NEUROIMÁGENES EN ENFERMEDAD DE PARKINSON: ROL DE LA RESONANCIA MAGNÉTICA, EL SPECT Y EL PET

RESUMENLa enfermedad de Parkinson (EP) es un trastorno neurodegenerativo, caracterizado por la pérdida progresiva de neuronas monoaminérgicas, en especial dopaminérgicas. En las últimas décadas, se han desarrollado diversos biomarcadores para el estudio de los pacientes con EP. Un grupo de estos biomarcadores son las neuroimágenes, como la resonancia magnética cerebral y las imágenes moleculares, en particular, la tomografía por emisión de positrones (PET) y la tomografía por emisión de fotón único (SPECT). Estas técnicas, se han empleado en el diagnóstico temprano de la EP, así como para mejorar el diagnóstico diferencial entre EP y otros parkinsonismos y para monitorizar la progresión de la enfermedad. Con estos fines, se ha utilizado la capacidad de estas técnicas para evaluar la pérdida de la actividad dopaminérgica y de otras vías monoaminérgicas, al igual que la posibilidad de valorar la inflamación y el metabolismo a nivel cerebral. Recientemente, los nuevos criterios para el diagnóstico de la EP reconocen al PET y SPECT como herramientas valiosas en el diagnóstico de esta enfermedad. En este artículo, se analiza la utilidad actual de las técnicas de imagen en pacientes con EP y otros parkinsonismos y sus potenciales aplicaciones futuras.SUMMARYParkinson's disease (PD) is a neurodegenerative disorder characterized by a progressive loss of monoaminergic neurons, particularly dopaminergic cell groups. Biomarkers have been developed in the last decades for the study of PD patients. Neuroimages, including Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography are part of these biomarkers evaluated in PD. These techniques had been used for the early diagnosis of PD, for the differential diagnosis between PD and other parkinsonisms and to monitor the progression of these disorders. The ability of these images to evaluate loss of monoaminergic activity and their capacity to estimate inflammatory and metabolic changes in the brain has been used. Recently the new criteria for diagnosis of PD have incorporated to PET and SPECT as useful tools in the diagnosis of this disorder. In this article, we review the utility of the neuroimages in patients with PD and some of their potential future applications

What does an explanted PASCAL device look like?

We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological pro We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological prosthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup. Keywords: Mitral regurgitation; PASCAL device; Transcatheter therapysthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup

Virtual learning of the digestive system: an experience developing an undergraduate course.

3 p.Cell biology, histology and embryology are three core subjects which are taught early in medicine, dentistry and veterinary science curricula. Collectively, they provide an essential foundation for the subsequent acquisition of clinical knowledge in each discipline; while conversely, an inability to assimilate such knowledge can lead to high failure and dropout rates in the early years of these degrees. Teaching of these sciences has traditionally been delivered through classroom-based methods and can thus be limited by time and financial constraints. Increasingly, the availability of online resources and electronic learning or “e-learning”, is greatly facilitating this learning process while circumventing the need for expensive laboratory equipment (Goldberg, 2007; Silva Lópes, 2003). Using information and communication technology associated with distance education, we set out to produce an e-learning course dedicated to the digestive system, aiming to promote an integrated comprehension. To achieve this, we implemented an undergraduate teaching project at the faculties of Agricultural Sciences and Veterinary Medicine of the National University of Rio Cuarto and also within Medical Sciences of the National University of Cordoba. In this communication we describe our experience of using the Internet in a network of academic integration: virtual teaching of the digestive system as an integrated thematic unitof embryology, histology and cell biology.Fil: Juri, Hugo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; ArgentinaFil: Ávila, Rodolfo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; ArgentinaFil: Samar, María. Universidad Nacional de Córdoba. Facultad de Odontología; ArgentinaFil: Mugnaini, María. Universidad Nacional de Río Cuarto. Facultad de Agronomía y Veterinaria; ArgentinaFil: Soñez, Carlos. Universidad Nacional de Río Cuarto. Facultad de Agronomía y Veterinaria; ArgentinaFil: Anderson, William. John Radcliffe Hospital. Oxford; United KingdomOtras Medicina Básic

Concomitant Coronary Artery Bypass in Patients with Acute Type A Aortic Dissection

Coronary Artery Bypass Grafting (CABG) is sometimes necessary in acute Type A Aortic Dissection (AAAD) repair. The aim of this study is to analyze the incidence, indications and influence in-hospital outcomes of AAAD repair requiring concomitant CABG in a high-volume single-center experience. Retrospective study of all consecutive AAAD patients. Those who underwent concomitant CABG were identified. Preoperative, intraoperative, postoperative and follow-up data were collected and analyzed. Between January 1, 2010 and December 31, 2016, 382 patients underwent emergency surgery for AAAD. Forty-one (10.7%) underwent concomitant CABG. In this group, mean age was 64 ± 14 years, 32 were male (78%). Indication for CABG was coronary dissection in 28 patients (68.3%), post-cardiopulmonary bypass (CPB) right heart failure in 7 (17.1%), post CPB left heart failure in (7.3%) and native coronary pathology in 3 (7.3%). In 33 (80.5%) one graft was needed, in 7 (17%) two were performed and in 1 patient (2.4%) 3 were necessary. The right coronary artery (RCA) was the only revascularized vessel in 26 cases (63.4%), the left coronary artery (LCA) alone in 11 (26.8%), and both coronary systems in 4 (9.8%). In-hospital mortality was 51.2% (N = 21); eight (19.5%) patients had postoperative myocardial infarction (MI) and 11 (26.8%) had a major neurological event. Multivariable logistic regression identified concomitant CABG as a predictor of in-hospital mortality (Odds Ratio (OR) = 3.8115, 95% CI= 0.514-2.138, p = 0.001). In our study, concomitant CABG was performed in 10.7% of AAAD repair surgery and it was associated with high in-hospital mortality. Keywords: Concomitant CABG; Predictors of mortality; Type A acute aortic dissectio

The trypanocidal activity of the alkaloid oliverine involves inhibition of DNA synthesis

The Trypanosoma cruzi parasite is an etiologic agent of the American trypanosomiasis called Chagas disease. This pathology affects more than 24 million persons and represents one of the most important public health problems in Latin America. Taking into account this, it is necessary the search of new antitrypanosomal agents that show a major level of efficacy and minor indexes of toxicity in affected patients. Vast source of them are the natural products from plants with enormous structural diversity. A particular type of these compounds is represented by aporphinoid alkaloids. In our experiments, anonaine (2), oliverine (3) and guatterine (5) displayed antitrypanosomal activity. The compound 3 showed the most important activity with an IC50 = 12.00 ± 0.36 μM. Its mechanism of action may include inhibition of DNA synthesis.Fil: Garro, Hugo Alejandro. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Química. Area de Química Orgánica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto de Investigaciones en Tecnología Química; ArgentinaFil: Juri Ayub, Maximiliano. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentina. Fundación Instituto Leloir; ArgentinaFil: Nieto, M.. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Química. Area de Química Orgánica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto de Investigaciones en Tecnología Química; ArgentinaFil: Lucero Estrada, Cecilia Stella Marys. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Area Microbiologia; ArgentinaFil: Pungitore, Carlos Rodolfo. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Química. Area de Química Orgánica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto de Investigaciones en Tecnología Química; ArgentinaFil: Tonn, Carlos Eugenio. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Química. Area de Química Orgánica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto de Investigaciones en Tecnología Química; Argentin

Parkinson disease mortality rates in Chile

Este estudio tiene como objetivo evaluar la tendencia de mortalidad por enfermedad de Parkinson en Chile en un período de 10 años y valorar las variaciones geográficas de dicha mortalidad

Producción de materiales virtuales en la educación médica de grado a distancia: Proyecto PIIMEG (Proyecto de Innovación e Investigación para el mejoramiento de la Enseñanza de Grado)

Las problemáticas actuales del proceso de enseñanza/aprendizaje en la clásica modalidad presencial de Biología Celular, Histología y Embriología, asignaturas del ciclo básico de las tres carreras biomédicas en las Facultades de Medicina, Odontología y Veterinaria son similares. Se detectan, entre otros,  descenso en el rendimiento académico, alta deserción estudiantil en los primeros años, fracasos y altos  porcentajes de  re-cursantes. Basándonos en el uso de nuevas tecnologías de la información y comunicación asociadas a la educación a distancia nos propusimos producir materiales educativos (Trabajos Prácticos virtuales y CD-ROM) con el objeto de introducir nuevas formas para mejorar la comprensión integrada del Sistema Digestivo en forma interdisciplinaria. Para ello llevamos a cabo el proyecto PIIMEG (Proyectos de Innovación e Investigación para el mejoramiento de la Enseñanza de Grado) entre Nodos pertenecientes las Facultades de Agronomía y Veterinaria de la Universidad Nacional de Río Cuarto y Ciencias Médicas de la Universidad Nacional de Córdoba. El objetivo del presente trabajo es describir los materiales virtuales producidos para la educación médica de grado a distancia  Se confeccionaron para el periodo lectivo 2010: 1-Trabajos Prácticos Virtuales colocados en la URL: www.histologíavirtual.fcm.unc.edu.ar, 2-CD-ROM. Se utilizaron imágenes de órganos del sistema digestivo de diferentes especies de la cavidad bucal, pertenecientes a: 1-diapotecas y 2-resultado de proyectos de investigación de las asignaturas involucradas. Creemos que mediante los Trabajos Prácticos virtuales y CD-ROM de la unidad  temática propuesta, podremos  potenciar las motivaciones de estudio comprensivo, reflexivo y conocimiento significativo revertiendo algunas de las problemáticas diagnosticadas

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

Background: Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair. Methods: Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group. Results: Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87). Conclusions: Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts. Keywords: Acute type A aortic dissection (AAAD); age; gende

Prior intake of new oral anticoagulants adversely affects outcome following surgery for acute type A aortic dissection

Objectives: Oral anticoagulation prior to emergency surgery is associated with an increased risk of perioperative bleeding, especially when this therapy cannot be discontinued or reversed in time. The goal of this study was to analyse the impact of different oral anticoagulants on the outcome of patients who underwent emergency surgery for acute type A aortic dissection (ATAAD). Methods: This was a single-centre retrospective study of patients treated with oral anticoagulation at the time of surgery for ATAAD. Outcomes of patients on new oral anticoagulant (NOAC) therapy were compared to respective outcomes of patients on Coumadin. Additionally, a survival analysis was performed comparing these 2 groups with patients who were operated on with no prior anticoagulation. Results: Between January 2013 and April 2020, a total of 437 patients (63.8 ± 11.8 years, 68.4% male) received emergency surgery for ATAAD; 35 (8%) were taking oral anticoagulation at the time of hospital admission: 20 received phenprocoumon; 14, rivaroxaban; and 1, dabigatran. Compared to Coumadin, NOAC was associated with a greater need for blood-product transfusions and haemodynamic compromise. Operative mortality was 53% in the NOAC group and 30% in the Coumadin group. A 5-year survival analysis showed no significant difference between the NOAC and the Coumadin group (P = 0.059). Compared to 402 patients treated during the study period without anticoagulation, patients taking NOAC had significantly worse survival (P = 0.001), whereas that effect was not observed in patients undergoing surgery who were taking Coumadin (P = 0.99). Conclusions: Emergency surgery for ATAAD in patients taking NOAC is associated with high morbidity and mortality. NOAC are a major risk factor for uncontrollable bleeding and haemodynamic compromise. New treatment strategies must be defined to improve surgical outcomes in these high-risk patients. Keywords: Acute aortic syndrome; Aortic dissection; Bleeding; Coumadin; DOAC; NOAC; Oral anticoagulation; Type A dissection