Long-term clinical impact of permanent cardiac pacing after transcatheter aortic valve implantation with the CoreValve prosthesis: a single center experience.

Aims: To determine the impact of permanent cardiac pacing after transcatheter aortic valve implantation (TAVI) with the CoreValveTM prosthesis in terms of all-cause mortality and morbidity [rehospitalizations for heart failure (HF) or stroke] at the long-term follow-up. Methods and results: The prospective analysis comprised 259 patients (138 women, 53.3%, age 78 ± 6 years) treated by a CoreValveTM prosthesis from April 2008 to December 2015. Forty-two patients were excluded for analysis: 9 with pre-existing permanent pacemaker (PPM) implantation, 19 who required a PPM during the follow-up and 14 patients because of hospital mortality during or after the CoreValveTM prosthesis implantation procedure. The remaining 217 patients were divided in two groups: Group-1 included those patients who required a PPM immediately after TAVI, and Group-2 included those patients who did not require permanent cardiac pacing at the long-term follow-up. Patients received follow-up at 1-month, 6-months, 12-months, and yearly thereafter. A total of 39 patients required a PPM immediately after TAVI (15.0%), but 178 patients (68.7%) did not. The mean follow-up was 37 ± 27 months (range 3-99 months) in both groups. There was no difference between the two groups in terms of all-cause mortality (52.6% vs. 56.8%, P = 0.125; HR 1.22 [0.87-1.77, 95% CI]), or stroke (13.3% vs. 15.1% P = 0.842; HR 1.12 [0.37-3.32, 95% CI]). However, patients who underwent PPM implantation developed an increase in readmissions for HF (21.1% vs. 31.9%, P = 0.015; HR 1.82 [1.23-3.92, 95% CI]). Conclusion: Patients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up.

Hellgrammite as a Non-Conventional Biomonitor for Surface Water and Environmental Health Assessment.

The larvae of dobsonflies from the genus Corydalus, commonly known as Hellgrammites, are characterized by their notable size, extensive range of occurrence, and extended period of immaturity, which can last up to one year. Hellgrammites are clearly known to exhibit sensitivity to pollution and habitat structure impacts. Given these unique features, using Corydalus texanus larvae is highly suitable as reliable biomonitoring agents to assess the ecological integrity of aquatic ecosystems. This protocol aims to provide the necessary tools for C. texanus assessment and demonstrate their efficacy through a case study. Research findings have practical implications, indicating that C. texanus larvae exhibit early-warning responses to mining pollution, bioaccumulating high amounts of heavy metals such as Zn, Fe, and Al. The presence or absence of C. texanus populations may serve as a helpful indicator for identifying potential issues related to ecosystem health. The unconventional approach has shown early warnings of pollution in mining-impacted sites, highlighting the need for timely action to protect the environment. Given their unique traits, the use of C. texanus larvae is highly suggested as a reliable non-conventional bioindicator.

[Intrarticular infiltration of bupivacaine and magnesium sulfate in distal radius fractures. A pilot study]. / Infiltración intraarticular con sulfato de magnesio y bupivacaína en fracturas de radio distal. Estudio piloto.

BACKGROUND: The distal radius fracture represent until 15% of all bone injuries in adults. The key in the recovery of mobility and functional outcomes are rehabilitation. The intra-articular application of magnesium sulphate has been used for postoperative pain. The objective was to determinate the improvement in pain and functional outcome of patients with distal radius fracture using intra-articular magnesium sulphate. MATERIAL AND METHODS: Patients with distal radius fracture treated with percutaneous pinning and cast immobilization was included and randomized into two groups. The group 1 was applied 1.0 ml of magnesium sulphate and 1.5 ml of injectable water; meanwhile the group 2, the water was replaced with 1 ml of bupivacaine (5 mg/ml). The intra-articular infiltration was applied at the end of immobilization. Pain, functionality and movement of the wrist was evaluated for two weeks. RESULTS: Twenty patients, 8 male and twelve females, with a mean age of 53 years (± 17 SD) was evaluated. A significative reduction of pain during the first minute and at three minutes after intra-articular infiltration in group 2 (p 0.05). Both groups presented better articular outcomes at the two weeks (p 0.05), and a better articular movement at same point (p 0.05). CONCLUSIONS: The intra-articular infiltration of magnesium sulphate plus bupivacaine help to reduces the pain.

ANTECEDENTES: Las fracturas de radio distal constituyen hasta 15% de todas las lesiones óseas en los adultos. La rehabilitación es clave en la recuperación de la movilidad y la capacidad funcional. El sulfato de magnesio intraarticular ha sido utilizado para control postoperatorio del dolor; el objetivo fue determinar la mejoría del dolor y la capacidad funcional de los pacientes con fractura de radio distal usando sulfato de magnesio intraarticular. MATERIAL Y MÉTODOS: Pacientes con fractura de radio distal tratados con clavos percutáneos e inmovilización fueron incluidos al azar en dos grupos. Grupo 1 infiltrado con 1.0 ml de sulfato de magnesio y 1.5 ml de agua estéril; en el grupo 2 esta última fue sustituida por 1 ml de bupivacaína (5 mg/ml). La infiltración se realizó al retiro de la inmovilización. El dolor, funcionalidad y rangos de movimiento fueron evaluados. RESULTADOS: 20 pacientes, ocho masculinos y 12 femeninos con edad promedio de 53 años (± 17 DE) fueron evaluados. Se encontró disminución significativa en el dolor al primer minuto y a los tres minutos después de la infiltración en el grupo 2 (p 0.05). Ambos grupos presentaron una mejoría significativa en la funcionalidad articular a las dos semanas (p 0.05), así como una mejoría gradual en la movilidad articular en ese mismo período (p 0.05). CONCLUSIONES: La infiltración de sulfato de magnesio en combinación con bupivacaína ayuda a disminuir el dolor.

Photosynthetic acclimation to photon irradiance and its relation to chlorophyll fluorescence and carbon assimilation in the halotolerant green alga Dunaliella viridis.

This work describes the long-term acclimation of the halotolerant microalga Dunaliella viridis to different photon irradiance, ranging from darkness to 1500 mumol m(-2) s(-1). In order to assess the effects of long-term photoinhibition, changes in oxygen production rate, pigment composition, xanthophyll cycle and in vivo chlorophyll fluorescence using the saturating pulse method were measured. Growth rate was maximal at intermediate irradiance (250 and 700 mumol m(-2) s(-1)). The increase in growth irradiance from 700 to 1500 mumol m(-2) s(-1) did not lead to further significant changes in pigment composition or EPS, indicating saturation in the pigment response to high light. Changes in Photosystem II optimum quantum yield (F(v)/F(m)) evidenced photoinhibition at 700 and especially at 1500 mumol m(-2) s(-1). The relation between photosynthetic electron flow rate and photosyntetic O(2) evolution was linear for cultures in darkness shifting to curvilinear as growth irradiance increased, suggesting the interference of the energy dissipation processes in oxygen evolution. Carbon assimilation efficiencies were studied in relation to changes in growth rate, internal carbon and nitrogen composition, and organic carbon released to the external medium. All illuminated cultures showed a high capability to maintain a C:N ratio between 6 and 7. The percentage of organic carbon released to the external medium increased to its maximum under high irradiance (1500 mumol m(-2) s(-1)). These results suggest that the release of organic carbon could act as a secondary dissipation process when the xanthophyll cycle is saturated.

Primary lung cancer in Mexico city: a report of 1019 cases.

A retrospective study was performed in patients diagnosed with primary lung cancer, and admitted to the Instituto Nacional de Enfermedades Respiratorias between 1984 to 1992. One thousand and nineteen patients were studied, 636 males and 383 females. We found a higher incidence in the group among 61-70 years of age in both sexes. The highest percentage of tumors were from the adenocarcinoma variety, followed by the epidermoid carcinoma, while the small-cell carcinoma presented a lower incidence. Smoking has been associated with the development of lung cancer. Many of our patients were smokers. The highest frequency was in smokers with a smoking habit of more than 30 years and a rate of more than 10 cigarettes per day. However, an important part of the patients with cancer did not have a smoking habit, which led us to believe that there are other etiological possibility factors (genetic or environmental) that could be involved. Most of the cases of cancer were staged as stage IIIb and stage IV and the patients had an ECOG of 1-2. The main symptoms were coughing, sputum, dyspnea and thoracic pain. This data shows an increasing frequency of lung cancer in Mexico city as well as other countries, it also shows that it is going to be a serious health problem in the future. We consider that in order to improve the prognosis, it is necessary to increase the educational and orientation campaigns among the adult population with or without a smoking history.

[Severe hand injury due to a high-energy gunshot projectile treated with arthrodesis of the carpus, synthetic bone graft and external fixators. Case report]. / Lesión severa de mano por proyectil de arma de fuego de alta energía con artrodesis del carpo e injerto sintético de hueso más fijadores externos. Reporte de un caso.

BACKGROUND: The incidence of hand gunshot wounds in civil patients has increased in recent years; it causes long-term or permanent disability and has a personal, social and economic impact. Severe hand injuries include: involvement of the greater palmar arch, fracture of two or more carpal bones, irreducible palmar dislocations, articular fractures of the distal radius, and neurovascular injuries. All of these injuries require multiple surgical procedures for the management of soft and musculoskeletal tissues. METHODS: We report the case of a patient with a Gustilo and Anderson grade IIIB open fracture of the right carpal bones caused by a gunshot projectile. He was treated with arthrodesis of the carpus using a synthetic graft, external fixation and rotation of a fasciocutaneous flap. RESULTS: The patient underwent surgical treatment of the carpal injury that consisted of Gustilo and Anderson grade IIIB open fracture of all carpal bones caused by a gunshot projectile. Surgery included arthrodesis of the carpus with a synthetic graft, stabilization with an external fixator, and a fasciocutaneous graft as skin cover. The clinical course according to the DASH scale had a score of 14.2 and the Michigan Hand score was 70, with a 12-month follow-up. CONCLUSIONS: Treatment with external fixation plus arthrodesis of the carpus with a synthetic graft and skin cover using a flap provided a good functional result in a patient who sustained a gunshot wound.

[Experience with the negative pressure closure system of chronic wounds in pediatric patients]. / Experiencia con el sistema de cierre de presión negativa en heridas crónicas en pacientes pediátricos: experiencia de 8 casos.

OBJECTIVE: To show the results and advantages of using the negative pressure closure system in a pediatric population with infections and wound closure defects. MATERIAL AND METHODS: A retrospective analysis was conducted on pediatric patients in whom the VAC(®) negative pressure wound closure system was used in the Shriners Hospital for Children, Mexico, from January 2008 to December 2012. We were able to include 8 patients treated with this system. We evaluated the cause for use, wound colonizing microorganism, number of days of stay at the hospital, number of times applied, interval of application, and number of days in the hospital until discharge after VAC(®) application, and final treatment. RESULTS: The average days after VAC aplication till discharge was 13.7 days. The final treatment in 7 of the 8 patients was direct closure or application of skin grafts for closure of the wounds. DISCUSSION: Through this study we were able to observe that, after the application of this treatment, there was an increase in the granulation tissue at the wounds, as well as resolution of the infection. CONCLUSIONS: We were able to confirm the efficiency of this treatment in controlling the infection and decreasing skin defects, allowing an easier and earlier wound closure.

Infiltración intraarticular con sulfato de magnesio y bupivacaína en fracturas de radio distal. Estudio piloto / Intrarticular infiltration of bupivacaine and magnesium sulfate in distal radius fractures. A pilot study

Resumen: Antecedentes: Las fracturas de radio distal constituyen hasta 15% de todas las lesiones óseas en los adultos. La rehabilitación es clave en la recuperación de la movilidad y la capacidad funcional. El sulfato de magnesio intraarticular ha sido utilizado para control postoperatorio del dolor; el objetivo fue determinar la mejoría del dolor y la capacidad funcional de los pacientes con fractura de radio distal usando sulfato de magnesio intraarticular. Material y métodos: Pacientes con fractura de radio distal tratados con clavos percutáneos e inmovilización fueron incluidos al azar en dos grupos. Grupo 1 infiltrado con 1.0 ml de sulfato de magnesio y 1.5 ml de agua estéril; en el grupo 2 esta última fue sustituida por 1 ml de bupivacaína (5 mg/ml). La infiltración se realizó al retiro de la inmovilización. El dolor, funcionalidad y rangos de movimiento fueron evaluados. Resultados: 20 pacientes, ocho masculinos y 12 femeninos con edad promedio de 53 años (± 17 DE) fueron evaluados. Se encontró disminución significativa en el dolor al primer minuto y a los tres minutos después de la infiltración en el grupo 2 (p < 0.05). Ambos grupos presentaron una mejoría significativa en la funcionalidad articular a las dos semanas (p < 0.05), así como una mejoría gradual en la movilidad articular en ese mismo período (p < 0.05). Conclusiones: La infiltración de sulfato de magnesio en combinación con bupivacaína ayuda a disminuir el dolor.

Abstract: Background: The distal radius fracture represent until 15% of all bone injuries in adults. The key in the recovery of mobility and functional outcomes are rehabilitation. The intra-articular application of magnesium sulphate has been used for postoperative pain. The objective was to determinate the improvement in pain and functional outcome of patients with distal radius fracture using intra-articular magnesium sulphate. Material and methods: Patients with distal radius fracture treated with percutaneous pinning and cast immobilization was included and randomized into two groups. The group 1 was applied 1.0 ml of magnesium sulphate and 1.5 ml of injectable water; meanwhile the group 2, the water was replaced with 1 ml of bupivacaine (5 mg/ml). The intra-articular infiltration was applied at the end of immobilization. Pain, functionality and movement of the wrist was evaluated for two weeks. Results: Twenty patients, 8 male and twelve females, with a mean age of 53 years (± 17 SD) was evaluated. A significative reduction of pain during the first minute and at three minutes after intra-articular infiltration in group 2 (p < 0.05). Both groups presented better articular outcomes at the two weeks (p < 0.05), and a better articular movement at same point (p < 0.05). Conclusions: The intra-articular infiltration of magnesium sulphate plus bupivacaine help to reduces the pain.

Lesión severa de mano por proyectil de arma de fuego de alta energía con artrodesis del carpo e injerto sintético de hueso más fijadores externos: Reporte de un caso / Severe hand injury due to a high-energy gunshot projectile treated with arthrodesis of the carpus, synthetic bone graft and external fixators.: Case report

Antecedentes: La incidencia de heridas por proyectil de arma de fuego en mano de pacientes civiles se ha incrementado en los últimos años, lo cual es causa de incapacidades prolongadas o definitivas con un impacto personal, social y económico. Las lesiones severas de mano incluyen: afección del arco palmar mayor, fractura de dos o más huesos del carpo, luxaciones palmares irreductibles, fracturas articulares de radio distal y lesiones neurovasculares, los cuales requieren de múltiples procedimientos quirúrgicos para el manejo de tejidos blandos y musculoesqueléticos. Métodos: Se describe el reporte de un paciente con fractura de los huesos del carpo derecho, expuestos grados IIIB de Gustillo y Anderson por proyectil de arma de fuego, el cual fue tratado con artrodesis del carpo mediante injerto sintético, fijación externa y rotación de colgajo fasciocutáneo. Resultados: Paciente que fue sometido a tratamiento quirúrgico de la lesión del carpo consistente en fractura de todos los huesos del carpo, expuestos grados IIIB de Gustillo y Anderson por proyectil de arma de fuego quien fue sometido a tratamiento quirúrgico mediante artrodesis del carpo con injerto sintético, estabilización con fijador externo y cobertura con colgajo fasciocutáneo, obteniendo una evolución clínica mediante la escala de DASH con un score de 14.2 y Michigan Hand score de 70 puntos con un seguimiento de 12 meses. Conclusiones: El tratamiento con fijación externa más artrodesis del carpo con injerto sintético y cobertura cutánea con colgajo proporcionó un resultado funcional bueno para un paciente con lesión por proyectil de arma de fuego.

Background: The incidence of hand gunshot wounds in civil patients has increased in recent years; it causes long-term or permanent disability and has a personal, social and economic impact. Severe hand injuries include: involvement of the greater palmar arch, fracture of two or more carpal bones, irreducible palmar dislocations, articular fractures of the distal radius, and neurovascular injuries. All of these injuries require multiple surgical procedures for the management of soft and musculoskeletal tissues. Methods: We report the case of a patient with a Gustilo and Anderson grade IIIB open fracture of the right carpal bones caused by a gunshot projectile. He was treated with arthrodesis of the carpus using a synthetic graft, external fixation and rotation of a fasciocutaneous flap. Results: The patient underwent surgical treatment of the carpal injury that consisted of Gustilo and Anderson grade IIIB open fracture of all carpal bones caused by a gunshot projectile. Surgery included arthrodesis of the carpus with a synthetic graft, stabilization with an external fixator, and a fasciocutaneous graft as skin cover. The clinical course according to the DASH scale had a score of 14.2 and the Michigan Hand score was 70, with a 12-month follow-up. Conclusions: Treatment with external fixation plus arthrodesis of the carpus with a synthetic graft and skin cover using a flap provided a good functional result in a patient who sustained a gunshot wound.

Short report: Asthma admissions and weather conditions in Costa Rica.

In Costa Rica there is little information about asthma admissions. In this report the monthly asthma admissions and weather data for a seven year period were reviewed. The hospital asthma admissions showed notable seasonal variation associated with variations in the rainfall and the relative humidity.

Toxina Botulínica en el tratamiento de las fisuras anales / Botulinum toxin in the treatment of anal fissures

La fisura anal es un desgarro del anodermo que puede afectar a todas las edades. Las fisuras crónicas son aquellas de másde 6 semanas o con signos morfológicos de cronicidad, que usualmente se encuentran en la línea media posterior. La esfinterotomía lateral interna, se considera el "estándar de oro", pero hasta un 35% de los pacientes a los que se les realiza este procedimiento, experimentan algún tipo incontinencia fecal permanente. La inyección de toxina botulínica ha comprobado ser segura tanto en niños como en adultos. Los índices de curación reportados han variado del 41% al 96%, su tasa de incontinencia temporal se ha reportado hasta en un 18% y ningún estudio ha notificado de la presencia de incontinencia permanente. La inyección de toxina botulínica es un procedimiento ambulatorio que no requiere anestesia y debe ser considerada como una opción terapéutica segura y muy efectiva para el tratamiento de la fisura anal

The anal fissure is an anoderm tear, which can affect all ages. Chronic fissures are those of more than 6 weeks or morphological signs of chronicity, usually found in the posterior midline. Sphincterotomy is considered the gold standard, but up to 35% of patients who undergo this procedure experience some permanent fecal incontinence. Injection of botulinum toxin has proven to be safe in children and adults. Reported cure rates have varied from 41% to 96%, the rate of temporary incontinence has been reported in up to 18% and no studies have reported the presence of permanent incontinence. Botulinum toxin injection is an outpatient procedure that requires no anesthesia and should be considered a safe therapeutic option and very effective for the treatment of anal fissure

A look inside the San Andreas Fault at Parkfield through vertical seismic profiling.

The San Andreas Fault Observatory at Depth pilot hole is located on the southwestern side of the Parkfield San Andreas fault. This observatory includes a vertical seismic profiling (VSP) array. VSP seismograms from nearby microearthquakes contain signals between the P and S waves. These signals may be P and S waves scattered by the local geologic structure. The collected scattering points form planar surfaces that we interpret as the San Andreas fault and four other secondary faults. The scattering process includes conversions between P and S waves, the strengths of which suggest large contrasts in material properties, possibly indicating the presence of cracks or fluids.

[Allergic fungal sinusitis: recent developments]. / Sinusitis alérgica micótica: conceptos actuales.

Allergic fungal sinusitis is a recently reported disease of the nose and paranasal sinuses. Since the first reports by Lamb et al and Katzenstein there has been controversy about its diagnosis and treatment. Recently diagnostic criteria have been suggested. To our judgement they have a high degree of specificity. Allergy to fungi elements is essential. Currently surgical treatment consist in an adequate ventilation of the nose and paranasal sinuses followed by the use of oral and topical steroids. Immunotherapy is controversial and more prospective studies are needed to evaluate its possible use.

Experiencia con el sistema de cierre de presión negativa en heridas crónicas en pacientes pediátricos: experiencia de 8 casos / Experience with the negative pressure closure system of chronic wounds in pediatric patients

Objetivo. Se exponen los resultados y ventajas del uso del sistema de presión negativa (VAC®) en los pacientes pediátricos con defectos cutáneos y/o infecciosos. Material y métodos. Análisis retrospectivo de los pacientes sometidos al uso del VAC® en el Hospital Shriners para Niños México, desde enero de 2008 a diciembre de 2012. Se incluyeron 8 pacientes tratados con el VAC®. Se evaluó el motivo de colocación, microorganismo colonizante de la herida, número de días de estancia, número de ocasiones aplicadas, intervalo de aplicación, número de días al alta posterior a la aplicación, y el tratamiento final. Resultados. Se observó que el promedio de días desde la colocación al alta fue de 13,7. El tratamiento final en 7 de los 8 pacientes fue cierre directo de la herida o aplicación de injerto cutáneo. Discusión. Mediante este estudio se pudo observar que después de la aplicación de este tratamiento hay una mejoría importante en la capacidad de granulación de las heridas, así como erradicación de las infecciones. Conclusiones. Se ha podido constatar la eficacia de este tratamiento en el control de la infección, y la disminución de los defectos cutáneos haciendo más sencillo y rápido el cierre de las heridas(AU)

Objective. To show the results and advantages of using the negative pressure closure system in a pediatric population with infections and wound closure defects. Material and methods. A retrospective analysis was conducted on pediatric patients in whom the VAC® negative pressure wound closure system was used in the Shriners Hospital for Children, Mexico, from January 2008 to December 2012. We were able to include 8 patients treated with this system. We evaluated the cause for use, wound colonizing microorganism, number of days of stay at the hospital, number of times applied, interval of application, and number of days in the hospital until discharge after VAC® application, and final treatment. Results. The average days after VAC aplication till discharge was 13.7 days. The final treatment in 7 of the 8 patients was direct closure or application of skin grafts for closure of the wounds. Discussion. Through this study we were able to observe that, after the application of this treatment, there was an increase in the granulation tissue at the wounds, as well as resolution of the infection. Conclusions. We were able to confirm the efficiency of this treatment in controlling the infection and decreasing skin defects, allowing an easier and earlier wound closure(AU)