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Background: Congenital heart disease (CHD) survival rate has improved dramatically due to advances in diagnostic and therapeutic techniques. However, concerning the unrepaired CHD population of moderate and severe complexity, the data regarding risk predictors and surgical outcomes are scarce. Our aim was to describe the surgical results and predictors of in-hospital outcomes in adult patients with moderate-to-severe complexity CHD that were not repaired in childhood. Methods: We conducted a retrospective cohort study that included 49 adult patients with moderate-to-complex CHD who were treated in a single medical centre. Clinical and echocardiographic variables were obtained on admission, after surgical procedures and during follow-up. Results: Most of the patients were female (66%). Left ventricular ejection fraction and right ventricular outflow tract fractional shortening were within the normal range. The median pulmonary artery systolic pressure was 37 (27-55) mm Hg. The median time was 118 (80-181) minutes for extracorporeal circulation and 76 (49-121) minutes for aortic cross-clamping. The most frequent complication was postoperative complete atrioventricular block (12.2%). In-hospital survival rate was 87.7%. The development of low cardiac output syndrome with predominant right ventricle failure in the postoperative period was the most important predictor of in-hospital death (P = 0.03). Conclusions: Deciding to treat adults with CHD is challenging in moderate and severe unrepaired cases. Adequate clinical, functional, and imaging evaluation is essential to determine each patient's suitability for surgical management and to achieve the best clinical outcome for this population.
Contexte: Grâce aux avancées réalisées en matière de techniques diagnostiques et thérapeutiques, la survie des patients atteints d'une cardiopathie congénitale s'est considérablement améliorée. Cependant, en ce qui concerne les personnes atteintes d'une cardiopathie congénitale non corrigée présentant une complexité modérée ou extrême, les données portant sur les facteurs de risque prédictifs ainsi que sur les résultats chirurgicaux sont rares. Notre objectif était de décrire les résultats chirurgicaux ainsi que les facteurs prédictifs des résultats obtenus en milieu hospitalier chez les patients adultes atteints d'une cardiopathie congénitale présentant une complexité modérée ou extrême qui n'a pas été corrigée pendant l'enfance. Méthodologie: Nous avons mené une étude de cohorte rétrospective comprenant 49 patients adultes atteints d'une cardiopathie congénitale modérée ou complexe qui ont reçu leurs traitements dans un seul centre médical. Les variables cliniques et échocardiographiques ont été obtenues au moment de l'admission, après les interventions chirurgicales et pendant la période de suivi. Résultats: Les patients étaient en majorité des femmes (66 %). La fraction d'éjection du ventricule gauche ainsi que la fraction de raccourcissement de la voie d'éjection ventriculaire droite sont demeurées dans les limites de la normale. La pression systolique médiane de l'artère pulmonaire a été de 37 mmHg (27-55 mmHg). Le temps médian écoulé pour la circulation extracorporelle a été de 118 minutes (80-181 minutes) et pour le clampage de la crosse aortique, de 76 minutes (49-121 minutes). Le bloc auriculo-ventriculaire postopératoire complet a été la complication la plus fréquente (12,2 %). Le taux de survie en milieu hospitalier a été de 87,7 %. Le développement du syndrome du faible débit cardiaque accompagné d'une insuffisance prédominante du ventricule droit durant la période postopératoire a constitué le principal facteur prédictif de décès à l'hôpital (p = 0,03). Conclusion: Il est difficile de traiter les adultes qui présentent une cardiopathie congénitale modérée ou sévère non corrigée. Il est essentiel que les évaluations cliniques, fonctionnelles et par imagerie soient réalisées de façon adéquate pour déterminer si une prise en charge chirurgicale convient aux patients et pour garantir les meilleurs résultats cliniques chez ces derniers.
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Background: In recent decades, adults living with congenital heart disease (ACHD) have improved their survival, thus increasing their predisposition to the onset of cardiometabolic risk factors and chronic health conditions. Objectives: The purpose of this study was to describe cardiometabolic risk profiles in the ACHD population and their relationship to congenital heart disease (CHD) lesion complexity. Methods: We performed a cross-sectional study from ACHD in a third-tier referral center in Mexico City. The association between cardiometabolic risk factors and CHD complexity was estimated using logistic regression models. Results: Our study cohort included 1,171 ACHD patients (median age: 31 [IQR: 23.2-42.7] years, male 63.6%). Cardiac diagnosis was classified as mild (44.9%), moderate (37.8%), and severe (17.2%) CHD complexity. Low high-density lipoprotein cholesterol (55%) was the most common cardiometabolic risk factor; followed by insulin resistance (54.5%) and prediabetes (52.4%). Patients with mild and moderate CHD had a higher prevalence of obesity and metabolic syndrome, while patients with severe CHD had a higher prevalence of hyperuricemia and subclinical hypothyroidism. In the logistic regression analysis, the severity of CHD was associated with higher odds of hyperuricemia (moderate CHD, OR: 1.87; 95% CI: 1.20-2.93; P = 0.010; severe CHD, OR: 2.75; 95% CI: 1.64-4.62; P < 0.001) and lower risks of metabolic syndrome (OR: 0.61; 95% CI: 0.41-0.91; P = 0.010), prediabetes (OR: 0.58; 95% CI: 0.42-0.81; P < 0.001), and arterial hypertension (OR: 0.49; 95% CI: 0.33-0.74; P < 0.001) compared with mild CHD complexity. Conclusions: We observed high rates of cardiometabolic risk factors in Mexican ACHD patients and these risk profiles varied by CHD lesion complexity. These results highlight the need for ongoing metabolic health surveillance in the ACHD population.
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INTRODUCTION: Introduction: breast milk (MH) contains nutrients and bioactive compounds for child development, including probiotic bacteria, which contribute to intestinal maturation. This benefit accompanies the individual until adulthood. There are new methods such as spray drying that give this compound a good conservation without loss of microbiota. Objective: the aim of this study was to analyze the viability of lactic acid bacteria isolated from human milk with probiotic potential after the spray drying process, as well as to evaluate the possible adhesion in the colon of mice of the Balb/C strain after feeding them powdered human milk and a commercial formula milk. Method: we isolated and identified the presence of lactic acid bacteria with possible probiotic potential in powdered human milk using the MALDI-TOF MS technique. Powdered human milk and a commercial formula milk were fed to mice of the Bald/C strain for 14 weeks. Glucose level and weight were measured in the mice. The feces were collected to verify the presence of lactic bacteria. The mice were sacrificed and their intestines were weighed, isolating the lactic acid bacteria both from the intestines and from the feces. The strains isolated from mice fed human milk were evaluated for their probiotic potential, analyzing their ability to inhibit pathogens, resistance to pH, temperature, adhesion, and hydrophobicity. Results: the presence of Lactobacillus fermentum LH01, Lactobacillus rhamnosus LH02, Lactobacullis reuteri LH03, and Lactobacillus plantarum LH05 in powdered human milk was identified. All strains showed a possible probiotic profile due to the ability of bacteria to resist low pH, bile salts, and exposure to gastric enzymes, as well as their hydrophobicity and self-aggregation capacity, and their failure to show hemagglutination or hemolysis activity in a culture medium rich in erythrocytes. We observed that the consumption of powdered human milk prevented weight gain and constipation in mice. Conclusions: after spray drying, strains with possible probiotic potential may be preserved in human milk. The consumption of powdered human milk with probiotic bacteria prevents constipation and weight gain in mice, when compared to those fed a commercial formula milk.
INTRODUCCIÓN: Introducción: la leche materna (HM) contiene los nutrientes y compuestos bioactivos necesarios para el desarrollo infantil, incluidas bacterias probióticas, que contribuyen a la maduración intestinal. Objetivo: el objetivo de este estudio fue analizar la viabilidad de las bacterias acidolácticas aisladas de la leche humana con potencial probiótico, después del proceso de secado, así como evaluar su posible adhesión en el colón de ratones (BAlb/C) alimentados con leche humana en polvo y leche de una fórmula comercial. Método: se aislaron e identificaron mediante la técnica de Maldi-Tof-MS las bacterias acidolácticas con posible potencial probiótico en la leche humana en polvo. Se alimentó con leche humana en polvo y leche de una fórmula comercial a ratones de la cepa Bald/C durante 14 semanas. Se midieron el nivel de glucosa y el peso. Las heces se recolectaron para verificar la presencia de bacterias lácticas. Los ratones se sacrificaron y se pesaron los intestinos, aislando las bacterias lácticas tanto de los intestinos como de las heces. En las cepas aisladas de la leche humana se evaluó el potencial probiótico analizando su capacidad para inhibir patógenos, resistir distintos pH y temperaturas, adherirse y mostrar hidrofobicidad. Resultados: se identificó la presencia de Lactobacillus fermentum LH01, Lactobacillus rhamnosus LH02, Lactobacullis reuteri LH03 y L. plantarum LH05 en la leche humana en polvo. Todas las cepas mostraron resistencia a los pH bajos, a las sales biliares y a la exposición a enzimas gástricas, así como una buena hidrofobicidad y capacidad de autoagregación. Además, no presentaron actividad de hemaglutinación o hemólisis en un medio de cultivo rico en eritrocitos. Observamos que el consumo de leche humana en polvo evita en los ratones el aumento de peso y el estreñimiento. Conclusiones: después del secado por aspersión, las cepas con posible potencial probiótico pueden conservarse en la leche materna. El consumo de leche humana en polvo con bacterias probióticas evita el estreñimiento y el aumento de peso en los ratones, en comparación con los alimentados con leche de una formula comercial.
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Lactobacillales/fisiologia , Leite Humano/microbiologia , Probióticos , Secagem por Atomização , Animais , Fenômenos Fisiológicos Bacterianos , Glicemia/análise , Peso Corporal , Fezes/microbiologia , Humanos , Intestinos/microbiologia , Lactobacillales/isolamento & purificação , Limosilactobacillus fermentum/isolamento & purificação , Limosilactobacillus fermentum/fisiologia , Lactobacillus plantarum/isolamento & purificação , Lactobacillus plantarum/fisiologia , Limosilactobacillus reuteri/isolamento & purificação , Limosilactobacillus reuteri/fisiologia , Lacticaseibacillus rhamnosus/isolamento & purificação , Lacticaseibacillus rhamnosus/fisiologia , Masculino , México , Camundongos , Camundongos Endogâmicos BALB C , PósRESUMO
INTRODUCTION: Introduction: breast milk is the first fundamental food of newborns and it provides all the sources of energy, nutrients and the immunological protection they need during their first months of life. Unfortunately, there are specific circumstances that imply that the mother cannot feed her baby correctly, since the mother's nutritional needs differ to a certain extent during different periods of life. Especially in breastfeeding, since nutritional needs are increased, due to the loss of nutrients, first by colostrum and then by breast milk. Objective: to demonstrate the influence of the diet of Mexican women on the nutritional quality and the presence of beneficial microorganisms in human milk. Methods: seventy descriptive surveys of nutrition and sampling of milk to women in nursing state were carried out. The milks were subjected to various bromatological and microbiological analyzes to evaluate their nutritional quality and possible probiotic activity. Results: it was shown that the mother's food intake influences the nutritional quality of the milk. Likewise, it affects the development and growth of lactic acid bacteria. Several strains were isolated and identified in human milk of the genus Lactobacillus, as well as pathogenic bacteria such as Lodderomyces elongisporus among others. Conclusions: the mothers' nutrition is directly reflected in the nutritional quality of the milk. It was observed that the amount of essential nutrients of milk such as carbohydrates, lipids and proteins vary according to the diet and life rhythm of the mothers, as well as the significant decrease of lactic bacteria with probiotic potential.
INTRODUCCIÓN: Introducción: la leche materna es el primer alimento fundamental de los neonatos y proporciona todas las fuentes de energía, nutrientes y protección inmunológica que necesitan durante sus primeros meses de vida. Lamentablemente, existen circunstancias específicas que implican que la madre no pueda alimentar correctamente a su bebé, ya que las necesidades nutricionales de la madre difieren en cierta medida durante los diversos periodos de la vida, especialmente en la lactancia, ya que se aumentan las necesidades nutricionales debido a la pérdida de nutrientes, primero por el calostro y luego a través de la leche materna. Objetivo: demostrar la influencia de la dieta de mujeres mexicanas sobre la calidad nutricional y la presencia de microorganismos benéficos en la leche humana. Métodos: se llevaron a cabo 70 encuestas descriptivas de nutrición y toma de muestras de leche a mujeres en estado lactante. Las leches fueron sometidas a diversos análisis bromatológicos y microbiológicos para evaluar su calidad nutricional y posible actividad probiótica. Resultados: se demostró que la ingesta de alimentos de la madre influye en la calidad nutricional de la leche. Asimismo, afecta el desarrollo y crecimiento de las bacterias lácticas. Se aislaron e identificaron diversas cepas en leche humana del género Lactobacillus, además de bacterias patógenas como el caso de Lodderomyces elongisporus, entre otros. Conclusiones: la alimentación de las madres se refleja directamente en la calidad nutricional de la leche. Se observó que la cantidad de nutrientes esenciales de la leche, como son los hidratos de carbono, lípidos y proteínas, varían conforme a la alimentación y el ritmo de vida de las madres, así como la disminución significativa de bacterias lácticas con potencial probiótico.
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Dieta , Leite Humano/microbiologia , Valor Nutritivo , Adolescente , Adulto , Feminino , Humanos , México , Adulto JovemRESUMO
Resumen Introducción: Durante muchos años el ácido úrico se ha considerado como un producto metabólico inerte del metabolismo de las purinas, sin embargo, ha sido recientemente asociado a una serie de estados de enfermedad crónica. No hay hallazgos concluyentes disponibles en la actualidad para tomar una conducta activa clara respecto al tratamiento de ácido úrico sérico, y cuál sería su objetivo terapéutico. Material y métodos: Debido a esta controversia, se decidió llevar a cabo una encuesta para evaluar cuáles son las decisiones que se toman en este contexto, en el ámbito médico de la Argentina. Se consultó en qué pacientes se evaluaba en forma rutinaria el ácido úrico sérico, resultando en un 53.2% de todos los pacientes, sin diferenciar patologías, y un 11.5% refirió que no lo realiza rutinariamente. Con respecto al tratamiento sólo refirieron tratarlo con enfermedad renal un 62.5%; con diabetes 61.7%; con síndrome metabólico 60.4%; con enfermedad cardiovascular un 50.3%; con gota, cálculos renales o dolor articular, un 91.3%, 74% y 36.1% respectivamente. Resultados: Los datos de la encuesta confirman la falta de evidencia en el criterio para la selección de pacientes, a los fines de evaluar los niveles de ácido úrico sérico y su tratamiento. Conclusiones: De esta forma, se concluye que prima la necesidad de realizar estudios prospectivos y randomizados de las patologías con alta incidencia de uricemia elevada, para poder determinar normativas que orienten una conducta a los especialistas según los resultados obtenidos, y que dicha decisión no esté basada solo en la opinión de los expertos.
Abstract Introduction: For many years, uric acid was considered to be an inert product of purine metabolism; however, it has recently been associated with a number of chronic diseases. Nowadays, there are no conclusive findings available regarding a clear action plan to treat serum uric acid or which specific therapeutic goals it would have. Methods: Given this controversy, a survey was conducted in order to evaluate which decisions are taken regarding this situation within the Argentinian medical community. The question was in which cases serum uric acid was routinely assessed and the result was 53.2% no matter the pathology; 11,5% of physicians did not assess it routinely. Regarding its treatment, 62.5% of them reported to have treated it as part of kidney disease; 61.7 % as part of diabetes; 60.4% as part of metabolic syndrome; 50.3% as part of cardiovascular disease; 91.3 % as part of gout; 74% as part of renal stones, and 36.1% as part of joint pain. Results: The data collected by means of the survey show a lack of evidence for establishing the patient selection criteria when evaluating levels of serum uric acid and its treatment. Conclusions: Therefore, it is concluded that it is necessary to conduct prospective and randomized studies of conditions with a high incidence of elevated uricemia in order to develop guidelines for specialists according to results; this decision should not be based on experts' opinion alone.
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Resumen ANTECEDENTES: El embarazo ectópico abdominal es una alteración poco frecuente, pero con alta tasa de morbilidad y mortalidad materno-fetal-neonatal. Para establecer el diagnóstico se requiere un alto grado de sospecha y casi siempre se efectúa durante el procedimiento quirúrgico. Es el único tipo de embarazo ectópico que puede llegar a término. CASO CLÍNICO: Paciente de 35 años, con antecedente obstétrico de dos cesáreas, que acudió al servicio médico por dolor abdominal de larga evolución, con varios meses de amenorrea, sin control prenatal. El dolor fue inicialmente adjudicado a una hernia umbilical, pero ante su persistencia se reexaminó a la paciente y se encontró una masa abdominal, por lo que se sospechó embrazo ectópico. El ultrasonido abdominal y la resonancia magnética confirmaron el embarazo de término, que finalizó mediante laparotomía. Se decidió dejar la placenta in situ, debido al riesgo de hemorragia por su remoción. Tanto el neonato como la madre fueron dados de alta en buenas condiciones después de dos semanas de estancia hospitalaria, con posterior seguimiento. CONCLUSIONES: Aunque el embarazo ectópico abdominal es una alteración poco frecuente, es importante saber qué debe hacerse de acuerdo con las semanas de gestación, debido al incremento reciente en su incidencia y a la alta tasa de complicaciones, con la finalidad de preservar el bienestar materno-fetal y la fertilidad femenina.
Abstract BACKGROUND: Abdominal pregnancy is a rare clinical entity with a high risk for both the mother and the product. It's diagnosis requires a high level of suspicion, being usually made during the surgical management of the case. It is the only type of ectopic pregnancy that can reach term. CLINICAL CASE: A 35 year-old patient, with two previous cesarean deliveries, who presents with chronic abdominal pain, without prenatal consultations and with several months of amenorrhea. The pain is initially atributted to an umbilical hernia, but due to it's persistence she is re-examined, finding an abdominal mass and raising suspicion of a possible ectopic pregnancy. She's sent to a hospital in western Mexico, where she undergoes abdominal examination with ultrasound and magnetic resonance, which shows a full term abdominal pregnancy, for which a laparotomy is performed. The placenta is left in situ, due to the high risk of hemorrhage associated with it's removal. Both the newborn and the mother are released from the hospital in good conditions after two weeks of stay, with subsequent follow-up. CONCLUSIONS: Despite it being a rare condition, it's important to be acquainted with the proper management according to the gestational age of the pregnancy due to the recent rise in it's incidence, as well as it's particularly high rate of complicactions, in order to preserve the wellbeing of both patients when possible, as well as maternal fertility.
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In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality.
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Glicemia , Intolerância à Glucose , Insuficiência Renal Crônica/metabolismo , Adulto , Idoso , Argentina , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The intestinal mucosa is exposed to a vast antigenic contact. Several antigen presenting cell (APCs) have been described within the gut associated lymphoid tissue (GALT) (Peyer's patches, lamina propria, mesenteric lymph nodes, muscular layer); however, this has been done almost exclusively in adult organisms. As there is no characterization of intestinal muscular layer's APCs during early neonate development we adapted the conventional technique used in adults, to the neonate intestine. We obtained the intestinal muscular layer from early neonates (days 0-3 upon birth) and from young mice (2 and 3 weeks after birth). A planar network of CD45(+), MHC-II(+), DEC-205(+) cells with irregular, some with prominent dendritic morphology was found at birth under basal physiological conditions, whereas Langerin(+) DCs appeared after two weeks. The variations seen in CD45(+), MHC-II(+) and DEC-205(+) cells along the early neonatal development, could be related to the new challenges by intestinal antigen exposure from the newborn diet (breast milk, solid food), and to important environmental changes (start walking, exploring the surroundings, etc). Our study reveals the presence of APCs in intestinal muscular layer at birth, and their subsequent changes in physiological, non-induced conditions, contributing basic information about these cells in the neonate intestinal immune system.