Ablación de arritmias cardiacas empleando un sistema de mapeo electroanatómico tridimensional en el Instituto Nacional Cardiovascular - INCOR

Objective. To describe the initial experience in ablation of cardiac arrhythmias using 3D mapping at the Instituto Nacional Cardiovascular INCOR (Lima, Peru). Methods. A retrospective descriptive study was carried out. During February 2020, data was collected from the medical records of all patients in whom ablation was performed using 3D mapping from July 2017 to December 2019. This procedure was performed in patients with symptomatic arrhythmia refractory to antiarrhythmic therapy. Results. Data were collected from 123 patients (median age: 46 years, 64.2% male), who had a median time of illness of 6 years. Among the arrhythmias treated, 19% had atrial fibrillation, 17.5% atrial tachycardia, 17.5% idiopathic ventricular arrhythmias, 16.6% Wolf Parkinson White syndrome / Atrioventricular reentrant tachycardia, 11.1% ventricular arrhythmias of the His-Purkinje conduction system, 9.5% scar related ventricular tachycardia associated, 6.4% atrial flutter and 2.4% intranodal tachycardia. The median fluoroscopy time was 26 minutes. Ablation was acutely successful in 95.9% of cases, acute complications were observed in 4.8%, and recurrence-free survival during the first year of follow-up was 74%. Conclusions. Our experience in ablation of cardiac arrhythmias using 3D mapping had a high acute success rate, low frequency of complications, and one-year recurrence-free survival of 74%.Objetivo. Describir la experiencia inicial en ablación de arritmias cardiacas empleando mapeo 3D en el Instituto Nacional Cardiovascular INCOR (Lima-Perú). Materiales y métodos. Estudio descriptivo, retrospectivo, donde se recolectaron datos de historias clínicas de todos los pacientes en los cuales se realizó ablación empleando mapeo 3D, desde julio de 2017 a diciembre de 2019. Este procedimiento se realizó a pacientes sintomáticos y refractarios a terapia antiarrítmica. Resultados. Se recolectaron datos de 123 pacientes (mediana de edad: 46 años, 64,2% varones), con una mediana del tiempo de enfermedad de 6 años. Entre las arritmias tratadas 19% tuvieron fibrilación auricular; 17,5% taquicardia auricular; 17,5% arritmias ventriculares idiopáticas; 16,6% síndrome de Wolf Parkinson White/taquicardia por reentrada auriculoventricular; 11,1% arritmias ventriculares del sistema de conducción His-Purkinje; 9,5% taquicardia ventricular asociada con cicatriz; 6,4% flutter atrial y 2,4% taquicardia intranodal. La mediana del tiempo de fluoroscopía fue de 26 min. La ablación tuvo éxito agudo en el 95,9% de los casos; las complicaciones agudas se observaron en 4,8%, y la sobrevida libre de recurrencias durante el primer año de seguimiento fue de 74%. Conclusiones. Nuestra experiencia en ablación de arritmias cardiacas empleando mapeo 3D presentó una alta frecuencia de ablación exitosa aguda y baja frecuencia de complicaciones, así como una sobrevida libre de recurrencias del 74%, estimada al año de seguimiento

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Toimintamallin johtaminen pilotoinnin avulla Lukuinto-ohjelmassa

Tiivistelmä Lukuinto-ohjelmassa (Lukuinto 2014) on pilotoinnin avulla etsitty käytäntöjä, jotka innostavalla tavalla monipuolistavat esi- ja perusopetuksessa lasten ja nuorten lukemisen tapoja. Uudet luku- ja kirjoitustaidot alati muuttuvassa tekstiympäristössä ovat niitä tulevaisuuden taitoja, joihin koulu ja kirjasto voivat yhdessä panostaa. (Korkeamäki 2011, 15; Coiro ym. 2014) Keskeisiä elementtejä kehittämistyössä on ollut koulun ja kirjaston yhteistyö ja kehittämistä tukevan koulutuksen räätälöinti yhteistyökumppaneiden kanssa. Koulutukset ovat toimineet ajattelun uudistajina ja tukena yhteisen tutkimusperustaisen käsitteistön omaksumiselle kirjaston ja koulun kesken

Evaluación del uso de antimicrobianos de reserva por pacientes hospitalizados en establecimientos de salud

It is a of drugs utilization, descriptive, transversal, observational, multicentric study that follows a transversal design, prescription type -indication- with the aim to determine the prevalence use of reserve antimicrobials in hospitalized patients, of all age groups, men and women in services of internal medicine. We applied two sheets of data collection: ATMR-S (for services) and ATMR-P (for patients) to obtain prevalence of reserve antimicrobials (ATMR) and the ATMR prescribed. The sheets were implemented on August 21, 2006 to 845 patients thatwerc hospitalized that day. Wereport an overall prevalence of ATMR prescribing by hospitals is 28%, with extreme values rangingfrom 18% to 38%; theprevalence of use by services is 32.3% with values ranging from 16.4% in obstetrics-gynecology, and 57.1 % in the intensive care unit. ATMR are the most prescribed according to hospital are vancomycin 500 mg. Injection and ceftazidime 1g. with 41.7% in the Guillermo Almenara Hospital and Dos de Mayo respectively; in the Naval Medical Center, 50% of patients of the medicine service was treated with ciprofloxacin 500 mg. Slotted tablet; in the Hospital of the National Police it was prescribed ceftriazone 1g. injection and vancomycin 500 mg.injection by 36%, and 100% of patients treated with ceftriozona 1g. injection. In general, these values are significantly lowerw with ATM in general (60%), but would have to continue monitoring to determine the impact of their use.Es un estudio de utilización de medicamentos, descriptivo, transversal, observacional, multicentrico, tipo prescripción - indicación, cuyo objetivo de determinar la prevalencia de uso de los antimicrobianos de reserva (ATMR) por pacientes hospitalizados, de todos los grupos etáreos, varones y mujeres, en los servicios de medicina interna, cirugía, pediatría, gineco- obstetricia y Unidad de Cuidados intensivos de 5 hospitales de Lima. Se aplicaron dos fichas de recolección de datos: ATMR-S (para servicios), y ATMR-P (para pacientes) con el fin de obtener la prevalencia de uso de antimicrobianos de reserva (ATMR) y los ATMR prescritos. Las fichas se aplicaron el día 21 de agosto del 2006, a 845 pacientes que ese día estaban hospitalizados. Se reporta una prevalencia global de prescripción de ATMR de 28%, con valores extremos que van del 18%, hasta 38%; la prevalencia de uso por servicios es de 32.3% con valores que fluctúan entre 16.4 % en Gineco obstetricia y 57.1 % en la Unidad de cuidados intensivos. Los ATMR más prescritos de acuerdo al hospital son la Vancomicina 500 mg. inyectable y ceftazidima 1 g inyectable con 41.7% en los hospitales Guillermo Almenara y Dos de Mayo; en el Centro Médico Naval, el 50% de pacientes del servicio de medicina fue tratado con ciprofloxacino 500 mg. Tableta ranurada; en el Hospital PNP se prescribió ceftriozona 19 inyectable y Vancomicina 500 mg. inyectable en el 36% y el 100% de pacientes recibió ceftriozona 1g inyectable.En general, las cifras halladas son significativamente mas bajas respecto al uso de antimicrobianos en general, pero habría que continuar con el monitoreo para precisar el impacto de su uso

Absence of low-temperature anomaly on the melting curve of He-4.

The melting pressure and pressure in the liquid at a constant density of ultrapure He-4 (0.3 ppb of He-3 impurities) have been measured with an accuracy of about 0.5 mu bar in the temperature range from 10 to 320 mK. The measurements show that the anomaly on the melting curve below 80 mK, which was recently observed [I. A. Todoshchenko et al., Phys. Rev. Lett. 97, 165302 (2006)], is entirely due to an anomaly in the elastic modulus of Be-Cu from which our pressure gauge is made. Thus, the melting pressure of He-4 follows the T-4 law due to phonons in the whole temperature range from 10 to 320 mK without any attribute of a supersolid transition