Human recombinant relaxin-2 (serelaxin) regulates the proteome, lipidome, lipid metabolism and inflammatory profile of rat visceral adipose tissue.

Recombinant human relaxin-2 (serelaxin) has been widely proven as a novel drug with myriad effects at different cardiovascular levels, which support its potential therapeutic efficacy in several cardiovascular diseases (CVD). Considering these effects, together with the influence of relaxin-2 on adipocyte physiology and adipokine secretion, and the connection between visceral adipose tissue (VAT) dysfunction and the development of CVD, we could hypothesize that relaxin-2 may regulate VAT metabolism. Our objective was to evaluate the impact of a 2-week serelaxin treatment on the proteome and lipidome of VAT from Sprague-Dawley rats. We found that serelaxin increased 1 polyunsaturated fatty acid and 6 lysophosphatidylcholines and decreased 4 triglycerides in VAT employing ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) based platforms, and that regulates 47 phosphoproteins using SWATH/MS analysis. Through RT-PCR, we found that serelaxin treatment also caused an effect on VAT lipolysis through an increase in the mRNA expression of hormone-sensitive lipase (HSL) and a decrease in the expression of adipose triglyceride lipase (ATGL), together with a reduction in the VAT expression of the fatty acid transporter cluster of differentiation 36 (Cd36). Serelaxin also caused an anti-inflammatory effect in VAT by the decrease in the mRNA expression of tumor necrosis factor α (TNFα), interleukin-1ß (IL-1ß), chemerin, and its receptor. In conclusion, our results highlight the regulatory role of serelaxin in the VAT proteome and lipidome, lipolytic function, and inflammatory profile, suggesting the implication of several mechanisms supporting the potential benefit of serelaxin for the prevention of obesity and metabolic disorders.

Impact of the Spanish consensus for improving lipid control on patients admitted for an acute coronary syndrome.

INTRODUCTION: In 2020, the Spanish Society of Cardiology published a consensus to improve lipid control in secondary prevention patients. This study was aimed to assess the impact of the implementation of this consensus in clinical practice. METHODS: Non-interventional, national and multicenter study, with a prospective and retrospective design in two cohorts. Implementation of the consensus was performed on the prospective cohort. Prospective cohort included patients with acute coronary syndrome (ACS) from December 2020 to March 2022 and were followed-up for 3 months. Retrospective cohort included patients with ACS in the same hospital, matched for main baseline clinical characteristics, between August 2019 to February 2020, with a follow-up of 3 months. Additionally, patients were included if they had previously received lipid-lowering therapy and LDL cholesterol (LDL-C) was >55 mg/dL. RESULTS: A total of 516 patients were included (245 in the prospective cohort and 271 in the retrospective cohort). Overall, mean age was 67.9 ± 11.4 years, 73.8 % were men, and 35.8 % had diabetes. At discharge, 98.4 % and 98.9 %, respectively (P = 0.71) were taking statins (90.6% vs 88.9 %; P = 0.564 high intensity statins), 58.4% vs 33.2 %; P<0.001 ezetimibe, 1.2% vs 0.4 %; P = 0.35 PCSK9 inhibitors. During the follow-up, the dose of statins was increased in 11.4% vs 3.3 % (P<0.001), and ezetimibe was added in 25.7% vs 25.8 % (P = 0.976). At study end, significantly more patients achieved LDL-C <55 mg/dL in the prospective cohort (45.6% vs 33.5 %; P = 0.013). CONCLUSIONS: The implementation of the Spanish lipid consensus was associated with a significant improvement of LDL-C control after only 3 months.

Rational design of biocatalysts based on covalent immobilization of acylase enzymes.

Acylases catalyze the hydrolysis of amide bonds. Penicillin G acylase (PGA) is used for the semi-synthesis of penicillins and cephalosporins. Although protein immobilization increases enzyme stability, the design of immobilized systems is difficult and usually it is empirically performed. We describe a novel application of our strategy for the Rational Design of Immobilized Derivatives (RDID) to produce optimized acylase-based immobilized biocatalysts for enzymatic bioconversion. We studied the covalent immobilization of the porcine kidney aminoacylase-1 onto aldehyde-based supports. Predictions of the RDID1.0 software and the experimental results led to the selection of glyoxyl-Sepharose CL 4B support and pH 10.0. One of the predicted clusters of reactive amino groups generates an enzyme-support configuration with highly accessible active sites, contributing with 82% of the biocatalyst's total activity. For Escherichia coli PGA, the predictions and experimental results show similar maximal amounts of immobilized protein and activity at pH 8.0 and 10.0 on glyoxyl-Sepharose CL 10B. However, thermal stability of the immobilized derivative is higher at pH 10.0 due to an elevated probability of multipoint covalent attachment. In this case, two clusters of amino groups are predicted to be relevant for PGA immobilization in catalytically competent configurations at pH 10.0, showing accessible active sites and contributing with 36% and 44% of the total activity, respectively. Our results support the usefulness of the RDID strategy to model different protein engineering approaches (site-directed mutagenesis or obtainment of fusion proteins) and select the most promising ones, saving time and laboratory work, since the in silico-designed modified proteins could have higher probabilities of success on bioconversion processes.

The lipidomic and inflammatory profiles of visceral and subcutaneous adipose tissues are distinctly regulated by the SGLT2 inhibitor empagliflozin in Zucker diabetic fatty rats.

The pharmacological inhibition of sodium-glucose cotransporter 2 (SGLT2) has emerged as a treatment for patients with type 2 diabetes mellitus (T2DM), cardiovascular disease and/or other metabolic disturbances, although some of the mechanisms implicated in their beneficial effects are unknown. The SGLT2 inhibitor (SGLT2i) empagliflozin has been suggested as a regulator of adiposity, energy metabolism, and systemic inflammation in adipose tissue. The aim of our study was to evaluate the impact of a 6-week-empagliflozin treatment on the lipidome of visceral (VAT) and subcutaneous adipose tissue (SAT) from diabetic obese Zucker Diabetic Fatty (ZDF) rats using an untargeted metabolomics approach. We found that empagliflozin increases the content of diglycerides and oxidized fatty acids (FA) in VAT, while in SAT, it decreases the levels of several lysophospholipids and increases 2 phosphatidylcholines. Empagliflozin also reduces the expression of the cytokines interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor-alpha (TNFα), monocyte-chemotactic protein-1 (MCP-1) and IL-10, and of Cd86 and Cd163 M1 and M2 macrophage markers in VAT, with no changes in SAT, except for a decrease in IL-1ß. Empagliflozin treatment also shows an effect on lipolysis increasing the expression of hormone-sensitive lipase (HSL) in SAT and VAT and of adipose triglyceride lipase (ATGL) in VAT, together with a decrease in the adipose content of the FA transporter cluster of differentiation 36 (CD36). In conclusion, our data highlighted differences in the VAT and SAT lipidomes, inflammatory profiles and lipolytic function, which suggest a distinct metabolism of these two white adipose tissue depots after the empagliflozin treatment.

Modeling and Experimental Validation of Algorithms for Maximum Quantity of Protein to be Immobilized on Solid Supports by Electrostatic Adsorption in the Strategy of Rational Design of Immobilized Derivatives.

Protein immobilization by electrostatic adsorption to a support could represent a good option. On the other hand, lysozyme (EC 3.2.1.17) is a little and basic protein. The objective of this work was to test the functionality of the strategy of Rational Design of Immobilized Derivatives for the immobilization by electrostatic adsorption of egg white lysozyme on SP-Sepharose FastFlow support. The RDID1.0 software was used to predict the superficial lysozyme clusters, the electrostatic configuration probability for each cluster, and the theoretical and estimated maximum quantity of protein to be immobilized. In addition, immobilization was performed and the experimental parameter practical maximum quantity of protein to be immobilized and the enzymatic activity of the immobilized derivative were assessed. The estimated maximum quantity of protein to be immobilized (9.49 protein mg/support g) was close to the experimental practical maximum quantity of protein to be immobilized (14.73 ± 0.09 protein mg/support g). The enzymatic activity assay with the chitosan substrate showed the catalytic functionality of the lysozyme-SP-Sepharose immobilized derivative (35.85 ± 3.07 U/support g), which preserved 78% functional activity. The used algorithm to calculate the estimated maximum quantity of protein to be immobilized works for other proteins, porous solid supports and immobilization methods, and this parameter has a high predictive value, useful for obtaining optimum immobilized derivatives. The applied methodology is valid to predict the most probable protein-support configurations and their catalytic competences, which concur with the experimental results. The produced biocatalyst had a high retention of functional activity. This indicates its functionality in enzymatic bioconversion processes.

May Measurement Month 2019: an analysis of blood pressure screening results from Venezuela, Latin America.

Cardiovascular diseases are the main cause of death in Venezuela. Raised blood pressure (BP) accompanied by diabetes mellitus, obesity, lipid abnormalities, and tobacco usage are the biggest contributors to mortality. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. MMM2019 included 24 672 subjects (mean age: 54.7 years, SD 25.2, 63.1% female). The proportion with hypertension was 48.9%; 14.3% were unknown hypertensives, 35.5% of those who receiving treatment had uncontrolled hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg); when considering all hypertensives, 53.3% were controlled. Sixty per cent of those on anti-hypertensive medication were on monotherapy, 27.7% were on two, and 7.7% were on three or more drugs. Body mass index, calculated for the total population, was on average 25.6 (SD: 4.8) kg/m2. 16.2% of participants were classified as obese, 34.0% as overweight, and 4.0% were classified as underweight. Diabetes mellitus was reported by 9.4%, smoking by 7.3%, and 10.5% reported drinking alcohol regularly. Conditions associated with higher BP levels were obesity, diabetes mellitus, and women with a history of hypertension during a previous pregnancy. These results are consistent with the two previous MMM campaigns and indicate that repeated screening can routinely identify hypertension. There is an urgent need for Venezuela to implement programmes of detection, treatment, and control not only for hypertension but also for other common cardiovascular risk factors.

Results of May Measurement Month 2018 campaign in Venezuela.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the main cause of death in Venezuela; hypertension is the primary risk factor. The May Measurement Month (MMM) study is a global initiative aimed at raising awareness of elevated blood pressure (BP). The previous MMM 2017 campaign showed 48.9% of participants had hypertension, higher than previous Venezuelan epidemiological studies. The MMM 2018 campaign included 28 649 participants screened [mean age: 54.2 (SD 15.13) years; female 62.8%] carried out mainly in pharmacies in 61 sites. Physical measurements included height, weight, and BP, taken in sitting position three times. After multiple imputations, 48.4% had hypertension, of which 87.7% were aware of their diagnosis. Of the individuals not receiving antihypertensive medication, 14.0% had hypertension and 33.7% of those receiving treatment had uncontrolled hypertension. Overall, the percentage of hypertensives with controlled hypertension was 54.8%. Body mass index was calculated for the total population, and it was on average 25.2 (SD: 4.65) kg/m2. Of all, 14.2% was classified as obese and 32.6% as overweight; meanwhile 4.8% as underweight. Diabetes was reported by 9.5%. These results suggest that repeated screening like the MMM campaign can routinely identify hypertension and consequently implement programmes of treatment in Venezuela, also other common risk factors, like obesity or diabetes.

Short-course antibiotic regimen compared to conventional antibiotic treatment for gram-positive cocci infective endocarditis: randomized clinical trial (SATIE).

BACKGROUND: Most serious complications of infective endocarditis (IE) appear in the so-called "critical phase" of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. METHODS: Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4-6 weeks). SAMPLE: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. INTERVENTION: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. CONCLUSIONS: SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4-6 weeks). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019-003358-10.

Results of the May Measurement Month 2017: blood pressure campaign in Venezuela-Americas.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the first cause of death in Venezuela; and hypertension is the main risk factor. May Measurement Month (MMM) is a global initiative aimed at raising awareness of elevated blood pressure (BP) and to act as a temporary solution to the lack of regular screening programmes. Some representative studies indicate prevalence of hypertension in Venezuela between 24 and 39%, and control rate around 20%. Sixty-four sites were included to participate in MMM, mainly in pharmacies. Physical measurements included height, weight, and abdominal circumference. Blood pressure was measured in the sitting position three times after resting for 5 min, 1 min apart, using validated oscillometric devices. 21 644 individuals were screened. After multiple imputation, 10 584 individuals [48.9% (50.7% male; 47.7% female)] had hypertension. Of individuals not receiving antihypertensive medication, 1538 (12.2%) were hypertensive. Of individuals receiving antihypertensive medication, 2974 (32.9%) had uncontrolled BP. About 16% had obesity calculated by body mass index; 43.8% of women and 20.7% of men had abdominal obesity. This was the largest BP screening carried out in Venezuela, in which 48.9% of the individuals had elevated BP, untreated hypertension was 12.2%, and one-third of subjects taking treatment were not controlled. About 16% had obesity by body mass index, and abdominal obesity is more common in women. These results suggest that repeated screening like MMM17 can identify hypertension in important numbers and can also evaluate programmes of hypertension treatment and control in Venezuela.

Proposal of a novel clinical score to predict heart failure incidence in long-term survivors of acute coronary syndromes.

INTRODUCTION: HF remains a frequent complication following MI and adversely affects prognosis. The objective of this study was to identify predictors of HF following MI and to design a risk score for its prediction. METHODS: Retrospective study of all consecutive patients admitted for MI. Primary end point was time to incident HF. Patients with previous history of HF were excluded. Death was modelled as competing risk. RESULTS: 5737 patients were included. Mean age was 66.32±12.80. During a median follow-up of 47.0months (23.0-73.0), 686 patients (12%) developed HF. Age, diabetes mellitus, peripheral artery disease, renal insufficiency, chronic obstructive pulmonary disease, persistent atrial fibrillation, haemoglobin, troponin peak, diuretic at admission, ventricular function, and revascularization were independent predictors for HF development. According to this multivariate regression analysis, we developed a novel score that allows for the identification of patients at high (≥16), medium (9-15) and low risk (<9) for HF development, with an AUC of 0.77 (IC 95%, 0.76-0.78; p=0.008). CONCLUSIONS: Clinical comorbidities were determinant for the development of HF following MI. A simple score effectively categorize patients into low, intermediate, and high-risk. This could be important in order to intensify medical treatment or consider additional interventions.

Diseño asistido por computadora de la inmovilización covalente de bromelina y papaína / Computer-aided design of bromelain and papain covalent immobilization

Enzymes as immobilized derivatives have been widely used in Food, Agrochemical, Pharmaceutical and Biotechnological industries. Protein immobilization is probably the most used technology to improve the operational stability of these molecules. Bromelain (Ananas comosus) and papain (Carica papaya) are cystein proteases extensively used as immobilized biocatalyst with several applications in therapeutics, racemic mixtures resolution, affinity chromatography and others industrial scenarios. The aim of this work was to optimize the covalent immobilization of bromelain and papain via rational design of immobilized derivatives strategy (RDID) and RDID1.0 program. Were determined the maximum protein quantity to immobilize, the optimum immobilization pH (in terms of functional activity retention), was predicted the most probable configuration of the immobilized derivative and the probabilities of multipoint covalent attachment. As support material was used Glyoxyl-Sepharose CL 4B. The accuracy of RDID1.0 program´s prediction was demonstrated comparing with experimental results. Bromelain and papain immobilized derivatives showed desired characteristics for industrial biocatalysis, such as: elevate pH stability retaining 95% and 100% residual activity at pH 7.0 and 8.0, for bromelain and papain, respectively; high thermal stability at 30 °C retaining 90% residual activity for both immobilized enzymes; a catalytic configuration bonded by immobilization at optimal pH; and the ligand load achieve ensure the minimization of diffusional restrictions.

Las enzimas inmovilizadas han sido ampliamente utilizadas en las industrias Alimentaria, Agroquímica, Farmacéutica y Biotecnológica. La inmovilización de proteínas es, probablemente, la tecnología más empleada para elevar la estabilidad operacional de estas moléculas. La bromelina (Ananas comosus) y la papaína (Carica papaya) son cisteín proteasas extensamente usadas como biocatalizadores inmovilizados con disímiles aplicaciones en la terapéutica, resolución de mezclas racémicas, cromatografía de afinidad, entre otros escenarios industriales. El objetivo del presente trabajo fue optimizar la inmovilización covalente de las enzimas bromelina y papaína a través de la estrategia de diseño racional de derivados inmovilizados (RDID) y el programa RDID1.0. Se predijo la cantidad máxima de proteína a inmovilizar, el pH óptimo de inmovilización (en términos de retención de la actividad funcional), la configuración más probable del derivado inmovilizado y la probabilidad de enlazamiento covalente multipuntual. Como soporte de inmovilización de empleó Glioxil-Sepharose CL 4B. La precisión de las predicciones llevadas a cabo con el programa RDID1.0 fue validada comparando con los resultados experimentales obtenidos. Los derivados inmovilizados de bromelina y papaína mostraron características deseadas para la biocatálisis a nivel industrial, tales como: elevada estabilidad al pH reteniendo el 95% y 100% de actividad residual a pH 7.0 y 8.0, para la bromelina y la papaína, respectivamente; una elevada estabilidad térmica con la retención del 90% de actividad residual a 30 °C para ambas enzimas; al pH de inmovilización óptimo la configuración obtenida es catalíticamente competente; y la carga de ligando alcanzada asegura la disminución de las restricciones difusionales.

Directed, strong, and reversible immobilization of proteins tagged with a ß-trefoil lectin domain: a simple method to immobilize biomolecules on plain agarose matrixes.

A highly stable lipase from Geobacillus thermocatenolatus (BTL2) and the enhanced green fluorescent protein from Aquorea victoria (EGFP) were recombinantly produced N-terminally tagged to the lectin domain of the hemolytic pore-forming toxin LSLa from the mushroom Laetiporus sulphureus . Such a domain (LSL(150)), recently described as a novel fusion tag, is based on a ß-trefoil scaffold with two operative binding sites for galactose or galactose-containing derivatives. The fusion proteins herein analyzed have enabled us to characterize the binding mode of LSL(150) to polymeric and solid substrates such as agarose beads. The lectin-fusion proteins are able to be quantitatively bound to both cross-linked and non-cross-linked agarose matrixes in a very rapid manner, resulting in a surprisingly dynamic protein distribution inside the porous beads that evolves from heterogeneous to homogeneous along the postimmobilization time. Such dynamic distribution can be related to the reversible nature of the LSL(150)-agarose interaction. Furthermore, this latter interaction is temperature dependent since it is 4-fold stronger when the immobilization takes place at 25 °C than when it does at 4 °C. The strongest lectin-agarose interaction is also quite stable under a survey of different conditions such as high temperatures (up to 60 °C) or high organic solvent concentrations (up to 60% of acetonitrile). Notably, the use of cross-linked agarose would endow the system with more robustness due to its better mechanical properties compared to the noncross-linked one. The stability of the LSL(150)-agarose interaction would prevent protein leaching during the operation process unless high pH media are used. In summary, we believe that the LSL(150) lectin domain exhibits interesting structural features as an immobilization domain that makes it suitable to reversibly immobilize industrially relevant enzymes in very simple carriers as agarose.

II norma venezolana para el monitoreo ambulatorio de presión arterialy automedición de presión arterial / II venezuelan norms for ambulatory monitoring of arterial pressure and self measurement

Durante los últimos 30 años el monitoreo ambulatorio de la presión arterial ha pasado de ser un método selectivo de investigación farmacológica a ser un método invaluable en el diagnóstico y valoración terapéutica del paciente hipertenso. Sin embargo, ha habido una variedad de criterios en la evaluación e interpretación de los resultados; de ahí la necesidad de presentar el estado del arte en cuanto al uso de esta metodología en la práctica clínica. Los valores de normalidad de la presión arterial medida a través del monitoreo ambulatorio de la presión arterial se diferencian de aquellos tomados en la consulta y en el hogar; así como, si se hacen durante el período de vigilia o sueño. La II Norma Venezolana para el Monitoreo Ambulatorio de la Presión Arterial y Monitoreo de Presión en el Hogar reportalos valores considerados normales; las indicaciones de su uso; la interpretación de los resultados; los equipos validados y recomendados en los ámbitos mundiales y nacionales; así los datos mínimos que debe poseer el reporte del monitoreo ambulatorio de la presión arterial.

During the past 30 years ambulatory blood pressure monitoring has gone from being a selective method of pharmacological research to a valuable method for the diagnosis and therapeutic assessment of patients with hypertension. However, there area variety of criteria for the evaluation and interpretation of results; hence the need for a state of the art approach to the use of this methodology in clinical practice. Normal blood pressure values measured by ambulatory blood pressure monitoring are different from those obtained in the clinic and in the home; as well as, during periods of wakefulness and sleep. The II Venezuelan Standards for Ambulatory Monitoringof Arterial Pressure and Monitoring of Pressure in the Home provide normal values; indications for use; interpretation of results; validated equipment as well as global and national recommendations; and the minimum data that a report should contain.

Tumor neuroendocrino de la mama: a propósito de un caso / Neuroendocrine tumor of the breast: a purpose of a case

Los tumores neuroendocrinos en la glándula mamaria, representan menos del 2 por ciento de las lesiones malignas que se presentan en la mama, un 30 por ciento pueden ser metastásicos, principalmente de tumores carcinoides intestinales. Se presenta el caso de una paciente femenina 64 años con el antecedente de carcinoma de mama izquierda pT1N1Mo Estadio II A, se le practicó en el año 2000 cirugía preservadora, recibió tratamiento sistémico y radioterapia, presentando recaída local, histológicamente y por inmuhistoquímica, como tumor neuroendocrino, en mayo de 2008 se le realiza mastectomía simple izquierda. Actualmente viva y sin enfermedad. Los tumores neuroendocrinos pueden presentarse en localizaciones extra intestinales. El diagnóstico debe realizarse por histología y confirmado con técnicas de inmunohistoquímica, son tumores de baja agresividad biológica, no se presentan síntomas sistémicos por liberación de hormonas como en otras localizaciones, y el tratamiento debe basarse en el estadio clínico de la enfermedad al momento del diagnóstico.

Neuroendocrines in the mammary gland tumors represent less than 2 percent of malignant injuries, which 30 percent can be source metastatic, mainly tumors intestinal carcinoid. The clinical of a female patient case 64 years old are presented with the antecedent of pT1N1Mo Stadium II A left breast carcinoma who was practiced in the year 2000 sparing surgery, received systemic therapy and radiotherapy, featuring local relapse, histological and inmuhistochemestry, as neuroendocrines, practicing it in May of 2008 mastectomy left, currently living and without disease tumor. Neuroendocrines tumors can occur in extra intestinal in lung, uterine and less common in the mammary gland neck locations. The diagnosis must be made by histology and confirmed with Immunohistochemistry techniques, are tumors of low biological aggression, not have systemic symptoms by release of hormones as in other locations, and treatment must be based on the clinical stage of the disease at the time of diagnosis.

Asistencia cardiovascular en el tercer nivel de atención médica: tendencias en Venezuela años 1962 a 1994 y 1999: II cirugía cardiovascular / Cardiovascular attendance in the third level of attention prescribes: tendencies in Venezuela years 1962 at 1994 and 1999: II cardiovascular surgey

Las enfermedades del corazón constituyen en Venezuela la primera causa de muerte y la tercera causa de años de vida potencialmente perdidos. La persistencia de tasas elevadas de mortalidad contrasta con el importante descenso de esas tasas en los países industrializados. A ese descenso han contribuido las intervenciones del tercer nivel de atención cardiovascular. El objetivo del presente estudio es documentar la práctica de la cirugía cardiovascular como un indicador del tercer nivel de atención. Se consideró la práctica de la cirugía cardiovascular en forma similar a como se consideró la hemodinamia en un trabajo previo. Se eligieron como indicadores el número y la modalidad de intervenciones quirúrgicas con circulación extracorpórea desde sus inicios hasta 1999. Los datos fueron solicitados en 1995 y en 1999 mediante encuestas dirigidas a los hospitales que realizan esta cirugía. Se estudió la distribución geográfica de esa práctica, su carácter asistencial público o privado, y sus tendencias en el tiempo. Se obtuvo respuesta del 88 por ciento de los hospitales en 1995 y del 96 por ciento en 1999. El estudio mostró que la práctica de la cirugía cardiovascular no ha sido continua en algunos hospitales públicos y que el número de procedimientos ha sido dispar y muy pequeño en algunos centros. El 82 por ciento de los procedimientos se realizó en Caracas, ese porcentaje ha variado moderadamente en el curso del tiempo. La práctica de la cirugía se inició en los hospitales públicos y se ha desplazado a los hospitales privados a lo largo del tiempo, donde predomina actualmente. La cirugía coronaria predomina en los hospitales privados en tanto que en los públicos predomina la cirugía valvular y congénita. El conocimiento del predominio metropolitano y privado de la práctica quirúrgica, y el pequeño número de intervenciones en algunos hospitales públicos, podría permitir formular recomendaciones que hagan viable la prestación de mejores servicios

Asistencia cardiovascular en el tercer nivel de atención médica: tendencia en Venezuela años 1958 a 1994 y 1999 / Cardiovascular attendance in the thrird level of attention prescribes: tendency in Venezuela years 1958 at 1994 and 1999

Las enfermedades del corazón constituyen en Venezuela la primera causa de muerte y la tercera causa de años de vida potencialmente perdidos. La persistencia de tasas elevadas de mortalidad contrasta con el importante descenso de esas tasas en los países industrializados. A ese descenso han contribuido las intervenciones del tercer nivel de atención cardiovascular. El objetivo del presente estudio es documentar la situación de la asistencia cardiovascular en Venezuela en este nivel de atención. Se eligieron como indicadores la práctica de la hemodinamia, que se considerará en este estudio, y la práctica de la cirugía cardiovascular, que se considerará en un estudio sucesivo. Ambas prácticas se documentarán desde sus inicios hasta 1999. Los datos fueron solicitados en 1995 y en 1999 mediante encuestas dirigidas a los hospitales públicos y privados que realizan prácticas de tercer nivel. Se estudió la distribución geográfica de esas prácticas, su carácter asistencial público o privado, y sus tendencias en el tiempo. Se obtuvo respuesta del 88 por ciento de los hospitales en 1995 y del 96 por ciento en 1999. El estudio mostró que la práctica de la hemodinamia no ha sido continua en algunos hospitales públicos y que el número de procedimientos ha sido dispar y muy pequeño en algunos centros. El 70 por ciento de los procedimientos se realizó en Caracas, y ese porcentaje no ha variado en el curso del tiempo. La práctica de la hemodinamia se inició en los hospitales públicos y se ha desplazado a los hospitales privados a lo largo del tiempo, donde predomina actualmente.La hemodinamia terapéutica predomina desde su inicio en los hospitales privados, donde se aplica casi exclusivamente a pacientes coronarios. Por el contrario, en los hospitales públicos estos procedimientos terapéuticos se aplicaron con mayor frecuencia a pacientes valvulares. El predominio metropolitano y privado de la práctica hemodinámica, así como la discontinuidad y escaso número de estudios en varios centros públicos podría permitir formular recomendaciones que hagan viable la prestación de mejores servicios