Detection rates of congenital heart disease in Guatemala

AbstractObjectivesIn developing countries, congenital heart disease is often unrecognised, leading to serious morbidity and mortality. Guatemala is one of the few developing countries where expert paediatric cardiac treatment is available and affordable, and therefore early detection could significantly improve outcome. We assessed regional congenital heart disease detection rates in Guatemala, and determined whether they correlated with the regional human development index.MethodsWe retrospectively reviewed all new cardiac referrals made in 2006 to the Unidad de Cirugia Cardiovascular Pediatrica, the only paediatric cardiac centre in Guatemala. We calculated regional detection rates by comparing the number of congenital heart disease referrals with the expected incidence using the National Ministry of Health birth data. We then compared the regional detection rates with the human development index data published in the United Nations 2006 Development Program Report using Spearman’s rank correlation.ResultsAn estimated 3935 infants with cardiac defects were born in Guatemala in 2006, an expected 1380 (35%) of whom had severe forms. Overall, only 533 children (14%) with cardiac defects were referred. Of these, 62% had simple shunt lesions, 13% had cyanotic lesions, and 10% had left-sided obstructive lesions. Only 11.5% of referred patients were neonates. Regional detection rates, ranged 3.2–34%, correlated with the regional human development index (r = 0.75, p &lt; 0.0001).ConclusionsCurrent detection of congenital heart disease in Guatemala is low and correlates with the regional human development index. Those detected are older and have less severe forms, suggesting a high mortality rate among Guatemalan neonates with complex cardiac defects.</jats:sec

New archaeomagnetic directions from Portugal and evolution of the geomagnetic field in Iberia from Late Bronze Age to Roman Times

This study presents new archaeomagnetic results from 33 combustion structures (kilns and hearths) from the archaeological sites of Castelinho, Crestelos, Olival Poço da Barca and Fonte do Milho in NE Portugal. The age of the investigated structures ranges from 1210 BC to 200 AD according to calibrated radiocarbon dating, thermoluminescence dating and archaeological constraints. Stepwise thermal and alternating field demagnetization isolate a single, stable, characteristic remanence component with very well defined directions. Rock magnetic analyses suggest low-Ti titanomagnetite/maghemite as the main magnetic carrier of the remanence. Mean directions are well grouped in most structures. The effect of thermoremanent anisotropy on mean directions has been evaluated and was found to be important. Inclination increases of between 2° and 13° after applying the anisotropy correction at specimen level. This highlights the requirement of evaluating this effect on the directions of small and flattened thin kilns and hearths. The 31 new directional data improve both the temporal and spatial distribution of the Iberian archaeomagnetic dataset from Late Bronze Age to Roman Times. Finally, a new directional palaeosecular variation curve for Iberia for the last twelve centuries BC is proposed. The curve has been computed using the bootstrap method and includes data coming from sites within 900 km of Madrid. The new palaeodirectional secular variation curve for Iberia is consistent with the Western European palaeosecular variation curve and with the prediction of regional European models

Razonamiento ordinario: modelos mentales y modelos formales

En este artículo se señala la relevancia de la interacción entre los modelos mentales (psicología cognitiva) y los modelos formales (inteligencia artificial) para la construcción de modelos del razonamiento ordinario desde una perspectiva cognitiva. Del estudio comparativo de ambos modelos se derivan algunos problemas ligados a la representación de las actitudes preposicionales y asimismo se sostiene que es importante seguir manteniendo a la lógica, en un sentido amplio, como patrón-guía que nos permita articular y, posiblemente, implementar algunos de los procesos deductivos de razonamiento que han sido previamente acotados en función de nuestros intereses o basándonos en nuestras intuicione

Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects Results and Cost-Effective Considerations in a Low-Income Country

ObjectivesWe compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala.BackgroundThe percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure.MethodsWe reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures.ResultsEighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. $3,329.50 ±$411.30 and U.S. $4,521.03 ±$429.71; p < 0.001, respectively). Cost of the device (U.S. $2,930.00) proved to be the main cause for this difference.ConclusionsWe confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective

Updated Iberian archeomagnetic catalogue: new full vector paleosecular variation curve for the last three millennia

In this work, we present 16 directional and 27 intensity high‐quality values from Iberia. Moreover, we have updated the Iberian archeomagnetic catalogue published more than 10 years ago with a considerable increase in the database. This has led to a notable improvement of both temporal and spatial data distribution. A full vector paleosecular variation curve from 1000 BC to 1900 AD has been developed using high‐quality data within a radius of 900 km from Madrid. A hierarchical bootstrap method has been followed for the computation of the curves. The most remarkable feature of the new curves is a notable intensity maximum of about 80 μT around 600 BC, which has not been previously reported for the Iberian Peninsula. We have also analyzed the evolution of the paleofield in Europe for the last three thousand years and conclude that the high maximum intensity values observed around 600 BC in the Iberian Peninsula could respond to the same feature as the Levantine Iron Age Anomaly, after travelling westward through Europe

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events