Influence of meteorological conditions on hospital admission in patients with acute coronary syndrome with and without ST-segment elevation: Results of the AIRACOS study. / Influencia de las condiciones meteorológicas en el ingreso hospitalario en pacientes con síndrome coronario agudo con y sin elevación del segmento ST: resultados del estudio AIRACOS.

OBJECTIVE: Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS. DESIGN: A prospective cohort study was carried out. SETTING: Coronary Care Unit of Hospital Universitario de Canarias PATIENTS: We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5µm diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters. RESULTS: A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6±2.6 vs. 998.8±2.5 mbar, P=.008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24, P=.004). CONCLUSIONS: In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS.

Chest pain secondary to drug use treated in hospital emergency departments in Spain.

OBJECTIVE: To determine the characteristics of patients with chest pain (CP) associated with recent drug use. METHODS: Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. RESULTS: CP accounted for 8.97% of attendances (males 82.9%, p<0.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, p<0.001), anxiety (42.5%, p<0.001), hypertension (13.6%, p<0.001) and arrhythmias (5.9%, p<0.001). Patients with TD received more treatment (81.9% vs 74.1%; p<0.001), although they were admitted less (7.6%, p=0.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). CONCLUSIONS: In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing.

[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. / Impacto de los «daily huddle¼ en la seguridad del paciente pediátrico hospitalizado.

INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

[Influence of diurnal variation in the size of acute myocardial infarction]. / Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio.

OBJECTIVE: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. INTERVENTIONS: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24hours). MAIN VARIABLES OF INTEREST: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. RESULTS: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). CONCLUSIONS: An onset of AMI between 0-12hours results in a significantly larger final size of necrosis compared with any other time of presentation.

[Differential characteristics of patients with acute coronary syndrome without ST-segment elevation compared to those with transient ST-segment elevation]. / Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST.

OBJECTIVE: To evaluate different characteristics of patients with acute coronary syndrome (ACS) without ST-segment elevation compared with transient St-segment elevation. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients of ACS without persistent ST-segment elevation. MAIN VARIABLES OF INTEREST: The population was divided intro 2 groups according to the presence of transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors, troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejection fraction, inhospital mortality and drugs. RESULTS: Patients identified as ACS with transient ST-segment elevation were significantly younger, smokers and predominantly male. At the same time, they showed a minor peak elevation of troponin I, a higher ejection fraction and, mainly single-vessel coronary disease. CONCLUSIONS: Patients with ACS with transient ST-segment elevation differ in the type of population, myocardial damage and coronary angiographic results with respect to patients with ACS without ST-segment elevation. More research is needed to clarify whether these differences imply a different therapeutic approach.

Unified protocol for anxiety disorders in two cities of Mexico measuring gamma activity: Study protocol for a randomized controlled trial.

BACKGROUND: The Unified Protocol for Emotional Disorders (UP) for emotional regulation manifests effective results in a broad range of mental disorders. The UP efficacy was tested in several countries, but it has not been tested within Mexican population. It is crucial to do more research and implement effective protocols to intervene Mexican population with Anxiety Disorders (AD). OBJECTIVE: This study aims to examine and describe the research procedures and treatment interventions of the UP in a Randomized Controlled Trial (RCT), to approach and treat AD in patients in 2 Mexican borderland cities, by applying the UP and an Electroencephalogram (EGG) neuro screening. METHODS: The enrolled patients will be randomized in a two-arm control trial with repeated measures, comprising between 18 and 60 years, that were diagnosed with an AD, and low scored in depression symptoms and suicidal ideation. The study will comprise of two conditions: an intervention group clinical trial with the UP or a waiting list control. The primary outcome measures will be applied on AD quantitative self-reports and a gamma activity by EGG before and after the intervention and in follow-ups of 3 and 6 months. The participants in the waiting list group, will receive the treatment after the trial first group completes the treatment. CONCLUSIONS: Processes and outcomes of this project, will provide evidence in order to apply the UP in a broader population with AD and other mental disorders also covered by this protocol, such as depression and borderline personality disorder in a broader Mexican population, a country that suffers with a major health issue with an increasing rate of mental disorders and scarce psychological and health coverage.

Identification of Senior At Risk scale predicts 30-day mortality among older patients with acute heart failure. / La escala Identification of Senior at Risk predice la mortalidad a los 30 días en los pacientes mayores con insuficiencia cardiaca aguda.

OBJECTIVE: To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF). DESIGN: Observational multicenter cohort study. SETTING: OAK-3 register. SUBJECTS: Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016. INTERVENTION: No. VARIABLES: Variable of study was ISAR scale. The outcome was all-cause 30-day mortality. RESULTS: We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value <.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points). CONCLUSIONS: scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.

New pharmacologic options in the treatment of acute coronary syndromes and myocardial ischemia-reperfusion injury: potential role of levosimendan.

Modern and effective therapeutic possibilities have improved the management and outcomes in acute coronary syndromes and acute myocardial infarction. However, substantial morbidity and mortality still remain. Myocardial ischemia-reperfusion injury may contribute to additional damage to myocardial necrosis and apoptosis. Therefore, it has been focused on attention and field of therapeutic actions in the last years. The main mechanisms involved in the pathogenesis of ischemia-reperfusion injury are depressed energy metabolism, elevated oxidative damage, and altered calcium homeostasis. In experimental trials, a variety of drugs have proved effectiveness for the prevention and treatment of the ischemia-reperfusion injury. However, its efficacy, not always confirmed, has not yet been established in clinical practice. On the basis of the strong evidence linking potassium ATP dependent channels opening in the myocardium and its proved cardioprotective role during ischemia, these channels have been pointed out as possible and promising pharmacological targets in this setting. Some evidences suggest that the calcium sensitizing agent levosimendan may have of beneficial and exerts cardioprotective effects on myocardial ischemia and ischemia-reperfusion injury. Further investigation is warranted on this novel application of levosimendan.

Elevated levels of oxidized low-density lipoprotein and impaired nocturnal synthesis of melatonin in patients with myocardial infarction.

This study was designed to investigate the relationship between nocturnal serum melatonin (MEL) levels and oxidized low-density lipoprotein (OxLDL) in patients with acute coronary syndrome (ACS). OxLDL plays a pivotal role in the development of atherosclerosis. Patients with coronary heart disease have an impaired nocturnal secretion of MEL. To date, there are no clinical human studies concerning the relationship of MEL to low-density lipoprotein (LDL) oxidation in patients with acute myocardial infarction (AMI). The study population contained 60 patients with AMI and 60 control subjects. Levels of circulating OxLDL were measured by a monoclonal antibody 4E6-based competition ELISA. Levels of circulating MEL were measured by an enzyme-immunoassay kit after chloroform extraction. Comparison of levels between AMI and controls, adjusted for age, revealed significantly higher nocturnal serum OxLDL levels (95.47+/-6.81 versus 68.35+/-4.07 U/l; p=0.004) in the AMI subjects. Nocturnal serum levels of MEL were lower in AMI than the control group (20.97+/-3.90 versus 53.19+/-7.80 pg/ml; p=0.009). Serum levels of total, high-density lipoprotein (HDL), and LDL cholesterol did not differ between the groups. Multiple regression analysis was performed on cases to study the association between AMI and serum levels of OxLDL and MEL (OR: 2.93; 95% CI, 2.89-2.98, p=0.01 and OR: 0.94; 95% CI, 0.89-0.97, p=0.02, respectively). This study demonstrates for the first time an independent association between nocturnal levels of OxLDL and MEL in patients with AMI. Additional population studies are necessary to further document these.

Ultra-fast and energy-efficient sintering of ceramics by electric current concentration.

Electric current activated/assisted sintering (ECAS) techniques, such as electrical discharge sintering (EDS) or resistive sintering (RS), have been intensively investigated for longer than 50 years. In this work, a novel system including an electrically insulated graphite die for Spark Plasma Sintering (SPS) is described, which allows the sintering of any refractory ceramic material in less than 1 minute starting from room temperature with heating rates higher than 2000°C/min and an energy consumption up to 100 times lower than with SPS. The system alternates or combines direct resistive sintering (DRS) and indirect resistive sintering (IRS). Electrical insulation of the die has been achieved through the insertion of a film made of alumina fibers between the graphite die and the graphite punches, which are protected from the alumina fiber film by a graphite foil. This system localized the electric current directly through the sample (conductive materials) as in DRS and EDS, or through the thin graphite foil (non-conductive materials) as in IRS, and is the first system capable of being used under EDS or RS conditions independently combining current concentration/localization phenomena.

[Regression of left ventricular hypertrophy in hypertensive patients]. / Regresión de la hipertrofia ventricular izquierda en hipertensos.

Left ventricular hypertrophy associated with systemic hypertension differs from left ventricular hypertrophy initiated by other pressure overload diseases. Its development depends not only of hemodynamics aspects but of biochemical factors. Many studies have demonstrated a close link between left ventricular hypertrophy and cardiovascular morbidity and mortality. For that reason the idea of reversal of left ventricular hypertrophy has been a goal of the antihypertensive treatment. From the literature review has been established that the most classes of antihypertensive medications reduce the left ventricular mass, though there is a variation in required duration of treatment. At this point the angiotensin converting enzyme inhibitors, probably because a double effect: hypotensive and blockers of the trophic stimulus of angiotensin II, seemed to be the most potent for reducing the left ventricular mass. Still we don't know if reversal of left ventricular hypertrophy, by the antihypertensive treatment, reduce independently the cardiovascular risk.

[Primary meningococcal pericarditis caused by meningococcus serogroup C]. / Pericarditis meningocócica primaria por serogrupo C.

We report the case of a 15-year-old female, with no previous medical history, who presented cardiac tamponade secondary to purulent pericarditis caused by Neisseria meningitidis serogroup C. This microorganism is the etiologic agent in 6-16% of the cases of purulent pericarditis, most in association with previous or concomitant central nervous system involvement (meningitis). Exceptionally, as in this case, the pericarditis is not accompanied by meningitis (Primary Meningococcal Pericarditis). The patient was treated with antibiotics, pericardiocentesis and steroids with excellent response. It is important to point out that meningococcal disease may present in unusual forms which may lead to diagnostic and therapeutics difficulties.

[Infectious endocarditis of prosthetic valves due to Staphylococcus capitis: a new case]. / Endocarditis infecciosa sobre válvulas protésicas causada por Staphylococcus capitis: un nuevo caso.

We present the case of a male patient with aortic and mitral valve bioprostheses who developed infectious endocarditis due to Staphylococcus capitis, which has recently been described as an agent producing infectious endocarditis in native and prosthetic cardiac valves. The patient's course evolved unfavorably, despite specific antibiotic treatment, leading to the surgical replacement of the valve, which completely resolved the problem. This case points out that, although rare, in infectious endocarditis due to Staphylococcus capitis its pathogenicity is significant.

[Right ventricular cardiomyopathy: a diagnosis to bear in mind]. / Miocardiopatía ventricular derecha: un diagnóstico a tener en cuenta.

Arrhythmogenic right ventricular cardiomyopathy is a entity of unknown etiology, that is pathologically characterized by right ventricular myocardial atrophy and fibroadipous tissue replacement. We present the case of a 65-year-old male patient with the diagnosis of chronic liver disease, whose study lead a diagnosis of Arrhythmogenic right ventricular cardiomyopathy.

[Plasma homocysteine levels in Spanish patients with coronary artery disease]. / Concentraciones de homocisteína en plasma en pacientes españoles con enfermedad arterial coronaria.

OBJECTIVE: A rise in plasma levels of the amino acid homocysteine (HCY) is a possible risk factor in cardiovascular disease. The mechanisms proposed to explain how HCY can increase the risk of vascular disease include its direct effect on the vascular endothelium and its role in increasing the risk of thrombosis. The present work has been designed to determine HCY levels in patients with coronary artery disease (CAD) residents in the Canary Islands and to establish whether hyperhomocysteinemia can be considered as an risk factor. METHODS: The sample studied consisted of 132 patients with, angiographically demonstrated, CAD and 18 controls with normal coronary arteries. Biochemical parameters determined included: HCY, vitamin B12, vitamin B6, folic acid, creatinine, cholesterol and its fractions, triglycerides, glucose and fibrinogen. RESULTS: Mean levels of HCY were not significantly different between the cases and controls (p = 0.37). In the distribution of HCY levels into quintiles there was no significant association between the quintiles and the occurrence of CAD (p = 0.57). Multiple logistic regression analysis in which the risk factors were compared with quintiles 2, 3, 4 and 5 of HCY did not reveal a significant relation between HCY levels and risk of CAD. CONCLUSIONS: This study questions the previously accepted consideration that hyperhomocysteinemia is a risk factor of CAD. Controlled intervention trials are, therefore, necessary to clarify the possible association between total HCY levels and cardiovascular disease.