Résumé La présente recherche passe en revue les acteurs armés du post-conflit colombien depuis la démobilisation partielle des Forces d'autodéfense unies de Colomia (AUC) en 2006 et jusqu'à la signature des accords de paix avec les Forces Armées Revolutionnaires de Colombienne-L'Armee Populaire (FARC-EP). Il vise à établir la transformation des acteurs insurgés et contre-insurgés armés en criminels transnationaux qui conduisent un capitalisme criminel tirant parti des lacunes institutionnelles, de l'absence d'acteurs économiques modernes et impactants dans la croissance économique et les potentiels de développement dans les départements du pays dans lesquels se concentrer. Il vise à établir un cadre initial pour étudier l'impact des lacunes institutionnelles, des économies illégales et de la présence d'acteurs armés dans la croissance économique des départements colombiens les plus touchés par la violence.

Resumo A presente pesquisa analisa os atores armados do pós-conflito da Colômbia desde a desmobilização parcial das Forças Unidas de Autodefesa de Colombia (AUC) em 2006 e até a assinatura dos acordos de paz com as Forças Armadas Revolucionárias do Colombia-Exército Popular (FARC-EP). Ele visa estabelecer a transformação de atores insurgentes e contra-insurgentes armados em criminosos transnacionais que dirigem um capitalismo criminoso aproveitando as lacunas institucionais, a ausência de atores econômicos modernos e impact antes nos potenciais de crescimento e desenvolvimento econômico nos departamentos do país em que se concentram. Ele busca estabelecer uma estrutura inicial para estudar o impacto de lacunas institucionais, economias ilegais e a presença de atores armados no crescimento econômico dos departamentos da Colômbia mais afetados pela violência.

Resumen Esta investigación indaga en los actores armados del posconflicto de Colombia a partir de la desmovilización parcial de las Autodefensas Unidas de Colombia (AUC), el año 2006 y hasta la firma de los acuerdos de paz con las Fuerzas Armadas Revolucionaria de Colombia-Ejército del Pueblo (FARC-EP). Busca establecer la transformación de actores armados insurgentes y contrainsurgentes en delincuenciales transnacionales que impulsan un capitalismo de tipo criminal aprovechando los vacíos institucionales, la ausencia de actores económicos modernos e impactan el crecimiento económico y potencialidades de desarrollo en los departamentos del país en que se concentran. Se busca establecer un marco inicial para estudiar el impacto de los vacíos institucionales, economías ilegales y presencia de actores armados en el crecimiento económico de los departamentos de Colombia más golpeados por la violencia.

Abstract This study analyses the armed actors in Colombia's post-conflict from the partial demobilization of the United Self-Defenses Forces of Colombia (AUC in Spanish) in 2006 until the peace agreements signing with the Revolutionary Armed-Forces of Colombia-People's Army (FARC-EP). It aims at establishing the insurgent and counterinsurgent armed actors' transformation into transnational criminal groups promoting criminal capitalism, taking advantage of institutional gaps and the absence of modern economic actors, thus impacting economic growth and potential development in the country's departments where they are concentrated. This paper works towards an initial framework to study the impact of institutional gaps, illegal economies and the presence of armed actors on economic growth in the Colombian departments most affected by violence.

ABSTRACT SARS-CoV-2 pandemic is an unprecedented health emergency, which involves a reorganization of elective procedures, facing a potential global health system collapse. In Chile, as in the rest of the world. most reproductive medicine centers have suspended their different assisted reproduction therapies (ART). However, due to the decrease in the number of infections and due to a greater collection of scientific evidence, the European Society for Human Reproduction and Embryology (ESHRE) have recommended restarting cycles gradually through triage systems, prioritizing patients through the generation of different scenarios. With this in mind, we carried out a review of the existing evidence so far regarding SARS-CoV-2 and reproductive medicine, and we tried to compile the different guidelines of the main international societies, to generate a recommendation adjusted to our local scenario.

RESUMEN La pandemia de SARS-CoV-2 es una emergencia sanitaria sin precedentes, que ha implicado un reordenamiento en la priorización de procedimientos médicos electivos, frente a un potencial colapso del sistema de salud a nivel mundial y riesgo de contagio del personal y pacientes. Al igual que en el resto del mundo, en Chile la mayoría de los centros de medicina reproductiva han debido suspender sus diferentes terapias de reproducción asistida (TRA). Sin embargo, a raiz de la disminución del número de contagios y mayor evidencia científica disponible, la Sociedad Europea de Reproducción Humana y Embriología (ESHRE) ha recomendado reiniciar los ciclos de medicina reproductiva de forma gradual, a través de sistemas de triage, priorizando pacientes por medio de la generación de distintos escenarios. Considerando esta recomendación, se realizó una revisión sobre la evidencia existente respecto a SARS-CoV-2 / COVID-19 en medicina reproductiva recopilando diferentes directrices de las principales sociedades internacionales, con el objetivo de generar una recomendación ajustada a la realidad nacional.

Background: Lack of compliance with medication prescription is common among older adults and hamper an adequate management of chronic conditions. Aim: To study the association between health literacy and medication adherence in older adults with chronic diseases in Temuco, Chile. Material and Methods: The Health Literacy survey for Spanish-speaking Adults, MiniMental examination and the Morisky-Green test to assess compliance with medication prescription were applied to 119 older adults aged 60 to 88 years. Results: All participants had an adequate global cognitive performance; 24% had inadequate literacy, and 42% did not comply with medication prescription. There was a significant correlation between health literacy and medication adherence. Conclusions: Health literacy influences medication adherence in Chilean older adults.

SUMMARY: The most used method in human identification is the dactyloscopy, which registers, analyzes and collates the fundamental types and characteristic points of figures present in the dactylogram determining the degree of coincidence, between a pattern of identity that is dubious, and one that is indubious. Due to the processes that affect the skin of corpses, such as putrefaction, the necropapiloscopy techniques that occupy the dermal patterns for human identification are used. The objective of the present work is to compare epidermal with dermal records and validate scientifically, this method of identification (epidermal - dermal). For this purpose, 32 cadaveric fingers of Chilean individuals, of both sexes and between 40 and 80 years were used. In order to obtain the epidermal and dermal artificial physical record, the technique of obtaining necrodactyle impressions was used and compared through of the technique of dactyloscopic comparison. These procedures were carried out by criminalistic experts of Carabineros de Chile. It was possible to show important differences between epidermis and dermis in terms of quantity and quality of characteristic points and presence of senile lines. In relation to fundamental types, it was evidenced that in the dermis it is difficult to observe fundamental types (blurred) but no digit was found that presented a different of fundamental type between epidermis and dermis. There were also differences by sex and age. Finally, it was possible to demonstrate that there is a similar morphological relationship between artificial physical records of epidermal papiloscopic patterns with dermal patterns from the same individual. This allows the use of dermal records for positive human identification. The results of this work are important in providing scientific evidence for human identification based on the dermal fingerprint pattern.

RESUMEN: El método más utilizado en identificación humana es el dactiloscópico, que registra, analiza y coteja los tipos fundamentales y puntos característicos de las figuras presentes en el dactilograma, determinando el grado de coincidencia, entre un patrón de identidad dubitada y uno de identidad indubitada. Debido a los procesos que afectan la piel de cadáveres, como la putrefacción entre otros, se utilizan las técnicas necropapiloscópicas que ocupan los patrones dérmicos para la identificación humana. El objetivo del presente trabajo es comparar registros epidérmicos con dérmicos, y validar científicamente, este método de identificación (epidérmico - dérmico). Para ello se utilizaron 32 dedos de cadáveres de individuos chilenos, de ambos sexos y de entre 40 y 80 años. Para obtener el registro físico artificial epidérmico y dérmico se utilizó la técnica de obtención de impresiones necrodactilares y se comparó a través de la técnica de cotejo dactiloscópico. Estos procedimientos fueron realizados por peritos criminalísticos de Carabineros de Chile. Se logró evidenciar diferencias importantes entre epidermis y dermis en cuanto a cantidad y calidad de puntos característicos y presencia de líneas seniles. En relación a tipos fundamentales, se evidenció que en dermis es difícil la observación de tipos fundamentales (borrosos) pero no se encontró ningún dígito que presentara tipo fundamental diferente entre epidermis y dermis. También se constataron diferencias por sexo y edad. Finalmente se pudo evidenciar, que existe una relación morfológica semejante entre registros físicos artificiales de patrones papiloscópicos epidérmicos con dérmicos provenientes del mismo individuo. Esto permite utilizar los registros dérmicos para la identificación humana positiva. Los resultados de este trabajo son importantes al aportar evidencia científica para la identificación humana en base al patrón dactiloscópico dérmico.

Background: Age plays a crucial role in women fertility and is related with a decreased oocyte quality and quantity. The evidence for this asseveration comes from data obtained in infertile women. However there is a paucity of studies in patients with proven fertility evaluating ovarian reserve and its decline with time. Aim: To measure antral follicle count (AFC) in probed fertile patients and to create a distribution chart based on variables that may affect its natural decline. Material and Methods: Observational prospective study. A transvaginal ultrasound was made between menstrual cycle days 3 and 5, evaluating AFC in 100 patients, followed during a year. Results: Median antral follicle count media was 14.5 (interval 3 to 26). There was a lineal decline of AFC with age. Women with hypertension and type 2 diabetes mellitus had significantly less follicles. However, a multiple regression analysis showed that only women's age was a significant predictor of AFC (R2 = 0.84). Conclusions: There was a lineal relationship between AFC and age in women with probed fertility.

Objetivo: Determinar el valor promedio nacional del indicador COPD en los Servicios de Odontología de una red de salud nacional y privada en Chile en 2012. Métodos: La población estudiada alcanzó a nivel nacional los 648235 casos y la muestra seleccionada fue de 16421 individuos. El único criterio de exclusión fue la condición de registro electrónico (ficha clínica) incompleto para las variables estudiadas. Los datos fueron registrados en una matriz excel ad doc, y de manera codificada, resguardando con ello el secreto estadístico y los derechos de los pacientes. Los datos se presentaron en rangos de edad, según los criterios aplicados en Chile por el Ministerio de Salud. La valoración del indicador COPD se realizó con base en clasificación de la Organización Mundial de la Salud. Los estadígrafos aplicados fueron de tendencia central y dispersión. La asociación entre las variables estudiadas y el COPD se estimó mediante las pruebas de Chi-cuadrado de Pearson. En todos los casos se empleó un nivel de significancia de α≤0,05. Resultados: El valor promedio nacional fue 3,76 (moderado). Se encontró asociación significativa entre COPD y las variables edad, sexo femenino y diagnóstico curativo.

Objective: To determine the national average value of the COPD indicator in dentistry services of a private national health network in Chile, 2012. Methods: The study population reached 648,235 cases, with a selected sample of 16,421 individuals. Exclusion criteria were the incomplete electronic records (medical records)for the variables studied. Data were recorded in an Excel matrix, and are encrypted, thus protecting the statistical confidentiality and patients’ rights. The data were presented in age ranges, according to the criteria applied in Chile by the Ministry of Health. COPD indicator assessment was made based on classification of the World Health Organization. Statistical graphics applied were central tendency and dispersion. The association between the study variables and COPD, was estimated using the Pearson´s Chi-square test. In all cases we used a significance level of alpha <_ 0.05. Results: The national average was 3.76 (moderate). Significant association was found between COPD and the variables age, female gender and healing diagnosis.

摘要 目的 对比调查墨西哥城三个医疗设施的护士和医生提供的早期医疗堕胎服务的有效性、安全性和可接受性。 方法 我们对医生或护士提供的药物堕胎和避孕咨询服务进行了随机非劣效试验。参与者是寻求堕胎的70 天或更短妊娠期孕妇。药物堕胎方案是现场服用...

Резюме Цель Изучить эффективность, безопасность и переносимость раннего медикаментозного аборта, выполняемого фельдшерами в сравнении с акушерами, в трех у...

Résumé Objectif Examiner l'efficacité, la sécurité et l'acceptabilité de l'avortement médical précoce pratiqué par un(e) infirmier(ière) par rapport au même acte réalisé par un médecin dans trois établissements de la ville de Mexico. Méthodes Nous avons mené un essai de non-infériorité randomisé sur l'avortement médical et le conseil en matière de contraception pratiqués par des médecins ou des infirmiers. Les participantes étaient des femmes enceintes souhaitant avorter à un terme de grossesse de 70 jours ou moins. Le protocole de l'avortement médical était de 200 mg de mifépristone administrés sur place par voie orale, suivis de 800 μg de misoprostol auto-administrés par voie orale à la maison 24 ...

Objective To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City. Methods We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self–administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7–15 days later. We did an intention-to-treat analysis for risk differences between physicians’ and nurses’ provision for completion and the need for surgical intervention. Findings Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians’ provision and 97.9% (425/434) for nurses’ provision. The risk difference between the group was 0.5% (95% confidence interval, CI: −1.2% to 2.3%). There were no differences between providers for examined gestational duration or women’s contraceptive method uptake. Both types of providers were rated by the women as highly acceptable. Conclusion Nurses’ provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.

ملخص الغرض دراسة فعالية ومأمونية ومقبولية تقديم خدمات الإجهاض الطبي المبكر بواسطة الممرضات مقارنة بالأطباء في ثلاثة مرافق في مكسيكو سيتي. الطريقة أجرينا...

Resumen Objetivo Examinar la eficacia, seguridad y aceptabilidad de la actuación de los enfermeros en los abortos con medicamentos en fases tempranas de la gestación en tres centros de Ciudad de México en comparación con la actuación los médicos. Métodos Se llevó a cabo un ensayo de no inferioridad aleatorio sobre la realización de abortos médicos y asesoramiento anticonceptivo por parte de médicos o enfermeros. Las participantes fueron mujeres embarazadas que buscaban interrumpir una gestación de 70 días o menos. El régimen para el aborto con medicamentos consistió en 200 mg de mifepristona por vía oral, administrados en el centro, seguidos de 800 μg de misoprostol autoadministrados por vía oral en casa 24 horas más tarde. Se indicó a las mujeres que acudieran a la clínica para realizar un seguimiento entre 7 y 15 días más tarde. Se realizó un análisis por intención de tratar de las diferencias de riesgo entre la asistencia de los médicos y los enfermeros para el término y la necesidad de una intervención quirúrgica. Resultados De 1017 mujeres elegibles, se incluyeron 884 en el análisis por intención de tratar, 450 en el brazo atendido por médicos y 434 en el grupo atendido por enfermeros. De las mujeres que se sometieron al aborto con medicamentos, el 98,4 % (443/450) de las atendidas por médicos y el 97,9 % (425/434) de las atendidas por enfermeras no requirieron ninguna intervención quirúrgica. La diferencia de riesgo entre el grupo fue de 0,5 % (intervalo de confianza del 95 %: −1,2 % al 2,3 %). No hubo diferencias entre los proveedores para la duración de la gestación examinada o método anticonceptivo de las mujeres. Las mujeres calificaron ambos proveedores como muy aceptables. Conclusión Los enfermeros son tan seguros, aceptables y eficaces como los médicos a la hora de asistir un aborto con medicamentos. Autorizar a las enfermeras a realizar abortos con medicamentos puede ayudar a satisfacer la demanda de servicios para un aborto seguro.

Background: Intracoronary delivery of autologous bone marrow mononuclear cells is an interesting therapeutic promise for patients with heart failure of different etiologies. Aim: To evaluate the long-term safety and efficacy of this therapy in patients with dilated cardiomyopathy of different etiologies under optimal medical treatment. Patients and Methods: Prospective, open-label, controlled clinical trial. Of 23 consecutive patients, 12 were assigned to autologous bone marrow mononuclear cell intracoronary transplantation, receiving a mean dose of 8.19 ± 4.43 x 10(6) CD34+ cells. Mortality, cardiovascular readmissions and cancer incidence rate, changes in functional capacity, quality of life questionnaires and echocardiographic measures from baseline, were assessed at long-term follow-up (37.7 ± 9.7 months) in patients receiving or not the cells. Results: No significant differences were observed in mortality, cardiovascular readmissions or cancer incidence rate amongst groups. An improvement in functional class and quality of life questionnaires in the transplanted group was observed (p < 0.01). The treated group showed a non-significant increase in left ventricular ejection fraction at long-term follow-up (from 26.75 ± 4.85% to 34.90 ± 8.57%, p = 0.059 compared to baseline). There were no changes in left ventricular volumes. We observed no improvement of these variables in the control group. Conclusions: Intracoronary transplantation of autologous bone marrow mononuclear cells is feasible and safe in patients with dilated cardiomyopathy of diverse etiologies. This therapy was associated to persistent improvements in functional class and quality of life. There was also a non-significant long-term improvement of left ventricular function.

This work presents the topology optimization of bi-dimensional structures in plane stress state, considering a bidirectional scheme of optimization, incorporating a penalization parameter that maximizes the stiffness, considering the kinematic constraints. An open source code was implemented in MATLAB, with capabilities to find the optimal structures for a certain volume fraction, modified to obtain the optimal structure considering a limited or admissible displacement. Two classical problems in the literature are analyzed by introducing the developed concepts. The results obtained indicate that, for a particular state of charge, it is possible to define different configurations for maximum rigidity, depending on the displacement considered. Each one of these configurations is structured on the basis of compression and tension elements that resemble a lattice, with almost uniform tensional distribution in each element. The relevance of this work is that it allows you to display the existence of maximum configurations, depending on the limit or admissible displacement and how this converges to a structure with uniform stress levels.

Se presenta la optimización topológica de estructuras bidimensionales en estado de tensión plana, considerando un esquema de optimización bidireccional que incorpora un parámetro de penalización para maximizar la rigidez de la estructura considerando restricciones del tipo cinemático. Un código abierto de optimización topológica escrito en MATLAB® con capacidades de encontrar el óptimo para una fracción de volumen definida a priori, se modifica para obtener la estructura óptima cuando se impone un desplazamiento límite o admisible. Dos problemas clásicos de la literatura se analizan introduciendo los conceptos desarrollados. Los resultados obtenidos permiten concluir que para un estado particular de carga es posible definir distintas configuraciones de máxima rigidez dependiendo del desplazamiento considerado. Cada una de estas configuraciones se estructura a base de elementos en compresión y tracción que se asemejan a un enrejado, con distribuciones tensionales casi uniformes en cada elemento. La relevancia del presente trabajo radica en que permite visualizar la existencia de configuraciones de máxima rigidez dependiendo del desplazamiento límite o admisible elegido y como este converge hacia una estructura con tensiones uniformes.

Available medical therapy is unable to completely prevent or revert the pathological cardiac remodeling secondary to ischemia or other injuries, which is responsible for the development of heart failure. Regenerative medicine through stem cells had an explosive development in the cardiovascular area during the past decade. Stem cells possess the capacity to regenerate, repair or substitute damaged tissue, allowing the reestablishment of its function. Stem cells can also modulate apoptosis, angiogenesis, fibrosis and inflammation, favoring the endogenous regenerative process initiated by the damaged tissue. These capacities have been corroborated in several animal models of cardiovascular diseases with positive results. In humans, therapies with bone marrow mononuclear stem cells, mesenchymal stem cells and cardiac stem cells are safe. Most randomized clinical trials in patients with myocardial infarction or cardiomyopathies of different etiologies have reported benefits on ventricular function, quality of life and even over mortality of treated patients. This article reviews the state of art of stem cell therapy in cardiovascular diseases, focusing on the most common cellular types used in patients with acute myocardial infarction and chronic cardiomyopathies of different etiologies.

Embryo cryopreservation improves efficiency and security of assisted reproduction techniques. Nonetheless, it can be questionable, so it must be justified from technical, legal and ethical points of view. This article analyses these perspectives. Embryo cryopreservation maximizes the probability of pregnancy, avoids new ovary stimulations and reduces the occurrence of multiple gestations. There is consensus that the in vitro embryo deserves legal protection by its own, although not as a newborn. Very few countries prohibit embryo cryopreservation based on the legal duty to protect human life since fecundation. Those countries that allow it, privilege womenós reproductive rights. In Chile and in Latin America, no laws have been promulgated to regulate human assisted reproduction. The moral status of the embryo depends on how it is considered. Some believe it is a potential person while others think it is just a group of cells, but all recognize that it requires some kind of respect and protection. There is lack of information about the number of frozen embryos and their final destination. As a conclusion the authors propose that women or couples should have the right to decide autonomously, while institutions ought to be clear in their regulations. And the legislation must establish the legal status of the embryo before its implantation, the couplesó rights and the regulation of the embryo cryopreservation. Personal, institutional or legal decisions must assume a concept about the moral status of the human embryo and try to avoid their destruction or indefinite storage.

A 20 year old woman developed rapidly progressive heart failure 9 weeks after delivery. For a few weeks she was hypertensive. A severe systolic dysfunction with an EF of 12% was shown on echocardiography. She recovered on conventional treatment of congestive heart failure. Eventually she received bromocriptine con the basis of favorable literature reports. A follow up control at one year showed an asymptomatic patient, however severe systolic dysfunction with EF 18% was still present.

Se presenta el caso clínico de una mujer de 20 años que presenta insuficiencia cardíaca de rápida instalación, asociada a síntomas de infección respiratoria viral, 9 semanas post parto. Previamente había presentado hipertensión en el puerperio precoz. Se demostró una severa disfunción sistólica (FE 12%). Se recuperó con medidas convencionales del tratamiento de Insuficiencia cardíaca y finalmente recibió bromocriptina basado en reportes favorables de la literatura respecto del uso de este fármaco. En el control al año de su alta, se mantenía asintomática pero persistía severa disminución de la FE (18%) y dilatación de cavidades izquierdas. Se revisa la información acerca de esta patología.

A 24 year old man presented with severe thrombocytopenia. An intracardiac mass was shown to be a metastasis from a malignant testicular tumor. Resection of the primary tumor and the intracardiac metastasis led to full recovery of thrombocytopenia.

Se describe el caso de un hombre de 24 años que se presenta con Púrpura trombocitopénico, cuyo estudio ecocardiográfico y tomografía computada demostró masa tumoral ocupando las cavidades derechas. Se evidenció posteriormente un tumor testicular izquierdo con componentes de seminoma y teratoma. Se resecó el tumor testicular y posteriormente el tumor intracardíaco, con normalización del recuento plaquetario.

Background: In 2005, acute myocardial infarction (AMI) was included in a universal health plan (GES) to reduce inequity in care and optimize its diagnosis and treatment. Aim: To evaluate the effect of GES in risk factor control and therapeutic management among patients with AMI. Material and Methods: A survey was conducted in 2008-2009 in six public hospitals. Patients were identified from a hospital based registry of AMI and evaluated one year later with laboratory tests and an interview. Results: The registry enrolled 534 patients with ST and non ST segment elevation myocardial infarction. Of these, 416 patients aged 63 ± 12 years (25% women) were evaluated one year later. Eighty three percent were evaluated by a cardiologist and 37% by a general practitioner. Twenty two percent were evaluated by a nurse and 22% by a nutritionist. At the moment of the interview, 9% smoked, 78% were overweight or obese, 24% performed moderate or vigorous physical activity ≥ 150 min/week, 60% had systolic pressure > 130 mmHg and 63% a diastolic pressure > 80 mmHg. In 30%, LDL cholesterol was > 100 mg/dl and in 43%, triglycerides were > 150 mm/dl. Twenty two percent were diabetic and among them, 52% had a glycosilated hemoglobin > 7%. Forty five percent of non-diabetic patients had a fasting glucose > 100 mg/dl. Ninety three percent were in treatment with aspirin, 86% with statins, 66% with b-blockers, and 73% with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and 20% with clopidogrel. Conclusions: Despite the high proportion of patients in treatment with evidence-based therapy, many do not achieve the targets for risk factor control with the new health care model.

Background: Recent studies indicate that intra-coronary delivery of autologous bone marrow mono-nuclear cells (BMCs) improves the ejection fraction (LVEF) and other clinical markers in patients with heart failure (HF). Aim: To evaluate the safety and efficacy of intraco-ronary delivery of autologous BMCs in patients with HF in dilated phase under optimal medical treatment. Method: Of 23 consecutive patients who met the inclusion criteria, 12 were assigned to autologous BMCs intracoronary transplantation, receiving a mean dose of 8.19±4.43 x 106 CD34+ cells (BMCs group). The remaining patients received only standard therapy (control group). All patients were evaluated by Electrocardiogram, Echocardiography, Holter Monitoring, Cardiac Magnetic Resonance Imaging, Stress Testing, Ventricular Late potetials, Heart Rate Variability, and regular clinical examination at baseline and at follow-up (3, 6 and 12 months). Repeated measures ANOVA and Bonferroni testing were used for statistic analysis. Results: The BMCs group presented a significant increase in EF at sixth months (26.75±4.85 vs. 37.82±6.97%, p=0.001) and 12 months post-transplant (26.75±4.85 vs. 37.27±7.51%, p=0.002). There was a significant improvement in functional (NYHA) in the transplanted group at 6 and 12 months (p<0.001). There were no significant changes concerning left ventricular volumes, heart rate variability and exercise stress testing. We observed no improvement of these variables in the control group. There were no complications related to the BMCs transplant. Conclusions: Intracoronary infusion of auto-logous BMCs, in addition to standard therapy, was associated with significant improvement of left ventricular function at 12 months in patients with HF. We observed no complications relative to the procedure.

Introducción: Estudios recientes indican que el trasplante intracoronario de células mononucleares de médula ósea (BMCs) autólogas, mejoran la fracción de eyección (FEVI) y otros marcadores clínicos en pacientes con insuficiencia cardíaca (IC). Objetivo: Evaluar la seguridad y eficacia de la administración intracoronaria de BMCs autólogas, en pacientes con insuficiencia cardíaca (IC) en fase dilatada, de diferente etiología y en óptimas condiciones de tratamiento médico. Método: De 23 pacientes consecutivos que cumplieron con los criterios de inclusión, 12 fueron asignados a trasplante intracoronario de BMCs autólogas, recibiendo una dosis media de 8.19±4.43 x 10(6) células CD34+ (Grupo trasplantado). Los pacientes restantes sólo recibieron terapia estándar (Grupo control). Todos los pacientes fueron evaluados mediante Electrocardiograma, Ecocardiografía, Holter ECG, RMN Cardíaca, Test de esfuerzo, Potenciales Ventriculares Tardíos, Variabilidad de Frecuencia Cardíaca y evaluación clínica a los 0, 3, 6 y 12 meses. La capacidad funcional (CF) fue evaluada clínicamente y por cuestionarios de calidad de vida. Elanálisis estadístico fue realizado mediante Test Anova, y test de Bonferroni. Resultados: El grupo trasplantado presentó un aumento significativo de la FEVI a los 6 meses (26.75±4.85 vs 37.82±6.97%, p=0.001) mejoría que se mantuvo a los 12 meses (26.75±4.85 vs 37.27±7.51%, p=0.002). Hubo una mejora significativa de la CF en el grupo trasplantado a los 6 y 12 meses (p<0.001). No hubo cambios significativos en los volúmenes de ventrículo izquierdo, así como en las restantes variables estudiadas. En el grupo control no observamos cambios de estas variables. No hubo complicaciones en relación al trasplante de BMCs. Conclusión: En pacientes con IC severa y baja FEVI, el trasplante intracoronario de células BMCs au-tólogas, se asoció a una mejoría significativa de la FEVI y la CF, a los 6 y 12 meses. Adicionalmente, no observamos complicaciones en relación con el procedimiento, lo que confirma la seguridad del trasplante intracoronario de BMCs.