Browsing by Autor "Raimondo Caltagirone"

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Anticoagulación en pacientes con fibrilación auricular y angiopatía amiloide Revisión de un tema complejo en base a la evidencia científica
(European Organization for Nuclear Research, 2022) Luis Dulcey; Juan Theran; Raimondo Caltagirone; Melissa Aguas
El riesgo de accidente cerebrovascular isquémico en la fibrilación auricular se puede cuantificar mediante la escala CHA2DS2-VASc. Los pacientes considerados de alto riesgo por la escala CHA2DS2-VASC deben ser anticoagulados, sin embargo, la angiopatía amiloide cerebral aumenta el riesgo de hemorragia intracraneal. Esta revisión tiene como objetivo destacar el tratamiento actual de los pacientes con angiopatía amiloide cerebral y fibrilación auricular. Los biomarcadores de sangrado para angiopatía amiloide cerebral incluyen las microhemorragias corticales, siderosis superficial cortical, la hemorragia subaracnoidea convexa, hemorragia intracerebral profunda y la hemorragia lobar. La evidencia científica señala que la hemorragia intracerebral profunda tiene una tasa de recurrencia anual del 8.9% y para hemorragia lobar anual es mayor al 19%. Las microhemorragias corticales aumentan el riesgo de hemorragia intracerebral profunda y lobar con la prescripción de anticoagulantes orales y este efecto es dosis dependiente. En pacientes con fibrilación auricular, los anticoagulantes deben evitarse en presencia de angiopatía cerebral amiloide y características predominantes de riesgo de sangrado tales como siderosis superficial cortical o hemorragia intracerebral profunda. Un ensayo controlado aleatorizado que compare anticoagulantes orales con un dispositivo para el cierre de la orejuela izquierda ayudaría a resolver este dilema trombosis-sangrado en este grupo de pacientes.
DESCRIPTION OF THE METABOLIC SYNDROME AND ITS INDIVIDUALIZED RISK IN A LATIN AMERICAN COHORT OF GERIATRIC PATIENTS WITH HYPOTHYROIDISM
(2023) Luis Dulcey; Juan Sebastián Theran León; Jaime Gomez; Rafael Guillermo Parales Strauch; Raimondo Caltagirone; Edgar Blanco; María Paula Ciliberti Artavia; Juan Camilo Martínez; Valentina Cabrera Peña; Maria Amaya
Abstract Introduction It is still discussed whether hypothyroidism as an independent risk factor for cardiovascular events. Our objective was to evaluate the association between hypothyroidism and the risks of cardiovascular events and mortality through 3 stratification systems. Methods A retrospective study was carried out by reviewing medical records in the period of January 2015 - December 2017 in a South American hospital. Patients had fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and plasma glucose were included. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution, and qualitative variables as percentages. Student’s test was performed to assess the differences between two variables. all statistical analyzes of the database results were performed with (SPSS for Windows, v.20.1; Chicago, IL). Results The present study has demonstrated metabolic syndrome criteria present in patients diagnosed with hypothyroidism in a high proportion. The male gender was 32% compared to the female 68%. The Framingham equation classified a higher percentage of women patients with hypothyroidism as low cardiovascular risk compared to the PROCAM and SCORE equations. Item was found that there was a greater cardiovascular risk in those patients with still uncontrolled hypothyroidism profile, showing a statistical correlation of this alteration for the 3 stratification systems used. Conclusions Hypothyroidism is a risk factor for cardiovascular disease. Uncontrolled hypothyroidism in the present study is associated with greater adverse outcomes in the medium and long term, the present study warns about the need to better characterize this patient cohorts.
Diastolic function and its relationship with the ATP-III criteria for metabolic syndrome in a Latin American cohort
(2023) María Gómez; Diego Acevedo; Silvia Fernanda Castillo Goyeneche; Anderson Felipe Arias; Luis Dulcey; Jaime Gomez; Carlos Hernandez; Juan Sebastián Theran León; Raimondo Caltagirone; Edgar Blanco
Abstract INTRODUCTION In South America, heart failure poses a substantial concern due to its widespread occurrence and insufficient data accuracy. Metabolic syndrome, a risk factor for heart disease and diabetes, is the focal point of the study, which seeks to examine its correlation with left ventricular diastolic function (LVDF) and indications of heart failure in adults within a South American hospital. MATERIALS AND METHODS A cross-sectional study with 2380 adults aged 65-79 in a South American hospital reveals connections between metabolic syndrome (MetS) and heart health. Using ATP-III criteria, MetS was identified, and cardiac function was assessed by echocardiography. Significant associations between MetS and various cardiac indicators were found. RESULTS Metabolic Syndrome (MetS) affected 33.1% of the sample, showing health differences and cardiac alterations, including ejection fraction changes. Associations with diastolic dysfunction criteria and complex relationships between natriuretic peptides and ventricular filling pressure were observed. CONCLUSIONS Metabolic syndrome links to significant changes in diastolic function and left ventricular structure, but not with alterations in the left atrium. Nevertheless, individuals with Metabolic Syndrome are more prone to receiving a diagnosis of chronic heart failure. Further extensive studies in diverse populations are advised.
Eficacia de la Denervación simpática renal como ultimo escalafón terapéutico en hipertensión refractaria, revisión de la literatura.
(2024) Luis Dulcey; Jhon Fredy Castillo Blanco; Juan Sebastián Theran León; Raimondo Caltagirone
Antecedentes: La hipertensión arterial acarrea una elevadísima carga de morbimortalidad por sus efectos deletéreos, pese al arsenal terapéutico tan amplio en algunos pacientes es refractaria. Estimaciones anteriores han colocado la carga global de enfermedad en adultos entre 30 y 32%, con la región de Asia Oriental y el Pacífico teniendo la mayor carga absoluta con poco más de 439 millones afectados. Además de las repercusiones en la salud, la hipertensión también conlleva costos económicos significativos. Metodología: Revisión amplia de la literatura sobre las actualizaciones en el área correspondiente al manejo de la hipertensión arterial refractaria y la utilidad de la terapia de denervación renal. Conclusiones: A pesar del tratamiento farmacológico bien establecido, la hipertensión sigue contribuyendo en gran medida a las muertes por enfermedades no transmisibles. Dada la bien conocida asociación de la hipertensión con enfermedades cardiovasculares adversas, la importancia del control de la presión arterial nunca ha sido más crucial. Tradicionalmente, el manejo farmacológico ha sido el pilar de la atención, sin embargo, con una carga de enfermedad cada vez mayor, ahora se están considerando enfoques alternativos e innovadores. Los sistemas de ablación basados en catéter mínimamente invasivos, dirigidos a los nervios simpáticos renales, se han propuesto como una forma más permanente de controlar la presión arterial.
Epilepsia secundaria a encefalitis por el virus de Epstein Barr
(2023) Luis Dulcey; Juan Sebastián Theran León; Valentina Cabrera Peña; Rafael Guillermo Parales Strauch; Raimondo Caltagirone; Edgar Blanco; María Paula Ciliberti Artavia
Presentación del caso. Se trata de una mujer de 44 años de edad, con historia de cefalea occipital, lenguaje incoherente y pensamiento confuso. Inicialmente presentaba diez puntos en la escala de Glasgow y una hemiparesia izquierda. La tomografía computarizada de cráneo, reportó edema cerebral con lesión hipodensa talámica derecha y deterioro neurológico progresivo. El electroencefalograma evidenció desaceleración unilateral hemisférica derecha. El estudio del líquido cefalorraquídeo describió hiperproteinorraquia y un recuento a predominio linfocitario de 450 células con glucorraquia conservada, sin presencia de bacterias.Intervención terapéutica. se manejó con soporte ventilatorio invasivo y con tratamiento antibiótico y antiviral a dosis meníngeas, además de anticonvulsivantes. Los hallazgos tomográficos de control reportaron una hidrocefalia; se colocó una derivación ventricular tipo Becker. La serología IgM resultó positiva para virus de Epstein Barr y se identificó el genoma viral en el líquido cefalorraquídeo, a través de la prueba de reacción en cadena de polimerasa. La tomografía cerebral de control, evidenció la persistencia de la ventriculomegalia y de edema cerebral, lo que generó el diagnóstico de una encefalitis de etiología viral complicada con epilepsia secundaria por una lesión estructural desmielinizante del hemisferio cerebral derecho. Evolución clínica. La intervención terapéutica con inmunoglobulina intravenosa generó una mejoría del estado general. Fue posible retirar la derivación ventricular y la ventilación pulmonar diez y 19 días después del ingreso, respectivamente. La paciente se encuentra actualmente en fisioterapia con persistencia de hemiparesia izquierda, alteraciones de la marcha, disartria y episodios convulsivos controlados durante los últimos seis meses.
Estrés y síntomas en personal de salud del Hospital Universitario de Los Andes
(2006) María D. Manzanilla; Tivizay Molina de González Méndez; Raimondo Caltagirone; Mariflor Vera; Adrián Torres
ResumenSe realiz un estudio transversal caso-control para determinar los niveles de autoapreciacin del estrs y la presencia de sntomas en mdicos residentes de post grado que laboran en
EXPRESSION OF VARIABILITY OF THE CYP2C19*2 GENE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION FROM A SOUTH AMERICAN HOSPITAL AND ITS FUTURE RELEVANCE IN THE INTERACTION BETWEEN GENETICS AND CARDIOLOGY
(2023) Luis Dulcey; Juan Sebastián Theran León; Jaime Gomez; Rafael Guillermo Parales Strauch; Raimondo Caltagirone; Edgar Blanco; María Paula Ciliberti Artavia; Juan Camilo Martínez; Valentina Cabrera Peña; Maria Amaya
Abstract Introduction Some Polymorphisms of the CYP2C19 gene are associated with a decrease in the activity of the enzyme they encode, being the case of CYP2C19*2 in causing a lower generation of active metabolite of clopidogrel and therefore a low or null antiplatelet action depending on the genotype present. Antiplatelet therapy, mainly clopidogrel, is considered essential treatment in the management of acute coronary syndromes (ACS). Target The frequency of the CYPC19*2 polymorphism, identified as relevant in resistance to clopidogrel, is unknown in the population of this part of South America. Methods A descriptive, observational and cross-sectional study was designed to determine the frequency of the CYP2C19*2 allele in patients with ACS admitted to a South American hospital during the period between 2015-2016, being the first study to determine polymorphism in our population. fifty-nine adults patients diagnosed with ACS were included, 48 male (81.3%) and 11 female (18.7%), aged between 54 and 86 years. The genotype for the CYP2C19 gene was determined through the PCRRFLP (Restriction Fragments Length Polymorphism) technique from DNA extracted desde peripheral blood . Results The allelic frequency of the CYP2C19*2 polymorphism was 28.5%. Three subgroups of metabolizers were characterized : extensive (*1/*1) 40 (67.8%), intermediate (*1/*2) 17 (28.9%) and poor (*2/*2) 2 (3.3%). Conclusions This high number of carriers of the CYP2C19*2 polymorphism in the context of ACS is relevant due to its association with a lower responsiveness to clopidogrel and the possible involvement in the choice of antiplatelet therapy, for which characterization studies are required most appropriate to identify the best therapeutic strategies in our populations through pharmacogenomics.
FERROKINETIC EVALUATION OF PATIENTS WITH ACUTE CORONARY SYNDROME AT A SOUTH AMERICAN HOSPITAL, PILOT STUDY
(2023) Luis Dulcey; Juan Sebastián Theran León; Valentina Cabrera Peña; Rafael Guillermo Parales Strauch; Raimondo Caltagirone; Edgar Blanco; María Paula Ciliberti Artavia; Juan Camilo Martínez
Abstract Introduction Alterations in the ferrokinetic profile are associated with cardiovascular disease, and the short- and long-term prognosis of these alterations is currently unknown. Design Prospective cohort analytical observational study Methods To determine the prognostic value of the alterations of the ferrokinetic profile in patients with myocardial infarction with and without ST-segment elevation, in a Health institution from July 2017 to May 2018. Results : From 72 patients, the main affected gender was male, in ages over 56 years old, the infarction with ST elevation being the most frequent. Among the associated comorbidities, the main one was hypertension with (n: 22; 53.7%) for infarction with elevation and (n: 23; 74.2%) for infarction without ST elevation. The most frequent alteration of the parameters of the ferrokinetic profile studied, was the iron deficit, found in (n:15; 36.6%) of the patients with ST elevation and (n:13; 41.9%) without ST elevation. Low levels of hemoglobin were present at admission (n:10; 24.4%) of the subgroup with ST elevation and (n:10; 32.3%) for no ST elevation, increasing the percentage to (n:13; 31.7%) (RR: 2) (95% CI -0.131-30.63), associated with low hemoglobin values at day 7 of hospitalization. There were 2 deaths (2.77%), which presented low levels of iron without anemia and infarction with ST elevation complicated by cardiogenic shock. Conclusions iron deficiency is a common comorbidity with a high mortality rate, and the decrease in hemoglobin after hospital admission was related to mortality, so both parameters should be taken into account in Infarction and cardiovascular disease.
Lipid-lowering therapy for patients with arterial hypertension and concomitant chronic obstructive pulmonary disease in a south American cohort
(2023) Diego Lobo; Santiago Bermudez; Luis Dulcey; Jaime Gomez; Carlos Hernandez; Juan Sebastián Theran León; Raimondo Caltagirone; Maria Amaya; María Gómez; Diego Acevedo
ABSTRACT Introduction to assess the lipid-lowering effect, the effect on endothelial function, oxidative stress of Rosuvastatin at a dose of 40 mg in patients with dyslipidemia, arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) initially, over time after 4 weeks and 12 months of treatment. Material and methods The prospective study included 33 patients (mean age 60 [54;61] years) with hypertension, COPD and dyslipidemia. The laboratory examination consisted of determining the lipid spectrum and the level of lipid peroxidation products (LPO). To assess the tolerability of the prescribed therapy, creatinine, bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were studied. To assess endothelial function, an endothelium-dependent vasodilation test (EDVD) was performed. Rosuvastatin at a dose of 40 mg was prescribed as lipid-lowering therapy. Initially, after 12 months, an ultrasound duplex scanning of the carotid arteries was performed to assess the presence of atherosclerotic plaques (AP) in the lumen of the vessel. The study was approved by the Local Ethics Committee of the Andes University in Merida, Venezuela (protocol No. 10 of December 25, 2017). Results after 4 weeks of treatment with Rosuvastatin at a dose of 40 mg, there was a significant decrease in total cholesterol levels by 26%, low-density lipoproteins (LDL) by 33%, triglycerides (TG) by 19%, while high-density lipoproteins (HDL) increased by 18%. Improvements in endothelial dysfunction (ED) and lipid peroxidation were observed during treatment with Rosuvastatin. Treatment with Rosuvastatin at a dose of 40 mg did not cause adverse reactions in patients. Conclusion correction of lipid metabolism disorders in patients with hypertension and COPD by prescribing Rosuvastatin at a dose of 40 mg can quickly reduce total cholesterol, LDL and TG, positively affecting endothelial function and lipid peroxidation processes. Therapy with Rosuvastatin at a starting dose of 40 mg in patients with dyslipidemia, hypertension and COPD is safe. After 12 months of regular use of Rosuvastatin at a dose of 40 mg, regression of AB was observed.
Longevity and frailty and their associated factors in the prognosis of coronary heart disease in a Latin American cohort
(2023) Luis Dulcey; Diego Acevedo; Silvia Fernanda Castillo Goyeneche; Anderson Felipe Arias; María Gómez; Jaime Gomez; Carlos Hernandez; Juan Sebastián Theran León; Raimondo Caltagirone; Edgar Blanco
Introduction to study the characteristics of the anamnestic history, the clinical course, as well as the nature of medical care for elderly patients with acute myocardial infarction (MI) and evaluate their impact on the prognosis of the disease. Material and methods the study included patients aged 60 years or older, survivors of acute myocardial infarction and registered in the database of the Hospital Universitario de los Andes in Merida, Venezuela (n=410). During the 2013-2018 study, a five-year prospective observation of patients with an assessment of their vital status was conducted. For the statistical processing of the data obtained, the Statistica V10.0 application package (StatSoft Inc.) was used. Results the analysis showed that 90% of the patients had a history of comorbid pathology. The presence of an atypical manifestation of myocardial infarction lengthened the prehospital stage of medical care for patients who were late in seeking medical attention (120 [49; 311.5] minutes), as well as the longest time until the first medical contact (26.5 [20; 40] minutes (p = 0.005)). One-fifth of patients were treated for acute MI in complementary hospitals, where the level of in-hospital mortality among elderly patients reached 65.7%, three times higher than the same figure in specialized cardiology departments (19, 7%, p< 0.001). Conclusion The main factors influencing long-term post-infarction in elderly patients were isolated systolic arterial hypertension, diabetes mellitus, renal dysfunction, previous myocardial infarction and acute stroke.
Pilot study of the FoxP3+ T lymphocyte count and its relationship with the Gensini score in patients with coronary heart disease and type 2 diabetes mellitus from a South American cohort
(2023) María Gómez; Diego Acevedo; Silvia Fernanda Castillo Goyeneche; Anderson Felipe Arias; Luis Dulcey; Jaime Gomez; Carlos Hernandez; Juan Sebastián Theran León; Raimondo Caltagirone; Edgar Blanco
Abstract INTRODUCTION One of the pathogenic links between type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) is low-intensity chronic inflammation, which is limited by FoxP3+ regulatory T cells. MATERIALS AND METHODS A comparative, observational, single-center, single-stage study was carried out. The severity of atherosclerosis was assessed by calculating the Gensini score based on selective coronary angiography. The absolute and relative content of CD4+CD25 high FoxP3+ and CD4+CD25 low FoxP3+ T cells in the blood was evaluated by flow cytometry. RESULTS 57 patients with chronic ischemic heart disease were examined. Patients with a combination of CHF and T2DM are characterized by an increase in the relative and absolute content of FoxP3+CD25 lymphocytes in the peripheral blood and an increase in the intranuclear content of FoxP3 in them, which is more pronounced in patients with disease moderate. atherosclerosis (Gensini score 17 to 45 points). CONCLUSIONS This was the first Latin American study that managed to show the relationship between an increase in the content of low FoxP3+CD25 lymphocytes in the peripheral blood with atherosclerosis in patients with a combination of coronary artery disease and DM2.
PULMONARY ASPERGILLOSIS COMPLICATED WITH HAEMOPHAGOCYTIC SYNDROME SECONDARY TO CHRONIC GRANULOMATOUS DISEASE DESCRIPTION OF THE FIRST CASE
(2020) Luis Dulcey; Jonathan Antonio Pineda; Jose Jorge Sampay; Hector Alonso Moreno; Raimondo Caltagirone; Hector Alonso Moreno; Especialista en Medicina Interna. Facultad de Medicina. Universidad de los Andes. Merida. Venezuela.; Raimondo Caltagirone; Medico Internista e Intensivista Facultad de Medicina. Universidad de los Andes. Merida.Venezuela.
Chronic granulomatous disease is a primary immunodeficiency caused by mutations in the genes of the 4 subunits of NADPH oxidase. Among the clinical findings are lymphadenopathies, hepatosplenomegalies and recurrent pneumonia. It is a 16-year-old male who presents productive cough with purulent expectoration, as well as progressive dyspnea and a loss of about 10 kilos of weight in the last 3 months, at the cervical level it presents bilateral adenomegalies, cardiopulmonary rhonchi scattered without cardiac alterations, at an abdominal hepatosplenomegaly, pancytopenic is found in the admission and an image compatible with an aspergilloma is evident in the thoracic radiograph. Bone marrow aspirate was performed with positive culture for fungi compatible with Aspergillus, staining and flow cytometry were performed with confirmation of Hemophagocytosis and Chronic Granulomatous Disease. This case is exceptional because it is the first report where the 3 entities coexist in the same patient.
Pustulosis exantémica generalizada posterior a vancomicina en paciente con pie de Charcot. Descripción de un evento adverso infrecuente y revisión de literatura
(European Organization for Nuclear Research, 2023) Luis Dulcey; Juan Theran; Aldahir Quintero; Raimondo Caltagirone; Melissa Aguas
La similitud entre la psoriasis pustulosa (PP) y la pustulosis exantemática aguda generalizada (PEGA) plantea problemas en el diagnóstico y tratamiento de estas dos condiciones. Existe una superposición clínica e histopatológica significativa entre PP y PEGA. La PP es un trastorno inflamatorio que tiene numerosos subtipos clínicos, pero todos con pústulas estériles compuestas por neutrófilos. PEGA es una reacción adversa cutánea grave que también se caracteriza por pústulas estériles no foliculares. Se presenta un caso sobre una paciente de género femenino de la sexta década de la vida quien posterior a uso de vancomicina por cuatro semanas comienza a presentar un exantema hipercrómico difuso con lesiones descamativas y gran extensión. Se considera cuadro de toxicidad farmacológica compatible con pustulosis exantémica generalizada iniciándose manejo con corticoides tópicos y suspendiendo el agente agresor. Las características clínicas que sugieren un diagnóstico de PP sobre PEGA incluyen antecedentes de psoriasis y la presencia de placas descamativas. Histológicamente, la espongiosis eosinofílica, la dermatitis de interfase vacuolar y la eosinofilia dérmica favorecen el diagnóstico de PEGA sobre PP. Es importante destacar que PP y PEGA varían en el curso clínico y el tratamiento. El tratamiento de la PP incluye esteroides tópicos, retinoides orales e inmunosupresores sistémicos. Se han investigado terapias más nuevas dirigidas a las IL-36, IL-23, IL-1 y PDE-4. La eliminación del agente agresor es una parte crucial del tratamiento de PEGA.