Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria.

INTRODUCTION: The diagnosis of acute myocarditis (AM) is complex due to its heterogeneity and typically is defined by either Electronic Healthcare Records (EHRs) or advanced imaging and endomyocardial biopsy, but there is no consensus. We aimed to investigate the diagnostic accuracy of these approaches for AM. METHODS: Data on ICD 10th Revision(ICD-10) codes corresponding to AM were collected from two hospitals and compared to CMR-confirmed or clinically suspected(CS) AM cases with respect to diagnostic accuracy, clinical characteristics, and all-cause mortality. Next, we performed a review of published AM studies according to inclusion criteria. RESULTS: We identified 291 unique admissions with ICD-10 codes corresponding to AM in the first three diagnostic positions. The positive predictive value(PPV) of ICD-10 codes for CMR-confirmed or CS-AM was 36%, and patients with CMR-confirmed or CS AM had a lower all-cause mortality than those with a refuted diagnosis (P = 0.019). Using an unstructured approach, patients with CMR-confirmed and CS AM had similar demographics, comorbidity profiles and survival over a median follow-up of 52 months (P = 0.72). Our review of the literature confirmed our findings. Outcomes for patients included in studies using CMR-confirmed criteria were favourable compared to studies with EMB-confirmed AM cases. CONCLUSION: ICD-10 codes have poor accuracy in identification of AM cases and should be used with caution in clinical research. There are important differences in management and outcomes of patients according to the selection criteria used to diagnose AM. Potential selection biases must be considered when interpreting AM cohorts and requires standardisation of inclusion criteria for AM studies.

[Manejo de la cesación tabáquica entre residentes de cardiología de Iberoamérica]. / Smoking cessation management among Iberoamerica's cardiology residents

Introduction and objectives: Although cardiologists frequently assist patients who suffer damage from smoking, the degree of training they receive to manage this problem during their residency is unknown. Because of this, we'd proposed to ­evaluate the preferences and practices of cardiology residents for smoking cessation of the attending patients. Materials and methods: Closed, prefixed, voluntary and anonymous survey among doctors who carried out the specialty of cardiology in 5 countries of Latin America and Spain. Results: 716 residents were surveyed; 62.4% from Argentina, 19% from Mexico, 6.8% from Spain, 6.7% from Chile, 3.2% from Uruguay, and 1.9% from Paraguay. When asked about the importance they assigned to this problem (using a scale of 1-10), 85.8% assigned this question a score of 8 or higher. While 80.5% of the participants expressed giving short anti-tobacco advice routinely, only 27.7% used pharmacological therapy for this purpose. Among those who did not use pharmacological therapy, 58.3% said that the reason was not being familiar with the treatments; 62.9% of the surveyed said they had not received any type of training in this problem. Those residents who received some type of training reported feeling more prepared for this (p < 0.0001). Conclusion: We found that cardiology residents have a low knowledge of pharmacological treatment and relatively low confidence to provide assistance in smoking cessation. This topic should be included in the training of future cardiologists in order to achieve a more comprehensive cardiovascular prevention.

Introducción y objetivos: Si bien los cardiólogos asisten cotidianamente a pacientes que sufren daño por el tabaquismo, no se conoce el grado de formación que reciben sobre esta problemática durante su residencia. Debido a ello nos propusimos evaluar las preferencias y prácticas de los residentes de cardiología para la cesación tabáquica de los pacientes que asisten. Materiales y métodos: Encuesta cerrada, prefijada, voluntaria y anónima entre médicos que realizaban la especialidad de cardiología en cinco países de Latinoamérica y España. Resultados: Se encuestaron 716 residentes: un 62.4% de Argentina, un 19% de México, un 6.8% de España, un 6.7% de Chile, un 3.2% de Uruguay y un 1.9% de Paraguay. Con respecto a la importancia que asignaban a esta problemática (empleando una escala de 1-10), el 85.8% le asignó a esta pregunta una puntuación de 8 o mayor. Mientras el 80.5% de los participantes expresó dar consejo breve antitabáquico sistemáticamente, solamente un 27.7% empleaban terapia farmacológica con este fin. Entre quienes no empleaban terapia farmacológica, el 58.3% manifestó que el motivo era no encontrarse familiarizados con los tratamientos. El 62.9% de los encuestados dijo no haber recibido ningún tipo de formación en esta problemática. Aquellos residentes que recibieron algún tipo de formación manifestaron sentirse más preparados (p < 0.0001). Conclusión: Encontramos un bajo conocimiento sobre el tratamiento farmacológico y relativamente poca seguridad por parte de los residentes de cardiología para brindar asistencia en cesación tabáquica. Consideramos esencial incluir este tópico en la formación de los futuros cardiólogos a fin de lograr una prevención cardiovascular más integral.

Ultra-high resolution mass spectrometry of physical speciation patterns of organic matter in fire-affected soils.

Fire is one of the most important modulating factors of the environment and the forest inducing chemical and biological changes on the most reactive soil component, the soil organic matter (SOM). Assuming the complex composition of the SOM, we used an ultra-high resolution mass spectrometry analysis technique to assess the chemical composition and fire-induced alterations in soil particle size fractions (coarse and fine) from a sandy soil in a Mediterranean oak forest at Doñana National Park (Southwest Spain). Electrospray ionization-Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICRMS) showed that the coarse fraction of soils not affected by fires consisted mainly of polyphenolic compounds consistent with little-transformed SOM and fresh biomass, whereas the fine fraction was enriched in protein and lipid like homologues suggesting microbially reworked SOM. In fire-affected SOM, the coarse fraction contained a high proportion of aromatic compounds, consistent with inputs of charred litter or in situ chemical transformation of the SOM. Analysis of the fine fraction revealed two differentiated chemical families pointing to the existence of two carbon pools; a native microbial-derived moiety composed of lipids and polypeptide compounds, and a secondary, pyrogenic or thermally-altered moiety rich in aromatic compounds. This work represents the first application of ultra-high resolution mass spectrometry to study the chemical composition of SOM in different particle size fractions.