirus infection boosts the host biosynthetic activity towards the production of viral components and the recombinant protein of interest, hyper-productive phenotypes being the result of a successful adaptation of the cellular network to that scenario. Spodoptera frugiperda derived Sf9 and Trichoplusia ni derived High Five cell lines have a major track record for the production of recombinant proteins, with High Five cells presenting higher productivities. A metabolic profiling of the two insect cell lines was pursued to underpin specific cellular traits behind productive phenotypes. Multivariate analysis identified cell-line dependent metabolic signatures linked to productivity. Pathway analysis highlighted cellular pathways of paramount importance in supporting infection and protein production. Moreover, better producer phenotypes proved to be correlated with the capacity of cells to shift their metabolism in favor of energy-generating pathways to fuel biosynthesis, a scenario observed in the High Five cell line. Metabolomic profiling allowed us to identify metabolic pathways involved in infection and recombinant protein production, which can be selected as targets for further improvement of the system.

Storytelling in community intervention research: lessons learned from the walk your heart to health intervention.

BACKGROUND: Contextually and culturally congruent interventions are urgently needed to reduce racial, ethnic, and socioeconomic inequities in physical activity and cardiovascular disease. OBJECTIVES: To examine a community-based participatory research (CBPR) process that incorporated storytelling into a physical activity intervention, and consider implications for reducing health inequities. METHODS: We used a CBPR process to incorporate storytelling in an existing walking group intervention. Stories conveyed social support and problem-solving intervention themes designed to maintain increases in physical activity over time, and were adapted to the walking group context, group dynamics, challenges, and traditions. LESSONS LEARNED: After describing of the CBPR process used to adapt stories to walking group sites, we discuss challenges and lessons learned regarding the adaptation and implementation of stories to convey key intervention themes. CONCLUSIONS: A CBPR approach to incorporating storytelling to convey intervention themes offers an innovative and flexible strategy to promote health toward the elimination of health inequities.

Lipid biomarkers and metabolic effects of lycopene from tomato juice on liver of rats with induced hepatic steatosis.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver disorders, covering steatosis to nonalcoholic steatohepatitis (NASH). Dietary factors may modulate its evolution, and antioxidants have been proposed as therapeutic agents. Among them, lycopene has been demonstrated to prevent the development of steatohepatitis and even to inhibit NASH-promoted early hepatocarcinogenesis induced by a high-fat diet in rats. These conclusions have been related to its antioxidant activity; however, NAFLD is more complex than a simple redox imbalance state since it disturbs several metabolic systems in the liver. In consequence, there is a lack of information related to the action of lycopene beyond antioxidant biomarkers. In this work, NAFLD was induced in rats using a hypercholesterolemic and high-fat diet to evaluate the effect of lycopene consumption from tomato juice on liver metabolism. Several classical antioxidant biomarkers related to NAFLD were measured to check the state of this disease after 7 weeks of the controlled diet. Moreover, a metabolomics platform was applied to measure more than 70 metabolites. Results showed clear differences in the classical antioxidant biomarkers as well as in the metabolic pattern, attending not only to the diet but also to the intake of lycopene from tomato juice. Interestingly, tomato juice administration partially reverted the metabolic pattern from a high-fat diet to a normal diet even in metabolites not related to the redox state, which could lead to new targets for therapeutic agents against NAFLD and to achieving a better understanding of the role of lycopene in liver metabolism.

EasyLCMS: an asynchronous web application for the automated quantification of LC-MS data.

BACKGROUND: Downstream applications in metabolomics, as well as mathematical modelling, require data in a quantitative format, which may also necessitate the automated and simultaneous quantification of numerous metabolites. Although numerous applications have been previously developed for metabolomics data handling, automated calibration and calculation of the concentrations in terms of µmol have not been carried out. Moreover, most of the metabolomics applications are designed for GC-MS, and would not be suitable for LC-MS, since in LC, the deviation in the retention time is not linear, which is not taken into account in these applications. Moreover, only a few are web-based applications, which could improve stand-alone software in terms of compatibility, sharing capabilities and hardware requirements, even though a strong bandwidth is required. Furthermore, none of these incorporate asynchronous communication to allow real-time interaction with pre-processed results. FINDINGS: Here, we present EasyLCMS (http://www.easylcms.es/), a new application for automated quantification which was validated using more than 1000 concentration comparisons in real samples with manual operation. The results showed that only 1% of the quantifications presented a relative error higher than 15%. Using clustering analysis, the metabolites with the highest relative error distributions were identified and studied to solve recurrent mistakes. CONCLUSIONS: EasyLCMS is a new web application designed to quantify numerous metabolites, simultaneously integrating LC distortions and asynchronous web technology to present a visual interface with dynamic interaction which allows checking and correction of LC-MS raw data pre-processing results. Moreover, quantified data obtained with EasyLCMS are fully compatible with numerous downstream applications, as well as for mathematical modelling in the systems biology field.

Enfermedad de Ménétrier y edemas bilaterales en un paciente joven / Menetrier’s disease and bilateral oedemas in a young patient

Introducción. La enfermedad de Ménétrier es una gastropatía hiperplásica de aparición excepcional, que se caracteriza por un engrosamiento marcado de los pliegues gástricos, a expensas fundamentalmente de una hiperplasia foveolar. La presentación clínica más frecuente es dolor epigástrico, náuseas o vómitos. Se ha descrito una elevada prevalencia de infección por Helicobacter pylori (90%), y se ha comprobado una mejoría clínica, analítica e histológica tras la erradicación de éste. Caso clínico. Varón de 45 años que consultó por edemas de dos meses de evolución en los miembros inferiores. La ecografía Doppler de los miembros inferiores y la linfogammagrafía isotópica fueron normales. En la analítica se observó una marcada hipoproteinemia, y entre los estudios adicionales destacaba una serología positiva para H. pylori. Se le realizó un tránsito esofagogastroduodenal donde se observó un engrosamiento marcado de los pliegues gástricos, que se confirmó con gastroscopia y biopsia. El examen anatomopatológico objetivó la existencia de una gastritis crónica mixta con hiperplasia foveolar focal, junto con la presencia de H. pylori. Se instauró un tratamiento erradicador, y el paciente mostró una mejoría significativa de los edemas y una normalización de la cifra de proteínas. Conclusión. Presentamos un caso de enfermedad de Ménétrier, cuya principal manifestación clínica –a diferencia de lo habitual– son los edemas periféricos. Cabe reseñar la importancia de incluir las gastroenteropatías pierdeproteínas dentro del diagnóstico diferencial de edemas periféricos sin causa vascular

Introduction. Ménétrier’s disease is rare hyperplastic gastropathy that is characterised by a notable thickening of the gastric folds, mainly due to foveolar hyperplasia. The most frequent clinical presentation is epigastric pain, nausea or vomiting. A high rate of prevalence of infection by Helicobacter pylori (90%) has been reported and clinical, analytical and histological improvement is observed once this has been eradicated. Case report. A 45-year-old male who visited due to a two-month history of oedemas in the lower limbs. Results of Doppler ultrasound scans of the lower limbs and isotopic lymphoscintigraphy imaging were normal. Lab tests revealed a notable hypoproteinemia and one of the most significant findings in the additional studies was positive serology for H. pylori. The upper gastrointestinal series that was performed revealed a notable thickening of the gastric folds, which was confirmed by means of gastroscopic and biopsy tests. A pathological examination revealed the existence of a chronic non-specific gastritis with focal foveolar hyperplasia, together with the presence of H. pylori. Treatment was established to eradicate the infection and the patient showed significant improvement with regard to the oedemas and normalisation of the protein count. Conclusion. We report a case of Ménétrier’s disease in which, uncharacteristically, the main clinical feature is the presence of peripheral oedemas. It is important to include protein-losing gastroenteropathies within the differential diagnosis of peripheral oedemas that have no vascular causation

Falso aneurisma arterial y Salmonella paratyphi / Arterial pseudoaneurysm and Salmonella paratyphi

Introducción. La etiología infecciosa es una causa frecuente de formación de pseudoaneurismas arteriales. Clásicamente se ha relacionado la bacteriemia por Salmonella con colonización endovascular. Caso clínico. Varón de 77 años, hipertenso, obeso, ex fumador y bebedor habitual, que acudió al servicio de urgencias por dolor, edema y empastamiento del miembro inferior derecho, con mala perfusión distal. El estudio de eco-Doppler confirmó una trombosis en la vena femoral común derecha, por lo que ingresó con la sospecha diagnóstica de flegmasia cerulea dolens. Comenzó entonces con la clínica del síndrome compartimental y picos febriles. Se le realizaron fasciotomías en los compartimentos anterior y lateral de la pierna derecha. En la tomografía axial computarizada (TAC) se observaron abscesos en el músculo psoas derecho. En los hemocultivos crecieron colonias de Salmonella paratyphi, por lo que se realizó una nueva TAC con contraste intravenoso para descartar una infección endovascular. Se visualizó una imagen nueva compatible con un pseudoaneurisma de la arteria ilíaca derecha. Se decidió la intervención quirúrgica urgente para la reparación vascular y el drenaje de los abscesos, por lo que se indicó previamente la colocación de un filtro de cava. Durante la colocación de éste, el paciente sufrió una parada cardiorrespiratoria y el posterior fallecimiento. Conclusión. En la necropsia se halló una perforación puntiforme en el ápex y el hemopericardio como probable origen del fallecimiento (AU)

INTRODUCTION. Arterial pseudoaneurysms are often produced as a result of infectious processes. Bacteraemia due to Salmonella has traditionally been related to endovascular colonisation. CASE REPORT. 77-year-old male, who was hypertensive, obese, previously a frequent smoker and drinker, and who visited the emergency department because of pain, oedema and investment of the right lower limb, with poor distal perfusion. A Doppler ultrasound scan confirmed the presence of thrombosis in the right common femoral vein, and was therefore admitted to hospital with a suspected diagnosis of phlegmasia cerulea dolens. The patient then started with a clinical picture of compartment syndrome and bouts of fever. Fasciotomies were performed in the anterior and lateral compartments of the right leg. Computerised axial tomography (CAT) scans revealed the presence of abscesses in the right psoas muscle. Colonies of Salmonella paratyphi grew in the blood cultures, so a second CAT scan was performed with intravenous contrast to preclude an endovascular infection. A new image was seen that was compatible with pseudoaneurysm of the right iliac artery. An urgent surgical intervention was performed to carry out vascular repair and to drain the abscesses, which required the prior placement of a vena cava filter. While this was being placed, the patient suffered a cardiorespiratory arrest and later died. CONCLUSIONS. The post-mortem examination revealed a pinhole perforation in the apex and haemopericardium as the probable cause of death (AU)

Evaluación de estenosis carotídea en pacientes subsidiarios de revascularización miocárdica / The evaluation of carotid stenosis in patients who can benefit from myocardial revascularisation

Introducción. La estenosis carotídea (EC) crítica es frecuente en pacientes pendientes de revascularización miocárdica (RM), aumenta el riesgo de ictus durante la cirugía y su diagnóstico es importante, aunque el tratamiento sea controvertido cuando coexisten ambas patologías. Objetivos. Estudiar la lesión carotídea en pacientes pendientes de RM y los factores asociados. Determinar la morbimortalidad de la cirugía combinada carotídea y la RM frente a cirugías separadas. Pacientes y métodos. Estudio prospectivo, observacional y consecutivo durante 16 meses; se realiza dúplex carotídeo en 140 candidatos a RM, y consideramos la EC crítica: lesión carotídea ≥ 70%, con un 72,9% varones y una edad media de 69,8 años. Realizamos análisis estadístico con SPSS 10.1, chi al cuadrado y test exacto de Fisher: p £ 0,05 es significativamente estadística. Resultados. Prevalencia de lesión carotídea: 16,5% EC ≥ 50%, 10% EC ≥ 70%, pero sólo 7,1% quirúrgicas, ya que cuatro casos fueron oclusión carotídea. 42,6% angor inestable, 5% fracción de eyección del ventrículo izquierdo < 30%. Encontramos asociación significativa entre EC crítica en este tipo de pacientes con las siguientes variables: enfermedad cerebrovascular en el 37,5% de los casos (p = 0,009); lesión de tronco coronario izquierdo (TCI) ≥ 50% en el 22,2% (p = 0,002) y no padecer diabetes (p = 0,028). Practicamos cinco cirugías secuenciales: endarterectomía carotídea (EAC) seguida de RM cuatro cirugías combinadas y una RM emergente sin EAC. La morbimortalidad de la RM en pacientes con EC < 70% fue: 0,61% mortalidad, 0,69% morbilidad –seis infartos agudos de miocardio (IAM) y tres ictus–. En EC quirúrgicas hubo un exitus, un IAM. Conclusiones. Consideramos indicación primaria el estudio con dúplex carotídeo en estos pacientes; es especialmente importante cuando existe lesión del TCI significativa (≥ 50%) y enfermedad cerebrovascular. Proponemos cirugía combinada en pacientes cardiológicamente inestables y es recomendable en lesión del TCI ³ 50%, aunque sean necesarios ensayos clínicos que mejoren la indicación

Introduction. Critical carotid stenosis (CS) is frequent among patients who are waiting for myocardial revascularisation (MR), it increases the risk of stroke during the operation and it is important to diagnose it, although when the two pathologies coexist there is some controversy about treatment. Aims. To study carotid lesions in patients waiting for MR and the associated factors. We also intended to determine the morbidity and mortality rates of combined carotid and MR surgery versus separate procedures. Patients and methods. The study was prospective, observational and consecutive over a period of 16 months; carotid duplex was performed in 140 candidates for MR and the CS was considered to be critical: carotid lesion ≥ 70%, with 72.9% males and a mean age of 69.8 years. Statistical analyses were performed with SPSS 10.1, chi squared and Fisher’s exact test. p £ 0.05 is statistically significant. Results. Prevalence rate of carotid lesions: 16.5% CS ≥ 50%, 10% CS ≥ 70%, but only 7.1% surgical, since four were cases of carotid occlusion. 42.6% unstable angina, 5% severe left ventricle ejection fraction < 30%. We found a significant association between critical CS in this kind of patients and the following variables: cerebrovascular disease in 37.5% of cases (p = 0.009); left coronary artery trunk (LCT) lesion ≥ 50% in 22.2% (p = 0.002) and not suffering from diabetes (p = 0.028). Five sequential surgical procedures were performed: carotid endarterectomy (CE) followed by MR four combined interventions and one emerging MR without CE. MR morbidity and mortality rates in patients with CS < 70% were: 0.61% mortality, 0.69% morbidity –six acute myocardial infarctions (AMI) and three strokes– and with surgical CS there was one death and one AMI. Conclusions. We consider the use of carotid duplex as a primary indication in the study of these patients; it is especially important when there is significant injury to the LCT (≥ 50%) and cerebrovascular disease. We propose combined surgery in cardiologically unstable patients and it is recommendable in LCT lesion ³ 50%, although further clinical trials are needed to improve the indication

Tromboembolia pulmonar secundaria al procedimiento de ablación con radiofrecuencia / Pulmonary thromboembolism associated with radiofrequency catheter ablation

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