Search

Summary Right ventricular (RV) involvement during acute inferior myocardial infarction is common and considered to be of prognostic relevance. It was speculated that particularly those patients with RV involvement would profit most from the use of thrombolytic therapy and thus are the key patient group to understanding controversial results on the overall clinical benefit of using thrombolysis during acute inferior myocardial infarction. In 200 consecutive patients with acute inferior myocardial infarction we assessed the eligibility for thrombolytic therapy and the prognostic impact of RV infarction in patients eligible or non-eligible for reperfusion therapy. Prognostic analyses were based on the in-hospital period and a 1–6-year follow-up (mean: 36±11 months). When based on ST-segment elevation in V4R, known as a reliable predictor for RV infarction (sensitivity 88%; specificity 78%; diagnostic efficiency 83%), 107 patients (54%) presented with evidence of RV ischemia. Seventy-one patients (36%) were found eligible for thrombolytic therapy. These patients showed a lower mortality (6/71 patients, 8%) and complication rate (22/71 patients, 31%) compared to patients non-eligible for thrombolysis (mortality: 32/129 patients, 25%; P RV infarction is a common complication of acute inferior myocardial infarction, determines an unfavourable inhospital prognosis and identifies patients who will profit most from using thrombolytic therapy.

Tesis (Magíster en Enseñanza del Inglés como Lengua Extranjera) The aim of this study is to explore the use of Facebook as an effective tool to improve EFL earners' writing skills in an informal context. To this end, this research will consider a sample of 10 EFL students of a gth grade in Peñalolen. Santiago. A mixed-method approach, within a qualitative paradigm is employed. For research purposes, documentary analysis and observation will be used to gather information regarding the usefulness of a Facebook Group (FBG). First, a FBG will be defined as a web page created within the Facebook social networking site, based around a reallife interest among learners of a gth grade. Second, Informal writing will be conceptualized within a process approach and it will be understood as a set of visible or tactile signs used to represent units of language in a systematic way that has, as its purpose, communication. Finally, improve will be approached as to raise participants' writing skills to a more excellent quality. To analyze learners' improvements of the written discourse, Participants will take a pre-test and after a month of being working and completing different tasks on a FBG, a post test will be taken. The aim is to contrast and analyze participants' results by using a focused holistic rubric. For instante, this study intends to assess the relevance of using social media to improve learners' writing skills. Within this enquiry, respondents are required to participate in a facebook group created by the teacher- researcher hosted by facebook here: http://www.facebook.corn/groups/l33405406809993/

Patent foramen ovale (PFO) is a relatively frequent remnant of the fetal circulation, causing transient right-to-left shunt. Its potential consequences include arterial hypoxemia and paradoxical embolism. Echocardiographic contrast imaging techniques make the detection of PFO possible during life. Over the past 20 yr, clinical research focused on the association between PFO and cryptogenic stroke, peripheral embolism, decompression sickness, platypnea-orthodeoxia, and fat embolism. However, although right-to-left shunt through a PFO can occur in the presence of normal right-side hemodynamics, patients with pulmonary embolism (PE) and elevated pressures in the right ventricle and atrium may be at particularly high risk to suffer hypoxemia and paradoxical embolism. In a study performed by our group, PFO was diagnosed in 35% of the patients with PE. These patients had an in-hospital death rate of 33% as opposed to 14% in patients without a PFO. Logistic regression analysis demonstrated that the only independent predictors of mortality were a PFO and arterial hypotension at presentation. Patients with a PFO also had a higher incidence of ischemic stroke and peripheral embolism. Moreover, significant differences were observed in arterial oxygen tension depending on the presence or absence of a PFO. Overall, the risk of a complicated in-hospital course was 5.2 times higher in patients with a PFO. Thus, in patients with PE and right ventricular dysfunction, PFO indicates a particularly high risk of death and arterial thromboembolic complications, and it is, in fact, one of the independent predictors of an adverse clinical outcome.

There is increasing evidence for a fatal interaction of myocardial ischemia, ventricular arrhythmias and sudden cardiac death in some patients with coronary artery disease. Evidence comes from autopsy studies, from the evaluation of patients who survived an episode of sudden cardiac death, from follow-up data of these patients either treated or not by revascularization therapy and/or an implantable cardioverter-defibrillator and indicate that reducing the individual ischemic burden will be beneficial to reduce the incidence of sudden cardiac death. Studies in patients with stable and especially with unstable angina using Holter monitoring could demonstrate that there is a close and causal relationship between myocardial ischemia inducing or aggravating life-threatening ventricular arrhythmias and sudden cardiac death particularly in patients with unstable and postinfarction status. This review summarizes some of our clinical knowledge on this topic and indicates that preventive strategies for myocardial ischemia are the antiarrhythmic treatment of choice in patients with severe coronary artery disease and patients with evidence or at risk for ischemic proarrhythmia.

Ketanserin and calcium antagonists are frequently used for the treatment of arterial hypertension in the elderly. The possibility that combined treatment with ketanserin and the calcium antagonist nifedipine have a pro-arrhythmic effect was investigated in 20 normal volunteers aged60 years with normal or slightly elevated blood pressure. Each subject received monotherapy with ketanserin or nifedipine for 1 week and the combined treatment during the following week. Clinical and biochemical parameters, ECG and 24-hour ECG recording were monitored before and at the end of the first and second treatment weeks. Ketanserin and nifedipine given in monotherapy or in combination did not modify, on average, blood pressure, heart rate, the biochemical variables and the QT interval. In the 24-hour ECG recordings, 2 normal subjects developed a marked increase in the frequency of ventricular ectopics, couplets and ventricular tachycardia after combined treatment. Therefore, the present investigation does not exclude the possibility that combined treatment with ketanserin and nifedipine could increase the prevalence of arrhythmia in some elderly patients.