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Background: Chagas cardiomyopathy (CC) increases cardiovascular mortality associated with congestive heart failure (CHF), ventricular arrhythmias (VA), and sudden cardiac death (SCD). Different imaging techniques have been tested to assess disease progression and cardiac risk in individuals with Chagas disease (ChD). In this systematic review, we evaluated the accuracy in detecting cardiac complications in CC patients using cardiac magnetic resonance (CMR) and speckle tracking echocardiography (STE). Methods: A search was done on PubMed, Cochrane, and Embase for studies in humans over 18 years of age with ChD. Demographic data, research methodology, imaging parameters, and cardiac outcomes were extracted, and study quality was assessed, resulting in a narrative description. Results: Twelve studies with 1124 patients were analyzed. One study discovered a contractility pattern by STE. Four studies assessed the identification of Early Cardiac Impairment (ECI) and VA risk, respectively, while three studies evaluated the risk of SCD. Global Longitudinal Strain (GLS) identified patients with ECI (-18.5 ± 3.4% non-fibrosis vs -14.0 ± 5.8% fibrosis, p = 0.006 and -18 ± 2% non-fibrosis vs -15 ± 2% fibrosis, p = 0.004). The amount of fibrosis > 11.78% or in two or more contiguous transmural segments were markers for VA risk. GLS and the amount of fibrosis were found to be predictors of SCD. Conclusions: STE may be considered a screening technique for identifying the subclinical status of CHF. CMR using Late Gadolinium Enhancement (LGE) is considered a relevant parameter for stratifying patients with ChD who are at risk of SCD. Fibrosis and GLS can be used as markers to categorize patients at risk for arrhythmias.
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Locusts have been reported to elevate metabolic rate in response to high carbohydrate diets; this conclusion was based on metabolic rates calculated from CO2 production, a common practice for insects. However, respiratory exchange ratio (RER, CO2 production divided by O2 consumption) can rise above 1 as a result of de novo lipid synthesis, providing an alternative possible explanation of the prior findings. We studied the relationship between macronutrient ingestion, RER and lipid synthesis using South American locusts (Schistocerca cancellata) reared on artificial diets varying in protein:carbohydrate (p:c) ratio. RER increased and rose above 1 as dietary p:c ratio decreased. Lipid accumulation rates were strongly positively correlated with dietary carbohydrate content and ingestion. RERs above 1 were only observed for animals without food in the respirometry chamber, suggesting that hormonal changes after a meal may drive lipid synthesis. Schistocerca cancellata does not elevate metabolic rate on low p:c diets; in fact, the opposite trend was observed.
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Carbohidratos de la Dieta , Grasas de la Dieta , Animales , Dieta , Ingestión de Alimentos , Periodo PosprandialRESUMEN
Until recently, the stem gall nematode Pterotylenchus cecidogenus was only registered in eastern Colombia. However, the disease has recently been observed in central Colombian oil palm plantations that use Desmodium ovalifolium as a cover crop. Soil, root, stem, and leaf samples were collected from D. ovalifolium. Plants showed foliar yellowing, leaf drying, and galls within stem nodes. Nematodes were identified, and the distribution, population density, and relative importance of different genera were determined. We performed morphometric and molecular identification of nematodes associated with gall symptoms. The D2-D3 segment of the large subunit-28S of ribosomal ribonucleic acid (RNA) and internal transcribed spacer (ITS) was sequenced, and phylogenetic analysis was performed. P. cecidogenus mainly occurred in the galls and to a lesser extent in the roots and soil. Nematodes were not found in leaf or inflorescence tissue. Morphological and morphometric data confirm the presence of P. cecidogenus in the stems of D. ovalifolium with gall symptoms. This study is the first to report deoxyribonucleic acid (DNA) sequences of P. cecidogenus. Based on D2-D3 and ITS partial sequences, P. cecidogenus is a sister species of the leaf-galling nematode Ditylenchus phyllobius (Sinm. Orrina phyllobia).
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Locusts are major intermittent threats to food security and the ecological factors determining where and when these occur remain poorly understood. For many herbivores, obtaining adequate protein from plants is a key challenge. We tested how the dietary protein : non-structural carbohydrate ratio (p : c) affects the developmental and physiological performance of 4th-5th instar nymphs of the South American locust, Schistocerca cancellata, which has recently resurged in Argentina, Bolivia and Paraguay. Field marching locusts preferred to feed on high carbohydrate foods. Field-collected juveniles transferred to the laboratory selected artificial diets or local plants with low p : c. On single artificial diets, survival rate increased as foods became more carbohydrate-biased. On single local plants, growth only occurred on the plant with the lowest p : c. Most local plants had p : c ratios substantially higher than optimal, demonstrating that field marching locusts must search for adequate carbohydrate or their survival and growth will be carbohydrate-limited. Total body lipids increased as dietary p : c decreased on both artificial and plant diets, and the low lipid contents of field-collected nymphs suggest that obtaining adequate carbohydrate may pose a strong limitation on migration for S. cancellata. Anthropogenic influences such as conversions of forests to pastures, may increase carbohydrate availability and promote outbreaks and migration of some locusts.
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Carbohidratos de la Dieta , Conducta Alimentaria , Saltamontes/fisiología , Herbivoria , Plantas , Animales , Argentina , Bolivia , Dieta , ParaguayRESUMEN
Housing quality is crucially linked to health and sustainability goals, yet there is limited research on informal housing and settlements where housing quality is poor, and the health risks are expected to be greatest. This paper describes the investigation of housing conditions in a low-income resettlement colony in Delhi. A novel transdisciplinary methodology to evaluate multiple housing health hazards and establish intervention priorities in participation with the community was developed. Findings from housing surveys and indoor environmental monitoring were contrasted with a participatory self-assessment-revealing the widespread prevalence of hazards and suboptimal housing conditions as well as substantial differences in priorities, and thus perspectives, between participants and researchers. Focus group discussions explored the findings and built consensus on priorities. Our findings uncovered how poor housing conditions affect daily practices and thus are likely to adversely affect socio-economic development and gender equality. We highlight limitations in current frameworks to assess housing hazards and argue that a transdisciplinary approach is vital to provide a holistic understanding and to develop effective interventions. These insights are crucial to inform inclusive solutions for adequate housing and human settlements that can support improved health and help achieve the sustainable development goals.
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Salud , Vivienda , Áreas de Pobreza , Grupos Focales , Vivienda/normas , Humanos , India , PrevalenciaRESUMEN
The diversity and community structure of arbuscular mycorrhizal fungi (AMF) associated with coconut (Cocos nucifera) roots was evaluated by next generation sequencing (NGS) using partial sequences of the 18S rDNA gene and by spore isolation and morphological identification from rhizosphere soil. Root samples from six different Green Dwarf coconut plantations and from one organic plantation surrounded by tropical dry forest along the coastal sand dunes in Yucatan, Mexico, were collected during the rainy and dry seasons. In total, 14 root samples were sequenced with the Illumina MiSeq platform. Additionally, soil samples from the dry season were collected to identify AMF glomerospores. Based on a 95-97% similarity, a total of 36 virtual taxa (VT) belonging to nine genera were identified including one new genus-like clade. Glomus was the most abundant genus, both in number of VT and sequences. The comparison of dry and rainy season samples revealed differences in the richness and composition of AMF communities colonizing coconut roots. Our study shows that the main AMF genera associated with coconut tree roots in all samples were Glomus, Sclerocystis, Rhizophagus, Redeckera, and Diversispora. Based on glomerospore morphology, 22 morphospecies were recorded among which 14 were identified to species. Sclerocystis sinuosa, Sclerocystis rubiformis, Glomus microaggregatum, and Acaulospora scrobiculata were dominant in field rhizosphere samples. This is the first assessment of the composition of AMF communities colonizing coconut roots in rainy and dry seasons. It is of importance for selection of AMF species to investigate for their potential application in sustainable agriculture of coconut.
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Micorrizas , Biodiversidad , Cocos , Hongos , México , Raíces de Plantas , Estaciones del Año , Microbiología del SueloRESUMEN
The red ring nematode (Bursaphelenchus cocophilus (Cobb) Baujard 1989) has been registered in oil palm crops in the North, Central and Eastern zones of Colombia. In Tibu (North Santander), there are doubts regarding the diagnostic and identity of the disease. Oil palm crops in Tibu with the external and internal symptoms were inspected, and tissue samples were taken from different parts of the palm. The refrigerated samples were carried to the laboratory of Oleoflores in Tibu for processing. The light microscopy was used for the quantification and morphometric identification of the nematodes. Specimens of the nematode were used for DNA extraction, to amplify the segment D2-D3 of the large subunit of ribosomal RNA (28S) and perform BLAST and a phylogeny study. The most frequently symptoms were chlorosis of the young leaves, thin leaflets, collapsed, and dry lower leaves, beginning of roughening, accumulation of arrows and short leaves. Bursaphelenchus, was recovered in most of the tissues from the samples analyzed: stem, petiole bases, inflorescences, peduncle of bunches, and base of arrows in variable populations. The morphometric data and sequences obtained for the segment D2-D3 confirms to B. cocophilus as the causal agent of red ring disease on oil palms in the study area. For our knowledge, this study reports the first partial sequences of segment D2-D3 of B. cocophilus in oil palm in Colombia.
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Infección por Mycobacterium avium-intracellulare , Miositis , Humanos , Complejo Mycobacterium avium , Infección por Mycobacterium avium-intracellulare/complicaciones , Infección por Mycobacterium avium-intracellulare/diagnóstico , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Miositis/complicaciones , Miositis/diagnósticoRESUMEN
BACKGROUND: We sought to evaluate the effect of application of the revised 2010 Task Force Criteria (TFC) on the prevalence of major and minor Cardiovascular Magnetic Resonance (CMR) criteria for Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) versus application of the original 1994 TFC. We also assessed the utility of MRI to identify alternative diagnoses for patients referred for ARVC evaluation. METHODS: 968 consecutive patients referred to our institution for CMR with clinical suspicion of ARVC from 1995 to 2010, were evaluated for the presence of major and minor CMR criteria per the 1994 and 2010 ARVC TFC. CMR criteria included right ventricle (RV) dilatation, reduced RV ejection fraction, RV aneurysm, or regional RV wall motion abnormalities. When quantitative measures of RV size and function were not available, and in whom abnormal size or function was reported, a repeat quantitative analysis by 2 qualified CMR physicians in consensus. RESULTS: Of 968 patients, 220 (22.7%) fulfilled either a major or a minor 1994 TFC, and 25 (2.6%) fulfilled any of the 2010 TFC criterion. Among patients meeting any 1994 criteria, only 25 (11.4%) met at least one 2010 criterion. All patients who fulfilled a 2010 criteria also satisfied at least one 1994 criterion. Per the 2010 TFC, 21 (2.2%) patients met major criteria and 4 (0.4%) patients fulfilled at least one minor criterion. Eight patients meeting 1994 minor criteria were reclassified as satisfying 2010 major criteria, while 4 patients fulfilling 1994 major criteria were reclassified to only minor or no criteria under the 2010 TFC.Eighty-nine (9.2%) patients had alternative cardiac diagnoses, including 43 (4.4%) with clinically significant potential ARVC mimics. These included cardiac sarcoidosis, RV volume overload conditions, and other cardiomyopathies. CONCLUSIONS: Application of the 2010 TFC resulted in reduction of total patients meeting any diagnostic CMR criteria for ARVC from 22.7% to 2.6% versus the 1994 TFC. CMR identified alternative cardiac diagnoses in 9.2% of patients, and 4.4% of the diagnoses were potential mimics of ARVC.
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Displasia Ventricular Derecha Arritmogénica/diagnóstico , Ventrículos Cardíacos/patología , Imagen por Resonancia Magnética/normas , Miocardio/patología , Adulto , Displasia Ventricular Derecha Arritmogénica/clasificación , Displasia Ventricular Derecha Arritmogénica/epidemiología , Displasia Ventricular Derecha Arritmogénica/patología , Displasia Ventricular Derecha Arritmogénica/fisiopatología , Medios de Contraste , Diagnóstico Diferencial , Femenino , Adhesión a Directriz , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Derecha/diagnóstico , Hipertrofia Ventricular Derecha/epidemiología , Hipertrofia Ventricular Derecha/patología , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Volumen Sistólico , Disfunción Ventricular Derecha/diagnóstico , Disfunción Ventricular Derecha/epidemiología , Disfunción Ventricular Derecha/patología , Función Ventricular DerechaRESUMEN
The Environmental Protection Agency (EPA) of the United States recently released the first-ever federal regulation on per- and polyfluoroalkyl substances (PFASs) for drinking water. While this represents an important landmark, it also brings about compliance challenges to the stakeholders in the drinking water industry as well as concerns to the general public. In this work, we address some of the most important challenges associated with measuring low concentrations of PFASs in drinking water in the field in real drinking water matrices. First, we review the "continuous monitoring for compliance" process laid out by the EPA and some of the associated hurdles. The process requires measuring, with some frequency, low concentrations (e.g., below 2 ppt or 2 ng/L) of targeted PFASs, in the presence of many other co-contaminants and in various conditions. Currently, this task can only (and it is expected to) be accomplished using specific protocols that rely on expensive, specialized, and laboratory-scale instrumentation, which adds time and increases cost. To potentially reduce the burden, portable, high-fidelity, low-cost, real-time PFAS sensors are desirable; however, the path to commercialization of some of the most promising technologies is confronted with many challenges, as well, and they are still at infant stages. Here, we provide insights related to those challenges based on results from ab initio and machine learning studies. These challenges are mainly due to the large amount and diversity of PFAS molecules and their multifunctional behaviors that depend strongly on the conditions of the media. The impetus of this work is to present relevant and timely insights to researchers and developers to accelerate the development of suitable PFAS monitoring systems. In addition, this work attempts to provide water system stakeholders, technicians, and even regulators guidelines to improve their strategies, which could ultimately translate in better services to the public.
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Background: To assess the diagnostic accuracy of the Mayo Clinic echocardiographic criteria for differentiating between constrictive pericarditis and restrictive cardiomyopathy. Methods: We searched electronic databases for the date range from their inception to July 1, 2022. The index tests were the Mayo Clinic echocardiographic criteria. We performed a bivariate random-effects model to estimate the pooled sensitivity and specificity, each with 95% confidence interval (CI). The area under the curve of the summary receiver operator characteristic curves, with 95% CI, was also calculated. Results: We included 17 case-control studies involving 889 patients. The pooled sensitivity and specificity (95% CI), respectively, were as follows: ventricular septal shift, 82% (60%-94%) and 78% (65%-87%); respiratory variation in mitral inflow ≥ 14.6%, 71% (51%-85%) and 82% (66%-91%); septal e' velocity ≥ 8 cm/s, 83% (80%-87%) and 90% (83%-95%); septal e' velocity/lateral e' velocity ≥ 0.88, 74% (64%-82%) and 81% (70%-88%); and hepatic vein ratio in expiration ≥ 0.79, 73% (65%-81%) and 71% (19%-96%). The area under the curve of the summary receiver operator characteristic curves varied from 0.75 to 0.85, with overlapping CIs across index tests. Conclusions: Our meta-analysis suggests that all echocardiographic parameters from the Mayo Clinic criteria have good diagnostic accuracy for differentiating between constrictive pericarditis and restrictive cardiomyopathy.
Contexte: Évaluation de l'exactitude diagnostique des critères échocardiographiques de la clinique Mayo visant à faire la distinction entre une péricardite constrictive et une cardiomyopathie restrictive. Méthodologie: Nous avons effectué une recherche dans des bases de données électroniques pour la période s'étendant de leur date de création au 1er juillet 2022. Les tests de concordance portaient sur les critères échocardiographiques de la clinique Mayo. Nous avons réalisé un modèle à effets aléatoires et à deux variables afin d'estimer la sensibilité et la spécificité en fonction des données regroupées, chacune avec un intervalle de confiance (IC) à 95 %. L'aire sous la courbe des courbes caractéristiques sommaires de la performance du test, avec un IC à 95 %, a également été calculée. Résultats: Nous avons inclus 17 études cas-témoins comptant 889 patients. Selon les données groupées, la sensibilité et la spécificité (IC à 95 %), respectivement, étaient les suivantes : déplacement du septum interventriculaire, 82 % (60 à 94 %) et 78 % (65 à 87 %); variation respiratoire lors du remplissage mitral ≥ 14,6 %, 71 % (51 à 85 %) et 82 % (66 à 91 %); vitesse eʹ mesurée en septal ≥ 8 cm/s, 83 % (80 à 87 %) et 90 % (83 à 95 %); rapport vitesse eʹ mesurée en septal/vitesse eʹ mesurée en latéral ≥ 0,88, 74 % (64 à 82 %) et 81 % (70 à 88 %); et rapport veineux hépatique lors de l'expiration ≥ 0,79, 73 % (65 à 81 %) et 71 % (19 à 96 %). L'aire sous la courbe des courbes caractéristiques sommaires de la performance du test variait de 0,75 à 0,85, avec des IC se chevauchant dans les tests de concordance. Conclusions: Notre méta-analyse laisse entendre que tous les paramètres échocardiographiques de la clinique Mayo ont une bonne exactitude diagnostique pour faire la distinction entre la péricardite constrictive et la cardiomyopathie restrictive.
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Background: We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. Methods: We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). Results: The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71 years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39 mL/kg/min, I2 = 0%) in the EBTP group compared to the control group. Conclusion: The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.
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Locusts are grasshoppers that migrate en masse and devastate food security, yet little is known about the nutritional needs of marching bands in nature. While it has been hypothesized that protein limitation promotes locust marching behavior, migration is fueled by dietary carbohydrates. We studied South American Locust (Schistocerca cancellata) bands at eight sites across Argentina, Bolivia, and Paraguay. Bands ate most frequently from dishes containing carbohydrate artificial diets and minimally from balanced, protein, or control (vitamins and salts) dishes-indicating carbohydrate hunger. This hunger for carbohydrates is likely explained by the observation that local vegetation was generally protein-biased relative to locusts' preferred protein to carbohydrate ratio. This study highlights the importance of studying the nutritional ecology of animals in their environment and suggests that carbohydrate limitation may be a common pattern for migrating insect herbivores.
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Background: After percutaneous coronary intervention (PCI), clopidogrel resistant patients are at an increased risk of major adverse cardiovascular and cerebrovascular events (MACCEs). We aimed to assess whether genotype-guided selection of oral antiplatelet drugs using a clinical decision support (CDS) algorithm reduces the occurrence of these ischemic events and improves outcomes among Caribbean Hispanic patients from Puerto Rico, who are underrepresented in clinical pharmacogenomic (PGx)-guided implementation studies. Methods: Individual platelet function testing (PRU) measures, CYP2C19*2 and PON1 rs662 genotypes, clinical and demographic data from 8 medical facilities were included. Patients were separated into standard of care (SoC) and genotype-guided groups (150 each). Risk scores were calculated based on a previously developed CDS risk prediction algorithm designed to make actionable treatment recommendations for each patient. Alternative therapy with ticagrelor was recommended for patients with a high risk score ≥2. Statistical associations between patient time free of MACCEs and predictor variables (i.e., treatment groups, risk scores) were tested in this population using Kaplan-Meier survival analyses and Cox proportional-hazards regression models. Results: Median age of participants is 67 years; BMI: 27.8; 48% women; 14% smokers; 59% with type-2 diabetes mellitus (T2DM). Among patients with high-risk scores who were free from MACCE events 6 months after coronary stenting, genotype-driven guidance of antiplatelet therapy showed superiority over SoC in terms of reducing the incidence rate of atherothrombotic events. Conclusions: The clinical utility of our PGx-driven CDS algorithm to reduce the incidence rate of MACCEs among post-PCI Caribbean Hispanic patients on clopidogrel was externally demonstrated. Clinical Trial Registration Unique Identifier: NCT03419325.
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At high density, juvenile locusts create marching hopper bands. Understanding the roles of temperature and vegetation on the movement of these bands shall allow to better forecast and control them. Following a hopper band in North Argentina in November 2019, we explored the thermoregulation behaviours of the South American locust, Schistocerca cancellata. Gut-content samples informed about the feeding status at different time of the day. Hoppers' body temperature was above cold air temperature in the mornings during basking and group-basking activities and before the onset of marching behaviour. Marching by walking or hopping was dominant at body temperatures close to 40 °C. Jumping, stilting, shading and perching on plants were seen as thermoregulatory behaviours to avoid ground temperatures above 50 °C. Feeding was observed throughout the day with continuous high gut contents despite an intermittent pattern of feeding-resting-marching. Speed and daily travelled distance of the front of the hopper band was depending on the type of encountered vegetation. Daily behavioural patterns, thermoregulatory behaviours, walking speed and daily travelled distances of S. cancellata were similar to the ones observed for the Desert locust, S. gregaria, in Africa. High air temperatures recorded during the observation times could explain the continuous feeding patterns. These species may have evolved behaviours of alternating consuming a bit and marching as a migration strategy to avoid staying where no food is available after the havoc left behind large hopper bands. Recommendations made for the control of Desert locust hopper bands can be extended to South American locust ones.
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Saltamontes , Animales , Regulación de la Temperatura Corporal , Conducta Alimentaria , Plantas , TemperaturaRESUMEN
A 35-year-old female presented to our emergency department with clinical signs of acute heart failure. Clinical workup identified severe right heart (RH) dilation and dysfunction with a crossing membrane structure in the right atrium. Right heart catheterization confirmed high output heart failure (HOHF), pulmonary hypertension (PH), and left-to-right blood shunting followed by the documentation of multiple liver and pulmonary arteriovenous malformations (AVMs). Hereditary Hemorrhagic Telangiectasia (HHT) diagnosis was made according to clinical criteria and was established as the cause of HOHF because of chronic volume overload from systemic to pulmonary shunts. With this illustrative case, we aim to discuss the broad spectrum of clinical manifestations of HHT and the unusual phenotype of HOHF secondary to HHT. This case also highlights the broad diagnosis of atrial echocardiographic abnormalities and cardiac structural distortion secondary to high output that can be misleading at imaging evaluation.
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The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation that in turn has an impact on morbidity and mortality. Echocardiography is necessary to grade tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair or replacement in severe cases. The aims of this review are to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation and the benefits of using three-dimensional echocardiography with some technical considerations and to propose a treatment algorithm.
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Desfibriladores Implantables , Marcapaso Artificial , Insuficiencia de la Válvula Tricúspide , Humanos , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Marcapaso Artificial/efectos adversos , Válvula Tricúspide , Desfibriladores Implantables/efectos adversos , ElectrónicaRESUMEN
Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.
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Trasplante de Corazón , Función Ventricular Izquierda , Adulto , Colombia , Trasplante de Corazón/efectos adversos , Ventrículos Cardíacos , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Centros de Atención TerciariaRESUMEN
Reader Q: There was no morphological information provided for the isolated specimens, and so it is not known if they are even Ganoderma [...].