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Introduction: in Mexico, tobacco and alcohol consumption represent a public health problem. Screening, brief intervention, and treatment models had shown effectiveness to reduce substances use, which is why they have been widely used in a variety of settings. The proximity of trained human resources with consumption problems and diverse situations is one of the most important opportunities they offer. Despite the extensive experience in developing these models, they have been poorly adapted for use by medical and health personnel at the first level of care. Objective: describe barriers and opportunities encountered during the operational implementation of a pilot project for screening, brief counseling and treatment aimed at medical personnel and related to the first level of health care in a Sanitary Jurisdiction of the State of Mexico. Method: two focus groups were carried out on a randomized sample of 15 of 64 certified health professionals who developed practical experience performing interventions with the population of their Health Establishment. Results: communication, personal and organizational barriers were found, however, opportunities that emerged from the implementation of this intervention model were also identified. Discussion and conclusions: the implementation of these interventions in the first level of care has various advantages for the personnel who apply them and the population that receives it, among which the increase in productivity of the screening and brief counseling actions reported in the System of Health Information as well as the opportunity to provide the user a personalized intervention specifically focused on their local population-based problems. ---------- Introducción: en México el consumo de tabaco y alcohol representa un problema de salud pública. Modelos de tamizaje, intervención breve y referencia a tratamiento han mostrado eficacia en disminuir dicho consumo, por lo que se emplean en distintos escenarios. Una de sus características más importantes es la cercanía de los profesionales con las situaciones y problemáticas sobre el consumo. Pese a la amplia experiencia en el desarrollo de estos modelos, han sido poco adaptados para su uso en personal médico y de salud en el primer nivel de atención. Objetivo: describir barreras y oportunidades encontradas durante la implementación de un proyecto piloto de tamizaje, consejería breve y referencia a tratamiento dirigido al personal médico y afín del primer nivel de atención en salud. Método: se realizaron dos grupos focales en una muestra aleatorizada de 15 profesionales de salud certificados de un total de 64, que desarrollaron experiencia práctica realizando intervenciones con la población de su establecimiento de salud. Resultados: se encontraron diversas barreras de comunicación, personales y organizacionales; sin embargo, también se identificaron oportunidades que emergen de la implementación de este modelo. Discusión y conclusiones: el uso de intervenciones breves en el primer nivel de atención tiene ventajas para quien las aplica y las recibe, como el incremento en la productividad de las acciones de tamizaje y consejería breve reportadas en el Sistema de Información en Salud, así como la oportunidad de brindar al usuario una intervención personalizada enfocada específicamente en los problemas de la población local.

Coronary lithoplasty (CL) is a balloon-based technique used to treat calcified lesions. This study reports the initial experience of treatment of calcified lesions with CL in an unselected and high-risk population.This was a prospective, multicenter registry, which included all consecutive cases with calcified coronary lesions that underwent CL between August, 2018 and August, 2019. Exclusion criteria consisted of a target lesion located in a small vessel (2.5mm) and the presence of dissection prior to CL. Quantitative coronary angiography and intravascular ultrasound/optical coherence tomography analysis were completed by an independent central core laboratory.This registry included 57 patients (66 lesions). The population was elderly (72.6±9.4 years) with high proportions of patients with diabetes (56%), chronic kidney disease (35%), and multivessel disease (84%). All lesions were classified as type B/C. More than 75% of lesions were predilated with noncompliant/semicompliant balloons or cutting-balloon. Rotablator was used in 5 lesions (7.6%) prelithoplasty. On average, CL required 1.17 balloons delivering a mean of 60 pulses. Successful CL was achieved in 98%. In 13% of cases, lithoplasty balloon was broken during therapy. There were few procedural complications: 2 cases of significant dissections (none related to lithoplasty balloon rupture) were successfully treated with drug-eluting stent implantation. One patient experienced stent thrombosis 2 days after successfully undergoing target lesion revascularization.This is a real-world multicenter registry, which supports the feasibility, safety, and short-term efficacy of PCI for calcified coronary lesions using CL in an unselected and high-risk population with promising results.

Introduction and objectives: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. Methods: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. Results: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 +/- 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score 20 mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%. Conclusions: Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality. (C) 2018 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.

We present the case of a 47 year old patient with a history of bicuspid aortic valve disease, severe symptomatic stenosis and dilation of the ascending aorta who underwent an aortic root reconstruction using the Bentall procedure. Two years after surgery, asymptomatic until then, the patient experienced general discomfort with progressive dyspnea, orthopnea and atypical chest pain for 1 month. The evolution was slow, gradually evolving to dyspnea on minimal effort. An electrocardiogram (ECG) revealed diffuse subendocardial injury and increased biomarkers (troponin I 31.6 ng/mL; creatine kinase-MB 147 IU/L) and the patient was referred to our center for an emergency coronary angiogram. Our initial examination found the following: the patient was generally unstable, hypotensive (90/60 mmHg) and tachycardia, no fever, dyspnea at rest, grade 3/6 aortic systolic murmur radiating to the carotids, ECG showing ST depression in V3-V6 and leukocytosis (29 000/mL). A transthoracic echocardiogram was performed, revealing abnormal movement of the prosthetic ring (Pr) suggesting dehiscence with grade III/IV periprosthetic aortic regurgitation. The study was completed with a real-time 3-dimensional transoesophageal echocardiography. We observed complete prosthetic valve dehiscence (Fig. 1) and a periprosthetic cavity at the level of the aortic root, corresponding to a pseudoaneurysm (Ps) with an internal flow and systolic collapse of the prosthetic conduit (PC) (Fig. 2). Emergent surgery was performed, which confirmed the echocardiographic findings (Fig. 3). The aortic valve conduit was replaced. Blood cultures were positive for Enteroccus faecalis, and the patient therefore completed 6 weeks of antibiotic treatment with ampicillin and streptomycin. Postoperative progress was good with no complications. (*) Area of dehiscence Hospital Son Dureta-Echocardiology