133 research outputs found
Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy
Obesity, metabolic syndrome, and type-2 diabetes
mellitus are 3 interrelated conditions that share a number
of pathophysiological mechanisms and that are frequently
observed to lead, in succession, to cardiovascular
complications. The fact that their prevalence is increasing
alarmingly should prompt all healthcare professionals
urgently to implement measures to prevent these
complications. The most effective, though also the least
adopted, are those related to lifestyle modification. Drug
treatment targeted at controlling risk factors (eg,
hypertension, dyslipidemia, and thrombophilia), metabolic
abnormalities, and excess weight is also necessary
Stem Cells to Regenerate Cardiac Tissue in Heart Failure
Myocardial regeneration is one of the most promising
therapeutic strategies for heart failure patients. Many experimental
studies have demonstrated that different types
of stem cell can differentiate into myocardial cells and tissues
necessary for regeneration of the damaged myocardium,
while studies in experimental animals suggest that
muscle (myoblast), bone marrow (mesenchymal, endothelial
or hematopoietic progenitors) and even heart cells
can help to improve heart contractility in vivo. These findings
have led several groups to undertake studies in patients
with myocardial infarction. However, the use of cellular
therapy in clinical trials is not without controversy,
mainly related with the need for better knowledge before
these therapeutic strategies are used in clinical practice.
Although significant enhancement of our knowledge of
the processes involved is fundamental, we do not consider
it unreasonable to initiate clinical trials in which specific
questions are posed, whose answers will allow us to
make further progress
Utilización de células madre para la regeneración miocárdica en la insuficiencia cardíaca
La terapia celular en la reparación miocárdica se vislumbra
como una de las estrategias terapéuticas con
mayor futuro en el tratamiento de la insuficiencia cardíaca.
Numerosos estudios in vitro recientes apoyan la potencialidad
de distintos tipos de células madre de diferenciarse
hacia los tejidos necesarios para regenerar el
tejido miocárdico dañado, mientras que estudios en animales
de experimentación sugieren que células madre
de músculo (mioblastos), médula ósea (progenitores mesenquimales,
endoteliales o hematopoyéticos) e incluso
del propio corazón pueden contribuir in vivo a mejorar la
contractilidad cardíaca. Estos trabajos han conducido a
que diversos grupos hayan iniciado estudios en pacientes
con infarto de miocardio. Sin embargo, la utilización
de la terapia celular en ensayos clínicos no está desprovista
de controversia, fundamentalmente relacionada con
la necesidad de aumentar nuestro conocimiento antes
de pasar a la aplicación clínica de estas estrategias terapéuticas.
Aunque es fundamental aumentar significativamente
el conocimiento de los procesos, no consideramos
irrazonable iniciar ensayos clínicos en los que se
identifiquen preguntas concretas cuya respuesta nos
permita avanzar en esta dirección
Avances en la cardiopatía isquémica aguda y crónica
Atherothrombosis is a key concept in our new pathophysiologic understanding of cardiovascular disease. It has led to new preventive strategies, both pharmacologic and lifestyle-related, to more specific treatments and to emerging imaging modalities
Clonidina en el tratamiento de la deshabituación tabáquica. Comparación con chicles de nicotina
The objective of our work was to carry out a prospective study on the effectiveness of clonidine and nicotine gum in the treatment of tobacco withdrawal. Sixty smokers were randomly distributed in two groups and were included in a tobacco withdrawal program. One group received oral clonidine treatment while the other group was given nicotine gum. Adjuvant therapy such as group therapy or psychotherapy was not performed. At the end of one year there were no significant differences between the two groups with regards to the number of subjects who have continued to stop smoking. There were also no significant differences between the two groups with regards to the symptoms of tobacco abstinence. When we studied the relation between treatment fulfillment and tobacco withdrawal we observed that the clonidine treated group had a significantly greater number of success compared to the nicotine group (p < 0.01)
Cardiac resynchronization therapy and valvular cardiomyopathy after corrective surgery
Cardiac resynchronization therapy (CRT) has been
shown to have clinical benefits in certain groups of
patients with advanced heart failure (HF). However,
patients with valvular cardiomyopathy are
underrepresented in randomized clinical studies. The aim
of this study was to assess the medium-term (i.e., at 6
months) effects of CRT in patients with HF exclusively
due to valvular disease. The study included 40
consecutive patients who underwent CRT device
implantation. At 6 months, there were improvements in
functional class, left ventricular remodeling, and
intraventricular dyssynchrony parameters in treated
patients. In this particular subgroup of patients, the
benefits of CRT were similar to those observed in patients
with HF due to other etiologies
Efecto de la localización del electrodo ventricular izquierdo sobre los parámetros ecocardiográficos de asincronía en pacientes sometidos a terapia de resincronización cardíaca
Introduction and objectives. Cardiac resynchronization
therapy has been shown to be an option in the treatment
of patients with congestive heart failure. The current
indication for this treatment is based on clinical and electrocardiographic
criteria, although echocardiography has
also been shown to be a useful tool for the diagnosis of
ventricular dyssynchrony. The aim of this study was to assess
left ventricular dyssynchrony by echocardiography
and to evaluate the effect of the stimulation site on the
magnitude of resynchronization.
Patients and method. We studied 25 patients with biventricular
stimulation (left ventricular lead located in a lateral
position in 13 patients, and in an anterior position in
12). A complete echo-Doppler evaluation, including left
ventricular ejection fraction, ventricular diameters and parameters
of inter- and intraventricular dyssynchrony, was
performed before implantation and 3 months after the
procedure, with the device connected and disconnected.
Results. Left ventricular ejection fraction increased significantly
from 23.7 (6.5) to 27.8 (5.5) (P=.007) at 3
months. In the group as a whole, biventricular pacing was
associated with a significant decrease in all intraventricular
dyssynchrony parameters (septal-to-lateral wall motion
delay and septal-to-posterior wall motion delay). This decrease
in septal-to-posterior wall motion delay and septalto-
lateral wall motion delay was significantly greater in patients
with the electrode implanted in the lateral position
(58.1 ms vs 118 ms; P=.02) than with the lead in the anterior
position (39.5 ms vs 86.5 ms; P=.04). Three patients,
all with the electrode in an anterior location, were considered
non-responders.
Conclusions. Left lateral free wall stimulation provided
significantly better intraventricular resynchronization compared
to stimulation at an anterior site. Echocardiography
is a useful tool to evaluate changes in intra- and interventricular
synchrony related to the pacing site
Fortalecimiento del proceso de publicidad registral del duplicado de tarjeta de identificación vehicular de la SUNARP en el marco del PP 113 servicios registrales accesibles y oportunos con cobertura universal, 2020-2021
La presente investigación aplicada titulada: “Fortalecimiento del Proceso de Publicidad Registral del Duplicado de Tarjeta de Identificación Vehicular de la SUNARP, en el Marco del Programa Presupuestal 113 Servicios Registrales Accesibles y Oportunos con Cobertura Universal, 2020-2021”, tiene como finalidad dotar a la Alta Dirección de la Superintendencia Nacional de los Registros Públicos, de instrumentos de gestión que coadyuven en el desarrollo de su misión institucional.
Para ello, presentamos propuestas de modernización, que aseguren que los Registros Públicos cuenten con normativa interna que permita brindar servicios eficientes y oportunos a los ciudadanos.
En este trabajo de investigación aplicada, se dan a conocer los problemas que enfrentan los ciudadanos, al solicitar una publicidad registral de Duplicado de Tarjeta de Identificación Vehicular, cuya competencia geográfica, le corresponde a una oficina distinta a la que presentó su solicitud, por lo que tiene que incurrir en costos y tiempo innecesarios
Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos
Recent data suggest that biventricular pacing may play
an important role in treating advanced heart failure in the presence of a
significant interventricular and/or intraventricular conduction disorder by
correcting cardiac dysynchrony. In this article, we review the initial technical
and clinical experience with cardiac resynchronization therapy in an
electrophysiology laboratory. METHODS: The first 22 consecutive patients with
severe congestive heart failure, ejection fraction < 0.35, NYHA functional class
III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers
were studied. Clinical, electrocardiographic, and echocardiographic evaluations
were made before and three months after pacemaker implantation. Acute functional
capacity testing with peak oxygen uptake was measured during biventricular pacing
and during intrinsic rhythm or right ventricular pacing three months after the
implantation procedure. RESULTS: The success rate of pacemaker implantation was
95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average
pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039)
from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure
decreased from an average of 3.12 (0.58) three months before the procedure to
1.38 (0.34) three months after the procedure. Peak oxygen uptake was
significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1)
ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3)
ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely
and with a high success rate in the electrophysiology laboratory. Biventricular
pacing seems to improve the symptoms of congestive heart failure in patients with
evidence of atrioventricular and/or interventricular/intraventricular
dysynchrony. An acute benefit in peak oxygen uptake was associated with
biventricular pacing after the implantation procedure
Análisis comparativo de pacientes con lesiones estenóticas y ectásicas coronarias
A total number of 177 patients with coronary lesions were studied. Sixty nine of them presented either a combination of stenotic and ectatic lesions (n = 18) or isolated ectatic lesions (n = 51) and 108 presented only stenotic lesions. Analyzing several clinical and epidemiological parameters we observed a significant difference with respect to the higher prevalence of hypertension among the group affected by ectatic lesions. We verified as well a higher prevalence of myocardial infarction in the group of ectasia associated to the stenotic lesions. Finally, a higher global mortality was observed in the group of ectasia associated to stenotic lesions after medical or surgical treatment
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