Endocardial Approach for Substrate Ablation in Brugada Syndrome

Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed by both endocardial and epicardial. The substrate in BrS is not completely understood. We investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Two patients agreed to undergo an endocardial biopsy and the samples were examined with transmission electron microscopy (TEM) to investigate the correlation between functional and ultrastructural alterations. About 13 patients (38.7 ± 12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before endocardial mapping, the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. When the greatest ST-segment elevation was in the third intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in fourth ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate located in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7 ± 15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations. Endocardial RFA can eliminate the BrS phenotype and inducibility during programmed ventricular stimulation (PVS)

Niveles de estrés en pacientes mexicanas embarazadas seropositivas al VIH

Resumen: Introducción: Una proporción considerable de mujeres infectadas por VIH en edad reproductiva desean ser madres, aun cuando conocen el riesgo que esto representa para su salud, la del futuro hijo y la probabilidad de transmisión vertical de la infección. Durante este proceso el estrés condiciona eventos neonatales adversos y afecta la relación madre-hijo, por ello, es importante caracterizar los niveles de estrés de estas pacientes. Objetivo: Caracterizar los niveles de estrés en pacientes mexicanas embarazadas, VIH positivas del Instituto Nacional de Perinatología. Material y método: Se realizó un estudio observacional, transversal, descriptivo en 73 embarazadas seropositivas al VIH; el nivel de estrés se evaluó mediante la prueba de Nowack. Resultados: Las áreas que conforman el perfil de estrés de Nowack se encontraron dentro del promedio de la población sana, con excepción de las conductas de tipo «A» (ira internalizada, ira expresada, premura de tiempo, rapidez laboral, impaciencia, búsqueda de mejoría, conducción ruda de vehículos, desconfianza, enojo, hostilidad) y los reactivos ARC (abuso de sustancias, alcohol y consumo de tabaco), cuyas puntuaciones fueron menores al promedio y que actúan como recursos protectores para que este tipo de conductas no se presenten. Conclusiones: La mayor parte de las pacientes embarazadas positivas al VIH presentó un nivel de estrés dentro del promedio de la población sana, lo que probablemente se asocia a la sensación de control que representa el hecho de encontrarse adheridas a una institución de primer nivel con atención integral. Abstract: Introduction: A significant proportion of HIV-infected women of reproductive age wish to become pregnant, even when they know the risk for their health and for their children, as well as the probability of vertical transmission of the infection. During this process, stress produces adverse neonatal events, affecting mother-child relationship. Therefore, it is important to determine the stress level of these patients. Objective: To determine the stress levels in HIV positive pregnant patients of the National Institute of Perinatology, Mexico. Material and method: An observational, cross-sectional, descriptive study was carried out on 73 HIV-positive pregnant patients, and the stress level was evaluated using the Nowack test. Results: The areas comprising the Nowack stress profile were within the limits of a healthy population, with the exception of type «A» behaviours (internalized anger, expressed anger, time haste, work speed, impatience, search for improvement, bad driving of vehicles, distrust, anger, hostility), and ARC reagents (substance abuse, alcohol and tobacco use), whose scores were lower than the average, acting as protective resources against this type of behaviour. Conclusions: The majority of HIV-positive pregnant patients presented a level of stress within the average of the healthy population. This is probably associated with the feeling of control that represents the fact of being attached to a first-level institution receiving integrated care. Palabras clave: Estrés, Embarazo, Transmisión vertical, Soporte institucional, VIH, Keywords: Stress, Pregnancy, Vertical transmission, Institutional support, HI

Congenital toxoplasmosis: Specific IgG subclasses in mother/newborn pairs

Anti-Toxoplasma gondii antibodies of all IgG subclasses were studied in mother/newborn pairs. IgG1 in the mothers and IgG3 in the newborns were related to offspring clinical problems; IgG2 and IgG3 in the babies were markers of vertical transmission, and IgG4 in mothers or children were associated to clinical problems. IgG subclasses may be markers of congenital infection or clinical outcome. © 2008 Lippincott Williams & Wilkins