Quality of Life and Clinical Outcomes in Elderly Patients Treated with Ventricular Pacing as Compared with Dual-Chamber Pacing

ABSTRACT Background Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers are believed to be more physiologic. However, it is not known whether either type of pacemaker results in superior clinical outcomes. Methods The Pacemaker Selection in the Elderly study was a 30-month, single-blind, randomized, controlled comparison of ventricular pacing and dualchamber pacing in 407 patients 65 years of age or older in 29 centers. Patients received a dual-chamber pacemaker that had been randomly programmed to either ventricular pacing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Short-Form General Health Survey. Results The average age of the patients was 76 years (range, 65 to 96), and 60 percent were men. Quality of life improved significantly after pacemaker implantation (P0.001), but there were no differences between the two pacing modes in either the quality of life or prespecified clinical outcomes (including cardiovascular events or death). However, 53 patients assigned to ventricular pacing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node dysfunction, but not those with atrioventricular block, had moderately better quality of life and cardiovascular functional status with dual-chamber pacing than with ventricular pacing. Trends of borderline statistical significance in clinical end points favoring dual-chamber pacing were observed in patients with sinus-node dysfunction, but not in those with atrioventricular block. Conclusions The implantation of a permanent pacemaker improves health-related quality of life. The quality-of-life benefits associated with dualchamber pacing as compared with ventricular pacing are observed principally in the subgroup of patients with sinus-node dysfunction. (N Engl J Med 1998;338:1097-104.

Descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas por medio de la técnica de dilución del colorante

The dilution technique has been used for the description of the circulatory dynamics in the heart and lungs of inhabitants of sea level and high altitude. The main purpose of this study was to measure the amount of blood in the lungs of these groups of people, through the formula of Newman, to show whether the natives of high altitudes have a greater amount of blood in the lungs. The following calculations were made: circulation time, volume, heart squeezing, intralorácico blood volume (Hamilton), central volume (Newman) and total blood volume. At sea level, 20 men and 15 women were studied. In altra (4,540 mts.) 10 men who were born and still living at 4,540 m were studied. When values are corrected per square meter of body surface, no marked difference between men and women at sea level, apart from the known hematologic differences. Natives live show longer circulation times, a volume slightly higher expulsion, increased blood volume and increased amount of blood in the lungs. When pulmonary blood volume, calculated with the formula of Newman, is expressed as a percentage of total blood volume, the high group also shows that individuals higher numbers of sea level.La técnica de dilución ha sido usada para la descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas. El principal propósito de este trabajo ha sido la medida de la cantidad de sangre contenida en los pulmones de estos grupos de personas, por medio de la fórmula de Newman, con objeto de demostrar si los nativos de las grandes alturas tienen una mayor cantidad de sangre en los pulmones. Los siguientes cálculos se hicieron: tiempos circulatorios, volumen de expulsión del corazón, volumen sanguíneo intralorácico (Hamilton), volumen central (Newman) y volumen sanguíneo total. Al nivel del mar se estudiaron 20 hombres y 15 mujeres. En la altra (4,540 mts.) se estudiaron 10 hombres que habían nacido y seguían viviendo a 4,540 mts. Cuando los valores se corrigen por metro cuadrado de superficie corporal , no hay diferencia marcada entre hombres y mujeres a nivel del mar, aparte de las conocidas diferencias hematológicas. Los nativos de la altura muestran tiempos circulatorios más prolongados, un volumen de expulsión ligeramente mayor, mayor volumen sanguíneo y mayor cantidad de sangre contenida en los pulmones. Cuando el volumen de sangre pulmonar, calculado con la fórmula de Newman, se expresa como porcentaje del volumen sanguíneo total, el grupo de altura también muestra cifras mayores que los individuos del nivel del mar

Descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas por medio de la técnica de dilución del colorante

The dilution technique has been used for the description of the circulatory dynamics in the heart and lungs of inhabitants of sea level and high altitude. The main purpose of this study was to measure the amount of blood in the lungs of these groups of people, through the formula of Newman, to show whether the natives of high altitudes have a greater amount of blood in the lungs. The following calculations were made: circulation time, volume, heart squeezing, intralorácico blood volume (Hamilton), central volume (Newman) and total blood volume. At sea level, 20 men and 15 women were studied. In altra (4,540 mts.) 10 men who were born and still living at 4,540 m were studied. When values are corrected per square meter of body surface, no marked difference between men and women at sea level, apart from the known hematologic differences. Natives live show longer circulation times, a volume slightly higher expulsion, increased blood volume and increased amount of blood in the lungs. When pulmonary blood volume, calculated with the formula of Newman, is expressed as a percentage of total blood volume, the high group also shows that individuals higher numbers of sea level.La técnica de dilución ha sido usada para la descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas. El principal propósito de este trabajo ha sido la medida de la cantidad de sangre contenida en los pulmones de estos grupos de personas, por medio de la fórmula de Newman, con objeto de demostrar si los nativos de las grandes alturas tienen una mayor cantidad de sangre en los pulmones. Los siguientes cálculos se hicieron: tiempos circulatorios, volumen de expulsión del corazón, volumen sanguíneo intralorácico (Hamilton), volumen central (Newman) y volumen sanguíneo total. Al nivel del mar se estudiaron 20 hombres y 15 mujeres. En la altra (4,540 mts.) se estudiaron 10 hombres que habían nacido y seguían viviendo a 4,540 mts. Cuando los valores se corrigen por metro cuadrado de superficie corporal , no hay diferencia marcada entre hombres y mujeres a nivel del mar, aparte de las conocidas diferencias hematológicas. Los nativos de la altura muestran tiempos circulatorios más prolongados, un volumen de expulsión ligeramente mayor, mayor volumen sanguíneo y mayor cantidad de sangre contenida en los pulmones. Cuando el volumen de sangre pulmonar, calculado con la fórmula de Newman, se expresa como porcentaje del volumen sanguíneo total, el grupo de altura también muestra cifras mayores que los individuos del nivel del mar

Marketing Internacional - AM65 - 202101

Las empresas en la actualidad tienen la necesidad de crecimiento, buscan internacionalizarse y desarrollar nuevos mercados, aprovechando las múltiples oportunidades que en la actualidad ofrece el mercado internacional. Esta situación afecta tanto a empresas grandes como pequeñas, ya que el tamaño no supone una limitación para competir en el exterior. Las ventajas competitivas desarrolladas en el mercado local representan el pilar de la expansión en los mercados internacionales de las empresas. Para ello, establecen estrategias efectivas de marketing internacional efectivas para que ingresen a mercados extranjeros, que aseguren la internacionalidad de la marca, productos y servicios de la organización. En este contexto, esta asignatura busca que el alumno adquiera una visión global de la problemática relativa al marketing internacional, descubriendo los principales aspectos a tener en cuenta para desarrollar una estrategia de marketing internacional. Asimismo, se entrenará en elegir los mercados internacionales que permitan a los empresarios internacionalizarse y experimentar cual es el desenvolvimiento en un ámbito internacional. De modo que, la empresa en la que labore a futuro, logre su expansión. El curso de Marketing Internacional, es una asignatura de especialidad de carácter teórico-práctico dirigido a los estudiantes de noveno ciclo de la carrera de Administración y Marketing. El presente curso desarrolla la competencia general de pensamiento crítico de nivel 3, dado que, resuelve una problemática relativa al marketing internacional y brinda una buena solución y aplicación de las principales estrategias y tácticas de marketing a nivel global. Por otro lado, desarrolla también la competencia específica de planeamiento estratégico de nivel 3, al realizar un análisis de los factores críticos que ayudan a estas empresas a seleccionar mercados internacionales con la consigna de que sean altamente rentables

Pulmonary imaging in coronavirus disease 2019 (COVID-19): a series of 140 Latin American children.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which resulted in the worldwide coronavirus disease 2019 (COVID-19) pandemic of 2020, has particularly affected Latin America. The purpose of the study was to analyze the imaging findings of pulmonary COVID-19 in a large pediatric series. Children with SARS-CoV-2 infection confirmed by either quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swabs or presence of circulating immunoglobulin M (IgM) antibodies and who underwent chest radiograph or CT or both were included in this retrospective multicenter study. Three pediatric radiologists independently reviewed radiographs and CTs to identify the presence, localization, distribution and extension of pulmonary lesions. We included 140 children (71 female; median age 6.3 years, interquartile range 1.6-12.1 years) in the study. Peribronchial thickening (93%), ground-glass opacities (79%) and vascular engorgement (63%) were the most frequent findings on 131 radiographs. Ground-glass opacities (91%), vascular engorgement (84%) and peribronchial thickening (72%) were the most frequent findings on 32 CTs. Peribronchial thickening (100%), ground-glass opacities (83%) and pulmonary vascular engorgement (79%) were common radiograph findings in asymptomatic children (n=25). Ground-glass opacity and consolidation were significantly higher in children who needed intensive care admission or died (92% and 48%), in contrast with children with a favorable outcome (71% and 24%, respectively; P Asymptomatic children and those with mild symptoms of COVID-19 showed mainly peribronchial thickening, ground-glass opacities and pulmonary vascular engorgement on radiographs. Ground-glass opacity and consolidation were more common in children who required intensive care admission or died

Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators.

BackgroundStandard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers are believed to be more physiologic. However, it is not known whether either type of pacemaker results in superior clinical outcomes.MethodsThe Pacemaker Selection in the Elderly study was a 30-month, single-blind, randomized, controlled comparison of ventricular pacing and dual-chamber pacing in 407 patients 65 years of age or older in 29 centers. Patients received a dual-chamber pacemaker that had been randomly programmed to either ventricular pacing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Short-Form General Health Survey.ResultThe average age of the patients was 76 years (range, 65 to 96), and 60 percent were men. Quality of life improved significantly after pacemaker implantation (P<0.001), but there were no differences between the two pacing modes in either the quality of life or prespecified clinical outcomes (including cardiovascular events or death). However, 53 patients assigned to ventricular pacing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node dysfunction, but not those with atrioventricular block, had moderately better quality of life and cardiovascular functional status with dual-chamber pacing than with ventricular pacing. Trends of borderline statistical significance in clinical end points favoring dual-chamber pacing were observed in patients with sinus-node dysfunction, but not in those with atrioventricular block.ConclusionThe implantation of a permanent pacemaker improves health-related quality of life. However, the quality-of-life benefits associated with dual-chamber pacing as compared with ventricular pacing are observed principally in the subgroup of patients with sinus-node dysfunction