Obstrucao Coronaria apos Implante por Cateter de Protese Valvar Aortica

Fundamentos: O implante por cateter de bioprótese valvar aórtica (TAVI) consolidou-se como alternativa para o tratamento de pacientes com estenose aórtica importante de alto risco cirúrgico. Contudo, há poucos dados na literatura com respeito à obstrução coronária que, apesar de rara, trata-se de grave complicação do TAVI. Objetivo: Avaliar, no contexto brasileiro, a presença dessa importante complicação. Métodos: Foram avaliados todos os casos de obstrução coronária incluídos no Registro Brasileiro de TAVI. Foram coletados dados clínicos, do procedimento, do manejo e de evolução intra-hospitalar. Resultados: Entre 418 pacientes consecutivos do registro, ocorreram três casos de obstrução coronária (incidência de 0,72%). Em sua totalidade, os pacientes eram do sexo feminino, sem cirurgia de revascularização miocárdica (CRM) prévia, com idade média de 85 ± 3 anos, EuroSCORE logístico de 15 ± 6% e STS de 9 ± 4%. Todos os casos foram realizados com a válvula balão-expansível Sapien XT. Em um dos pacientes, com dados de tomografia computadorizada pré-procedimento, verificaram-se origem das artérias coronárias baixa e seio de Valsalva estreito. Todos os pacientes apresentaram-se clinicamente com hipotensão importante e mantida, imediatamente após o implante da válvula, e, apesar de angioplastia com implante de stent, todos os pacientes foram a óbito, sendo dois periprocedimento e um durante hospitalização. Conclusão: A obstrução coronária como complicação do TAVI, apesar de rara, é potencialmente fatal, podendo ocorrer mais frequentemente em mulheres e com as próteses expansíveis por balão. Fatores anatômicos podem estar relacionados com sua ocorrência, ressaltando-se a importância de boa avaliação pré-procedimento no sentido de evitar essa grave complicação.

Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty

Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

Feather mites of the Aralichus canestrinii (Trouessart) complex (Acarina, Pterolichidae) from New World parrots (Psittacidae). and conclusions to the study / Warren T. Atyeo, Tila M. Pérez.

n.s. no.62(1990)

Andrés Pérez: una vida para el teatro

Si pienso en el teatro, más allá de una definición académica del término, pienso en una fiesta y un evento popular con participación “masiva”, pienso en un ritual, en un espacio sagrado y todo eso está presente en el trabajo de Andrés Pérez. Esta es mi verdad, la que voy a contar en este escrito, una verdad subjetiva sin duda y además una verdad que pasa no solo a través de lo efímero del teatro, sino también pasa por los recuerdos de mis testigos, por su memoria, gracias a las entrevistas que he realizado, a las notas de prensa y a los libros que he leído, la figura de Andrés Pérez ha tomado cuerpo y voz, por ejemplo con los videos que he logrado encontrar donde se hace presente. Otro elemento para mí interesante de la figura de Andrés es la popularidad que tiene en Chile y en Suramérica. Es muy conocido por haber trabajado casi siempre con personajes e historias marginales y por no haberse olvidado nunca de donde venía, llevando así el teatro a lugares pobres, por eso la gente lo ama: es una figura viva en la memoria de la sociedad chilena. La figura de Andrés Pérez, quedó grabada en el imaginario colectivo y se ha convertido en un héroe post dictadura y en plena época de reconciliación ha llegado al éxito. Fue el creador de un teatro masivo y popular, uniendo elementos del circo, magia, mimo, danza, teatro, música…

Venezuelan economic laboratory. The Case of the altruistic economy of Felipe Pérez Martí

Felipe Pérez Martí, who was the Venezuelan Minister of Planning and Development in the government of Hugo Chávez, proposes an economic model that he calls the altruistic economy or fourth way, which leads cooperative game theory to its logical extremes postulating a pure communism. Here we sustain that, first, it is impossible in the model of Pérez Martí to marginally allocate non-primary goods to those most in need or who most value them, facing a problem of defective economic calculation, and second, in order to achieve equality, he would have to replace his atomic local planners by a central planner, who would be unable to overcome the problem of imperfect and and incomplete information.

Repositori de preservació digital de la Biblioteca de Catalunya: informe descriptiu i de situació / Redactat per Karibel Pérez i Eugènia Serra del Grup de Preservació Digital de la BC

Com a responsable de la preservació del patrimoni bibliogràfic a Catalunya, la Biblioteca de Catalunya ha dedicat molts recursos a digitalitzar documents analògics, alhora que ha incorporat al seu fons documents creats directament en format digital. En l’actualitat representen un volum important, i per això el Grup de Preservació Digital de la BC ha descrit les necessitats i processos que són la base del disseny d’un repositori que garanteixi la perdurabilitat d’aquests documents. El present informe en descriu els detalls.

Description of Micropygomyia (Micropygomyia) ancashensis sp. nov. and the female of Lutzomyia (Helcocyrtomyia) chavinensis Pérez & Ogusuku (Diptera, Psychodidae, Phlebotominae) from Ancash department, Peru

A male of a new species Micropygomyia (Micropygomyia) ancashensis sp. nov. and a female of the Lutzomyia (Helcocyrtomyia) chavinensis Pérez & Ogusuku, 1999 captured in the Antonio Raymondi province, department of Ancash, Peru are described and illustrated. The new species belongs to the cayennensis series, being closest to Mi. lewisi (Feliciangeli Ordoñez & Férnandez) though presenting highly sclerotized pseudotracheae on the labella that seem to constitute an autapomorphy among American Phlebotominae, and a clypeus almost completely covered with setae, as in Warileya. The female of Lu. chavinensis is close to those of Lu. blancasi Galati & Cáceres 1990, Lu. noguchii (Shannon, 1929), and Lu. pallidithorax Galati & Cáceres 1994.

Genetic diversity of Leishmania infantum field populations from Brazil

Leishmania infantum (syn. Leishmania chagasi) is the etiological agent of visceral leishmaniasis (VL) in Brazil. The epidemiology of VL is poorly understood. Therefore, a more detailed molecular characterization at an intraspecific level is certainly needed. Herein, three independent molecular methods, multilocus microsatellite typing (MLMT), random amplification of polymorphic DNA (RAPD) and simple sequence repeats-polymerase chain reaction (SSR-PCR), were used to evaluate the genetic diversity of 53 L. infantum isolates from five different endemic areas in Brazil. Population structures were inferred by distance-based and Bayesian-based approaches. Eighteen very similar genotypes were detected by MLMT, most of them differed in only one locus and no correlation was found between MLMT profiles, geographical origin or the estimated population structure. However, complex profiles composed of 182 bands obtained by both RAPD and SSR-PCR assays gave different results. Unweighted pair group method with arithmetic mean trees built from these data revealed a high degree of homogeneity within isolates of L. infantum. Interestingly, despite this genetic homogeneity, most of the isolates clustered according to their geographical origin.

Reduced susceptibility to vancomycin and biofilm formation in methicillin-resistant Staphylococcus epidermidis isolated from blood cultures

This study aimed to correlate the presence of ica genes, biofilm formation and antimicrobial resistance in 107 strains of Staphylococcus epidermidis isolated from blood cultures. The isolates were analysed to determine their methicillin resistance, staphylococcal cassette chromosome mec (SCCmec) type, ica genes and biofilm formation and the vancomycin minimum inhibitory concentration (MIC) was measured for isolates and subpopulations growing on vancomycin screen agar. The mecA gene was detected in 81.3% of the S. epidermidis isolated and 48.2% carried SCCmec type III. The complete icaADBC operon was observed in 38.3% of the isolates; of these, 58.5% produced a biofilm. Furthermore, 47.7% of the isolates grew on vancomycin screen agar, with an increase in the MIC in 75.9% of the isolates. Determination of the MIC of subpopulations revealed that 64.7% had an MIC ≥ 4 μg mL-1, including 15.7% with an MIC of 8 μg mL-1 and 2% with an MIC of 16 μg mL-1. The presence of the icaADBC operon, biofilm production and reduced susceptibility to vancomycin were associated with methicillin resistance. This study reveals a high level of methicillin resistance, biofilm formation and reduced susceptibility to vancomycin in subpopulations of S. epidermidis. These findings may explain the selection of multidrug-resistant isolates in hospital settings and the consequent failure of antimicrobial treatment.

L'Enfer de la mère Cardine, traitant de la cruelle et terrible bataille qui fut aux enfers, entre les diables et les maquerelles de Paris, aux nopces du portier Cerberus et de Cardine, qu'lles vouloyent faire royne d'enfer ; et qui fut celle d'entr'elles qui donna le conseil de la trahyson, etc. ([Réimpression]) / Outre plus est adioustée une chanson de certaines Bourgeoises de Paris, qui faignant d'aller en voyage furent surprinses au logis d'une maquerelle, à S. G. des Prez.

Comprend : Deploration et complaincte de la mere Cardine de Paris, cydevant gouvernante du huleu sur l'abolition d'iceluy : trouvée après le deceds d'icelle Cardine en un escrain auquel estoient ses plus privez et pretieux secretz,...

Les Apontamentos de Antonio de Paula Brito

This article deals with the main characteristcs of the apontamentos, a Santiaguense caboverdean creole grammar published both in Capeverdean an Portuguese in 1887