Comparison of rivaroxaban and low molecular weight heparin in the treatment of cancer-associated venous thromboembolism: a Swedish national population-based register study.

BACKGROUND: Treating cancer-associated venous thromboembolism (CAT) with anticoagulation prevents recurrent venous thromboembolism (rVTE), but increases bleeding risk. OBJECTIVES: To compare incidence of rVTE, major bleeding, and all-cause mortality for rivaroxaban versus low molecular weight heparin (LMWH) in patients with CAT. METHODS: We developed a cohort study using Swedish national registers 2013-2019. Patients with CAT (venous thromboembolism within 6 months of cancer diagnosis) were included. Those with other indications or with high bleeding risk cancers were excluded (according to guidelines). Follow-up was from index-CAT until outcome, death, emigration, or end of study. Incidence rates (IR) per 1000 person-years with 95% confidence interval (CI) and propensity score overlap-weighted hazard ratios (HRs) for rivaroxaban versus LMWH were estimated. RESULTS: We included 283 patients on rivaroxaban and 5181 on LMWH. The IR for rVTE was 68.7 (95% CI 40.0-109.9) for rivaroxaban, compared with 91.6 (95% CI 81.9-102.0) for LMWH, with adjusted HR 0.77 (95% CI 0.43-1.35). The IR for major bleeding was 23.5 (95% CI 8.6-51.1) for rivaroxaban versus 49.2 (95% CI 42.3-56.9) for LMWH, with adjusted HR 0.62 (95% CI 0.26-1.49). The IR for all-cause mortality was 146.8 (95% CI 103.9-201.5) for rivaroxaban and 565.6 (95% CI 541.8-590.2) for LMWH with adjusted HR 0.48 (95% CI 0.34-0.67). CONCLUSIONS: Rivaroxaban performed similarly to LMWH for patients with CAT for rVTE and major bleeding. An all-cause mortality benefit was observed for rivaroxaban which potentially may be attributed to residual confounding. TRIAL REGISTRATION NUMBER: NCT05150938 (Registered 9 December 2021).

Rivaroxaban Versus Low-Molecular-Weight Heparins in a Broad Cohort of Patients With Cancer-Associated Venous Thromboembolism: An Analysis of the OSCAR-US Program.

Cancer-associated venous thromboembolism (CAT) guidelines recommend direct oral anticoagulants as alternatives to low-molecular-weight heparin (LMWH) in most patients. This study compared the effectiveness and safety of rivaroxaban versus LMWH for a broad CAT cohort. The cohort study used electronic health data from January 2012 to December 2020 to evaluate patients with active cancer experiencing acute venous thromboembolism (VTE) and treated with rivaroxaban or LMWH. Propensity score-overlap weighted hazard ratios (HRs) and 95% confidence intervals (CIs) for VTE, bleeding-related hospitalization, and all-cause mortality were calculated. In total, 4935 patients were identified (27.9% on rivaroxaban and 72.1% on LMWH). The cancer types included gastrointestinal (29.4%), genitourinary (26.2%), lung (24.0%), breast (19.7%), and hematologic (14.4%). Rivaroxaban was associated with a reduction in recurrent VTE versus LMWH among all patients with cancer (HR = 0.78; 95%CI = 0.61-0.99) at 3 months. No differences in bleeding-related hospitalization or all-cause mortality were observed. Directionally similar results to those at 3 months were observed at 6 months for all outcomes. In conclusion, we observed fewer recurrent VTE cases and no increase in bleeding-related hospitalizations with rivaroxaban versus LMWH at 3 months in this patient cohort with various cancer types.

Rivaroxaban versus Apixaban for Treatment of Cancer-Associated Venous Thromboembolism in Patients at Lower Risk of Bleeding.

This retrospective study, utilizing U.S. electronic health record (EHR) data from January 2013 to December 2020, sought to assess whether rivaroxaban and apixaban had similar effectiveness and safety in the treatment of cancer-associated venous thromboembolism (VTE) in patients with a cancer type not associated with a high risk of bleeding. We included adults diagnosed with active cancer, excluding esophageal, gastric, unresected colorectal, bladder, noncerebral central nervous system cancers and leukemia, who experienced VTE and received a therapeutic VTE dose of rivaroxaban or apixaban on day 7 post-VTE, and were active in the EHR ≥12 months prior to the VTE. Primary outcome was the composite of recurrent VTE or any bleed resulting in hospitalization at 3 months. Secondary outcomes included recurrent VTE, any bleed resulting in hospitalization, any critical organ bleed, and composites of these outcomes at 3 and 6 months. Inverse probability of treatment-weighted Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). We included 1,344 apixaban and 1,093 rivaroxaban patients. At 3 months, rivaroxaban was found to have similar hazard to apixaban for developing recurrent VTE or any bleed resulting in hospitalization (HR: 0.87; 95% CI: 0.60-1.27). No differences were observed between cohorts for this outcome at 6 months (HR: 1.00; 95% CI: 0.71-1.40) or for any other outcome at 3 or 6 months. In conclusion, patients receiving rivaroxaban or apixaban showed similar risks of the composite of recurrent VTE or any bleed resulting in hospitalization in patients with cancer-associated VTE. This study was registered at www.clinicaltrials.gov as #NCT05461807. Key Points Rivaroxaban and apixaban have similar effectiveness and safety for treatment of cancer-associated VTE through 6 months.Clinicians should therefore consider patient preference and adherence when choosing the optimal anticoagulant.

Effectiveness and Safety of Rivaroxaban and Low Molecular Weight Heparin in Cancer-Associated Venous Thromboembolism.

Background: Direct-acting oral anticoagulants (DOACs) are alternatives to low molecular weight heparin (LMWH) in most cancer-associated thrombosis (CAT) patients. Objectives: This study sought to compare the effectiveness and safety of rivaroxaban and LMWH for venous thromboembolism (VTE) treatment in patients with an active cancer type not associated with a high risk of DOAC bleeding. Methods: An analysis of electronic health records from January 2012 to December 2020 was performed. Patients were adults, had active cancer, experienced an index CAT event, and were treated with rivaroxaban or LMWH. Patients with cancers with an established high risk of bleeding on DOACs were excluded. Baseline covariates were balanced using propensity score-overlap weighting. HRs with 95% CIs were calculated. Results: We identified 3,708 CAT patients treated with rivaroxaban (29.5%) or LMWH (70.5%). The median (25th-75th percentiles) time on anticoagulation was 180 (69-365) and 96 (40-336) days for rivaroxaban and LMWH patients. At 3 months, rivaroxaban was associated with a 31% reduced risk of recurrent VTE vs LMWH (4.2% vs 6.1%; HR: 0.69; 95% CI: 0.51-0.92). No difference in bleeding-related hospitalizations or all-cause mortality was observed (HR: 0.79; 95% CI: 0.55-1.13 and HR: 1.07; 95% CI: 0.85-1.35, respectively). Rivaroxaban reduced the recurrent VTE risk (HR: 0.74; 95% CI: 0.57-0.97) but not bleeding-related hospitalizations or all-cause mortality at 6 months. At 12 months, no difference was observed between cohorts for any of the previously mentioned outcomes. Conclusions: Among active cancer patients experiencing VTE and not at high risk of bleeding on DOACs, rivaroxaban was associated with a reduced risk of recurrent VTE versus LMWHs at 3 and 6 months but not 12 months. (Observational Study in Cancer-Associated Thrombosis for Rivaroxaban-United States Cohort [OSCAR-US]; NCT04979780).

Seek COVER: using a disease proxy to rapidly develop and validate a personalized risk calculator for COVID-19 outcomes in an international network.

BACKGROUND: We investigated whether we could use influenza data to develop prediction models for COVID-19 to increase the speed at which prediction models can reliably be developed and validated early in a pandemic. We developed COVID-19 Estimated Risk (COVER) scores that quantify a patient's risk of hospital admission with pneumonia (COVER-H), hospitalization with pneumonia requiring intensive services or death (COVER-I), or fatality (COVER-F) in the 30-days following COVID-19 diagnosis using historical data from patients with influenza or flu-like symptoms and tested this in COVID-19 patients. METHODS: We analyzed a federated network of electronic medical records and administrative claims data from 14 data sources and 6 countries containing data collected on or before 4/27/2020. We used a 2-step process to develop 3 scores using historical data from patients with influenza or flu-like symptoms any time prior to 2020. The first step was to create a data-driven model using LASSO regularized logistic regression, the covariates of which were used to develop aggregate covariates for the second step where the COVER scores were developed using a smaller set of features. These 3 COVER scores were then externally validated on patients with 1) influenza or flu-like symptoms and 2) confirmed or suspected COVID-19 diagnosis across 5 databases from South Korea, Spain, and the United States. Outcomes included i) hospitalization with pneumonia, ii) hospitalization with pneumonia requiring intensive services or death, and iii) death in the 30 days after index date. RESULTS: Overall, 44,507 COVID-19 patients were included for model validation. We identified 7 predictors (history of cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, hyperlipidemia, kidney disease) which combined with age and sex discriminated which patients would experience any of our three outcomes. The models achieved good performance in influenza and COVID-19 cohorts. For COVID-19 the AUC ranges were, COVER-H: 0.69-0.81, COVER-I: 0.73-0.91, and COVER-F: 0.72-0.90. Calibration varied across the validations with some of the COVID-19 validations being less well calibrated than the influenza validations. CONCLUSIONS: This research demonstrated the utility of using a proxy disease to develop a prediction model. The 3 COVER models with 9-predictors that were developed using influenza data perform well for COVID-19 patients for predicting hospitalization, intensive services, and fatality. The scores showed good discriminatory performance which transferred well to the COVID-19 population. There was some miscalibration in the COVID-19 validations, which is potentially due to the difference in symptom severity between the two diseases. A possible solution for this is to recalibrate the models in each location before use.

Perfil de compra de dispositivos de medición de presión arterial, Chile 2018-2020 / Profile of Blood pressure measurement devices purchased in Chile 2018-2020 / Perfil de compra de dispositivos para aferição da pressão arterial, Chile, 2018-2020

RESUMEN Objetivo. Describir los tipos de dispositivos de medición de presión arterial comercializados a través de la plataforma Mercado Público entre los años 2018 y 2020. Métodos. Estudio de tipo descriptivo procedente de las transacciones realizadas a través de Mercado Público en el periodo 2018 y 2020, para la adquisición de dispositivos de medición de presión arterial. Para los equipos automáticos, se buscó el estado de validación otorgado por organismos internacionales. Los resultados se presentan en frecuencias absolutas y relativas. Resultados. Entre los años 2018-2020, aumentó la adquisición de dispositivos automáticos de un 15% a un 75%, y se presentó una reducción del 40,9% al 7,5% en equipos mercuriales y de 38,7% al 15,8% en equipos aneroides. De los 772 dispositivos automáticos, el 52,6% contó con validación de precisión. Conclusiones. Considerando que Chile está comprometido con la Iniciativa HEARTS en las Américas, y que la prevención y control de la HTA es fundamental para reducir la mortalidad por enfermedades no trasmisibles, resulta crucial garantizar una medición de presión arterial precisa. El presente documento aporta información relevante respecto de las transacciones realizadas y el perfil de compra de dispositivos de medición de presión arterial a través de la plataforma Mercado Público, observándose una tendencia creciente en la obtención de equipos automáticos validados durante el periodo evaluado.

ABSTRACT Objective. To describe the types of blood pressure measurement devices marketed through the Mercado Público platform between 2018 and 2020. Methods. This is a descriptive study based on transactions on the Mercado Público platform for the purchase of blood pressure measurement devices in the 2018-2020 period. A search was made for any validation granted by international organizations for automatic devices. The results are expressed as absolute and relative frequencies. Results. Between 2018 and 2020, purchases of automatic devices increased from 15% to 75%, while purchases of mercury-based devices dropped from 40.9% to 7.5%, and aneroid devices fell from 38.7% to 15.8%. Of the 772 automatic devices, 52.6% were validated for accuracy. Conclusions. Given that Chile is committed to the HEARTS Initiative in the Americas, and that prevention and control of hypertension is critical to reducing mortality from noncommunicable diseases, it is crucial to ensure accurate blood pressure measurement. This document provides relevant information on transactions and the purchase profile of blood pressure measurement devices on the Mercado Público platform. A growing trend was observed in the purchase of validated automatic equipment during the evaluation period.

RESUMO Objetivo. Descrever os tipos de dispositivos de aferição da pressão arterial comercializados por meio da plataforma Mercado Público, entre 2018 e 2020. Métodos. Estudo descritivo das transações realizadas por meio do Mercado Público, no período de 2018 a 2020, para a compra de dispositivos de aferição da pressão arterial. No caso de dispositivos automáticos, foi verificado se possuíam validação concedida por organizações internacionais. Os resultados são apresentados na forma de frequências absolutas e relativas. Resultados. Entre 2018 e 2020, a aquisição de dispositivos automáticos aumentou de 15% para 75%. Houve uma redução de 40,9% para 7,5% na compra de esfigmomanômetros de mercúrio e de 38,7% para 15,8% na compra de esfigmomanômetros aneroides. Dos 772 dispositivos automáticos, 52,6% tinham exatidão validada. Conclusões. Considerando que o Chile está comprometido com a Iniciativa HEARTS nas Américas e que a prevenção e o controle da hipertensão arterial sistêmica é fundamental para reduzir a mortalidade por doenças não transmissíveis, é essencial garantir a aferição exata da pressão arterial. Este documento fornece informações relevantes sobre as transações realizadas e o perfil de compra de dispositivos de aferição da pressão arterial por meio da plataforma Mercado Público, mostrando uma tendência crescente na aquisição de dispositivos automáticos validados durante o período de avaliação.

Chile's public healthcare sector hypertension control rates before and during the pandemic and HEARTS implementation / Tasas de control de la hipertensión en el sector de salud pública en Chile antes y durante la pandemia y aplicación de la iniciativa HEARTS / Taxas de controle da hipertensão arterial no setor de saúde pública do Chile antes e durante a pandemia e implementação da iniciativa HEARTS

ABSTRACT Hypertension (arterial blood pressure ≥ 140/90 mmHg) is a risk factor for cardiovascular diseases, with the greatest burden of attributable deaths in Chile, having a national prevalence of 27.6%. In 2018, the implementation of HEARTS begun in primary health care centers of the Public Health System, with the aim of achieving increase in control rates, by raising the proportion of hypertensive individuals who meet blood pressure goals (< 140/90 mmHg for individuals 15-79 years old and of 150/90 mmHg for individuals 80 years and older), and thus contributing to reduce cardiovascular morbidity and mortality associated with this condition. This is a descriptive study that follows average treatment and control rates from the Public Health System between 2017-2021 obtained from health centers statistics reports during HEARTS implementation. Treatment and control rates remained at 57% and 39% respectively between 2017-2019. Between 2020 and 2021, in the context of the SARS-CoV-2 pandemic, treatment and control rates decreased very significantly, reaching 46% and 26%, respectively, in December 2021, even though the number of centers reporting the implementation of HEARTS increased from 227 to 387 in this same period. Prior to the pandemic, during the last quarter of 2019, a decrease in cardiovascular health controls was already observed as a result of social protests. In light of the results, the technical pillars of the HEARTS Initiative have an important role in helping to recover the population control rates reached in 2019 and increasing the speed to achieve better hypertension control rates.

RESUMEN La hipertensión arterial (presión arterial ≥ 140/90 mmHg) es un factor de riesgo para las enfermedades cardiovasculares, que tienen la mayor carga de muertes atribuibles en Chile. En este país, la hipertensión tiene una prevalencia nacional del 27,6%. En el 2018 se inició la aplicación del paquete técnico HEARTS en los centros de atención primaria de salud del sistema público de salud de Chile, con el objetivo de lograr un aumento de las tasas de control, al elevar la proporción de personas hipertensas que cumplen con las metas de presión arterial (< 140/90 mmHg para personas de 15 a 79 años y de 150/90 mmHg para personas de 80 años o más) y así contribuir a reducir la morbilidad y la mortalidad cardiovascular asociadas a esta enfermedad. En este estudio descriptivo se realiza un seguimiento de las tasas promedio de tratamiento y control del sistema público de salud entre el 2017 y el 2021 obtenidas de los informes estadísticos de los centros de salud durante la aplicación de la iniciativa HEARTS. Las tasas de tratamiento y control se mantuvieron en 57% y 39%, respectivamente, en el período entre el 2017 y el 2019. Entre el 2020 y el 2021, en el contexto de la pandemia de SARS-CoV-2, las tasas de tratamiento y control disminuyeron de manera muy significativa, y se ubicaron en 46% y 26%, respectivamente, en diciembre del 2021, a pesar de que el número de centros que notificaron la aplicación de HEARTS aumentó de 227 a 387 en el mismo período. Antes de la pandemia, en el último trimestre del 2019, ya se había observado una disminución en los controles de salud cardiovascular debido a las protestas sociales. En vista de estos resultados, los pilares técnicos de la iniciativa HEARTS desempeñan un papel importante para ayudar a recuperar las tasas de control que se habían alcanzado en el 2019 y acelerar la consecución de mejores tasas de control de la hipertensión.

RESUMO A hipertensão (pressão arterial ≥ 140/90 mmHg) é um fator de risco para doenças cardiovasculares, com a maior carga de mortes atribuíveis no Chile, onde a prevalência nacional é de 27,6%. Em 2018, teve início a implementação da iniciativa HEARTS em centros de atenção primária à saúde do sistema de saúde pública, com o objetivo de elevar as taxas de controle, pelo aumento da proporção de indivíduos hipertensos que alcançam as metas de pressão arterial (< 140/90 mmHg para pessoas de 15-79 anos e de 150/90 mmHg para pessoas a partir de 80 anos), e, assim, contribuir para a redução da morbimortalidade cardiovascular associada a essa condição. Este é um estudo descritivo que acompanha as taxas médias de tratamento e controle no sistema de saúde pública entre 2017 e 2021, obtidas de relatórios estatísticos dos centros de saúde durante a implementação da iniciativa HEARTS. Entre 2017 e 2019, as taxas de tratamento e de controle foram, respectivamente, de 57% e 39%. Entre 2020 e 2021, no contexto da pandemia causada pelo SARS-CoV-2, houve uma diminuição muito significativa das taxas de tratamento e de controle, que chegaram, respectivamente, a 46% e 26% em dezembro de 2021, embora o número de centros que informaram ter implementado o pacote HEARTS tenha aumentado de 227 para 387 no mesmo período. Antes da pandemia, durante o último trimestre de 2019, já se observava uma diminuição dos controles da saúde cardiovascular em consequência de uma onda de protestos sociais. Os resultados mostram que os pilares técnicos da iniciativa HEARTS são importantes para ajudar a recuperar as taxas de controle na população alcançadas em 2019 e aumentar a velocidade para atingir melhores taxas de controle da hipertensão.

Cardiopulmonary and hematologic response to the test Course Navette 20 meters in University Students / Respuesta cardiopulmonar y hematólogica al test de Course Navette de 20 metros en Estudiantes Universitarios

Abstract: Introduction: Young people who start the university life face a key stage for the acquisition of habits and lifestyles. The test Course Navette is one of the most used worldwide because of its easy measurement, validity, effectiveness and sensitivity in different age ranks. Material and methods: An observational, descriptive and transversal study with quantitative approach; with 100 students participating (43 men and 57 women) with an average age of 21.06 ± 2.43 at the University of Santander, Cúcuta. For the development of this research, were obtained measurements anthropometric, hematological, physiological and performance on an empty stomach Leger test. Results: 62% of participants had a BMI of normal weight, 24% overweight and obesity and underweight was 8 and 6% respectively. In turn 32% of men and 17.5% of women have high cardiovascular risk according to abdominal circumference. VO2max. in the Leger test was 32.92 ± 7.12 to 533.80 ± 371.34 meters traveled. Regarding glycemia before the test was 80.99 ± 11.91 and after 105.59 ± 20.89. Conclusion: No significant differences in fat percentage were found (p = 0,863), muscle (p = 0,740) and water (p = 0,804) after Leger test. However, there were significant changes in FC, TAS, TAD, red cells, white cells, hemoglobin, platelets and blood glucose levels (p = 0,000). Regarding the VO2max. (p = 0,597) and travel meters (p = 0,619) no differences were found by gender.

Resumen: Introducción: Los jóvenes que inician la vida universitaria enfrentan una etapa clave y vital para la adquisición de hábitos y estilos de vida. El test de Course Navette es uno de los test más utilizados a nivel mundial, debido a su fácil medición, validez, efectividad y sensibilidad en diferentes rangos de edad. Material y métodos: Un estudio observacional, descriptivo y transversal con enfoque cuantitativo; en el que participaron 100 estudiantes (43 hombres y 57 mujeres) con una edad promedio de 21.06 ± 2.43 de la Universidad de Santander, Cúcuta. Para el desarrollo de esta investigación, se obtuvieron medidas antropométricas, hematológicas, fisiológicas y realización del test de Leger en ayunas. Resultados: El 62% de los participantes tuvieron un índice de masa corporal (IMC) de normopeso, el 24% sobrepeso y para obesidad e infrapeso fue 8 y 6% respectivamente. A su vez el 32% de los hombres y el 17.5% de las mujeres tienen alto riesgo cardiovascular según medidas de circunferencia abdominal. El VO2máx. en el test de Leger fue de 32.92 ± 7.12 con 533.80 ± 371.34 metros recorridos. Respecto a la glucemia antes del test fue de 80.99 ± 11.91 y después 105.59 ± 20.89. Conclusión: No se encontraron diferencias significativas en el porcentaje graso (p = 0,863), muscular (p = 0,740) y agua (p = 0,804) después del test de Leger. No obstante, hubo cambios significativos en la FC, TAS, TAD, glóbulos rojos, blancos, linfocitos, hemoglobina, plaquetas y glucemia (p=0,000). Respecto al VO2máx. (p = 0,597) y metros recorridos (p = 0,619) no se encontraron diferencias según género.

Study of parental models: building an instrument for their exploration / Estudo da modelagem parental: a construção de um estudo para a exploração / Estudio de modelos parentales: la construcción de un instrumento para su exploración

Objective: This research presents the construction of an attributional questionnaire concerning the different parental models and factors that are involved in family interactions. Method: A mixed methodology was used as a foundation to develop items and respective pilots that allowed checking the validity and internal consistency of the instrument using expert judgment. Results: An instrument of 36 statements was organized into 12 categories to explore the parental models according to the following factors: parental models, breeding patterns, attachment bonds and guidelines for success, and promoted inside family contexts. Analyzing these factors contributes to the children’s development within the familiar frown, and the opportunity for socio-educational intervention. Conclusion: It is assumed that the family context is as decisive as the school context; therefore, exploring the nature of parental models is required to understand the features and influences that contribute to the development of young people in any social context.



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Objetivo: Construir um questionário para identificar os padrões de reprodução, de apego e de sucesso que moldam os pais na interação familiar atualmente. Método: Uma metodologia mista foi utilizada na elaboração dos itens, e posteriores testes pilotos para a validação e consistência interna do instrumento, avaliado por um júri, constituído por especialistas. Resultados: Obteve-se um instrumento com 36 declarações, organizadas em 12 agrupamentos para a exploração de modelos familiares, de acordo com os fatores: criação dos filhos, laços familiares e os padrões de sucesso, existentes em contextos familiares e cada um deles com suas respectivas dimensões. A análise desses fatores forneceu informações sobre a natureza da formação da família nuclear e as áreas de oportunidade para a intervenção socioeducativa. Conclusão: Neste trabalho assume-se que o contexto familiar é tão decisivo como o contexto escolar, sendo assim, explorar a natureza dos modelos familiares, atualmente, é necessário para o conhecimento das características e influências da formação dos jovens, em qualquer contexto social.

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Objetivo: Construir un cuestionario para identificar los patrones de reproducción de apego y de éxito que forman los padres en la interacción familiar en la actualidad. Método: De corte mixto para elaboración de ítems, con pruebas piloto para validez y consistencia interna del instrumento y evaluación por un jurado compuesto por expertos. Resultados: Se obtuvo un instrumento con 36 enunciados, organizados en 12 grupos para la exploración de modelos familiares, conformado por los factores: crianza de los hijos, los vínculos familiares y los patrones de éxito existentes en contextos familiares y cada uno de ellos con sus respectivas dimensiones. El análisis de estos factores proporciona información sobre la naturaleza de la formación de la familia nuclear y las áreas susceptibles de intervención socioeducativa. Conclusión: En este trabajo se parte del supuesto de que el contexto familiar es tan determinante como el contexto escolar, por lo tanto, explorar la naturaleza de los modelos familiares en la actualidad, es necesario para el conocimiento de las características e influencias de la formación de los jóvenes, en cualquier contexto social.
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Association between long-term exposure to traffic-related air pollution and subclinical atherosclerosis: the REGICOR study.

BACKGROUND: Epidemiological evidence of the effects of long-term exposure to air pollution on the chronic processes of atherogenesis is limited. OBJECTIVE: We investigated the association of long-term exposure to traffic-related air pollution with subclinical atherosclerosis, measured by carotid intima media thickness (IMT) and ankle-brachial index (ABI). METHODS: We performed a cross-sectional analysis using data collected during the reexamination (2007-2010) of 2,780 participants in the REGICOR (Registre Gironí del Cor: the Gerona Heart Register) study, a population-based prospective cohort in Girona, Spain. Long-term exposure across residences was calculated as the last 10 years' time-weighted average of residential nitrogen dioxide (NO2) estimates (based on a local-scale land-use regression model), traffic intensity in the nearest street, and traffic intensity in a 100 m buffer. Associations with IMT and ABI were estimated using linear regression and multinomial logistic regression, respectively, controlling for sex, age, smoking status, education, marital status, and several other potential confounders or intermediates. RESULTS: Exposure contrasts between the 5th and 95th percentiles for NO2 (25 µg/m3), traffic intensity in the nearest street (15,000 vehicles/day), and traffic load within 100 m (7,200,000 vehicle-m/day) were associated with differences of 0.56% (95% CI: -1.5, 2.6%), 2.32% (95% CI: 0.48, 4.17%), and 1.91% (95% CI: -0.24, 4.06) percent difference in IMT, respectively. Exposures were positively associated with an ABI of > 1.3, but not an ABI of < 0.9. Stronger associations were observed among those with a high level of education and in men ≥ 60 years of age. CONCLUSIONS: Long-term traffic-related exposures were associated with subclinical markers of atherosclerosis. Prospective studies are needed to confirm associations and further examine differences among population subgroups.

Diagnóstico de tromboembolismo pulmonar agudo / Diagnosis of acute pulmonary thrombo-embolism

El tromboembolismo pulmonar agudo es una patología respiratorio y cardiovascular importante por su frecuencia; su eventual gravedad y sus dificultades diagnósticas. Sus factores de riesgo son la obesidad, el tabaquismo, la hipertensión la inmovilización prolongada y los anticonceptivos orales.La sospecha clínica es importante pero insuficiente para asegurar el diagnóstico. Entre los muchos recursos diagnósticos actualmente disponibles, destacan la radiografía de tórax; el electrocardiograma; la ecocardiografía doppler; la cintigrafía ventilación-perfusión; la tomografía helicoidal y sobre todo la angiografía pulmonar que sigue siendo el patrón de oro.

Could the [14C]urea breath test be proposed as a 'gold standard' for detection of Helicobacter pylori infection ?

BACKGROUND: The urea breath test (UBT) with a microdose of [14C] is a non-invasive and simple method for the assessment of gastric infection by Helicobacter pylori. The aim of this study was to compare the [14C]UBT with invasive methods widely used for assessment of H. pylori gastric infection, including histology with hematoxylin-eosin staining, the gastric smear technique using Giemsa staining, and the biopsy urease test. MATERIAL/METHODS: We evaluated patients referred to our clinic for elective upper gastrointestinal endoscopy excluding those on antibiotics and/or bismuth during the previous 4 weeks, patients on H+ blockers or H2 antihistamines during the previous 7 days, pregnant women, and patients who had undergone gastric surgery or had bleeding disorders. Eighty-nine patients ranging in age from 18-75 years were included in the final study population, 61 women and 28 men (mean age: 43(15 years). RESULTS: When histology alone was considered as the reference standard, sensitivity for the [14 C]UBT was 94%, with a specificity of 37%; when the Giemsa technique, sensitivity was 95%, and specificity 35%; and when the biopsy urease test, sensitivity was 94% and specificity 45%. With two or more invasive techniques together considered as the reference standard, the [14C]UBT had a sensitivity of 95%, with a specificity of 44%. CONCLUSIONS: [14C]UBT is an objective and reproducible technique, capable of sampling the whole gastric mucosa. It shows high sensitivity, but low specificity, which could be explained by limited gastric sampling plus subjective interpretation in the invasive techniques that are currently used as gold standard.