Arterial stiffness assessment in coronary microvascular dysfunction and heart failure with preserved ejection fraction: An initial report from the WISE-CVD continuation study.

Background: Heart failure with preserved ejection fraction (HFpEF) is the most common cardiac complication in patients with coronary microvascular dysfunction (CMD), yet its underlying pathways remain unclear. Aortic pulse-wave velocity (aPWV) is an indicator of large artery stiffness and a predictor for cardiovascular disease. However, aPWV in CMD and HFpEF is not well characterized and may provide understanding of disease progression. Methods: Among participants without obstructive coronary artery disease, we evaluated 51 women with suspected CMD and 20 women and men with evidence of HFpEF. All participants underwent aPWV measurement (SphygmoCor, Atcor Medical) with higher aPWV indicating greater vascular stiffness. Cardiac magnetic resonance imaging (CMRI) assessed left ventricular (LV) ejection fraction, CMD via myocardial perfusion reserve index (MPRI), and ventricular remodeling via LV mass-volume ratio. . Statistical analysis was performed using Wilcoxon rank sum tests, Pearson correlations and linear regression analysis. Results: Compared to the suspected CMD group, the HFpEF participants were older (65 ± 12 vs 56 ± 11 yrs., p = 0.002) had higher BMI (31.0 ± 4.3 vs 27.8 ± 6.7 kg/m2, p = 0.013), higher aPWV (10.5 ± 2.0 vs 8.0 ± 1.6 m/s, p = 0.05) and lower MPRI (1.5 ± 0.3 vs1.8 ± 0.3, p = 0.02), but not remodeling. In a model adjusted for cardiovascular risk factors, the HFpEF group had a lower LVEF (estimate -4.78, p = 0.0437) than the suspected CMD group. Conclusions: HFpEF participants exhibit greater arterial stiffness and lower myocardial perfusion reserve, with lower LVEF albeit not remodeling, compared to suspected CMD participants. These findings suggest arterial stiffness may contribute to progression from CMD to HFpEF. Prospective work is needed and ongoing.

Spatial assessment of wolf-dog hybridization in a single breeding period.

Understanding the dynamics of wolf-dog hybridization and delineating evidence-based conservation strategies requires information on the spatial extent of wolf-dog hybridization in real-time, which remains largely unknown. We collected 332 wolf-like scats over ca. 5,000km2 in the NW Iberian Peninsula to evaluate wolf-dog hybridization at population level in a single breeding/pup-rearing season. Mitochondrial DNA (MtDNA) and 18 ancestry informative markers were used for species and individual identification, and to detect wolf-dog hybrids. Genetic relatedness was assessed between hybrids and wolves. We identified 130 genotypes, including 67 wolves and 7 hybrids. Three of the hybrids were backcrosses to dog whereas the others were backcrosses to wolf, the latter accounting for a 5.6% rate of introgression into the wolf population. Our results show a previously undocumented scenario of multiple and widespread wolf-dog hybridization events at the population level. However, there is a clear maintenance of wolf genetic identity, as evidenced by the sharp genetic identification of pure individuals, suggesting the resilience of wolf populations to a small amount of hybridization. We consider that real-time population level assessments of hybridization provide a new perspective into the debate on wolf conservation, with particular focus on current management guidelines applied in wolf-dog hybridization events.

Treatment for children with severe aplastic anemia and sickle cell disease in low income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO): Part III.

Treatment of hematologic disorders in low-income countries (LIC) is difficult. This report summarizes treatment of sickle cell disease and aplastic anemia by pediatric hematologists from 15 LIC who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with severe sickle cell disease were treated with low dose hydroxyurea, which safely reduced vaso-occlusive crises. Patients with severe aplastic anemia fared poorly due to lack of availability and high cost of anti-thymocyte globulin and cyclosporine and lack of access to stem cell transplantation. Appropriate therapy was most likely to occur in MISPHO centers with an active twinning program with a center in a high-income country.

Hidronefrosis fetal: evaluación prenatal y pronóstico en 33 casos / Fetal hydronephrosis: prenatal assessment and prognosis in 33 cases

Entre los meses de octubre de 1996 y febrero de 1998 los autores evaluaron prospectivamente 33 fetos en los cuales la exploración ultrasonográfica detallada de la anatomía fetal reveló dilatación de la pelvis renal. El protocolo de seguimiento incluyó tamaño de la pelvis renal, ecogenicidad cortical, tamaño vesical y volumen de líquido amniótico. Todos los recién nacidos fueron evaluados por neonatólogo, nefrólogo y urólogo infantil con seguimiento individual promedio de 2 años. La hidronefrosis fue unilateral en 20 casos (61 por ciento) y bilateral en 13 casos (39 por ciento). Hubo 21 casos de hidronefrosis leve (64 por ciento), 6 casos de hidronefrosis moderada (18 por ciento) y 6 casos de hidronefrosis severa (18 por ciento). De los 21 casos de hidronefrosis leve, 19 (90 por ciento) evolucionaron prenatalmente con absoluta estabilidad y no presentaron infección del tracto urinario en el seguimiento pediátrico. De los 6 casos de hidronefrosis moderada, la dilatación de la pelvis renal se mantuvo estable durante todo el embarazo, pero la prevalencia de ITU al seguimiento pediátrico fue de un 50 por ciento. En los 6 casos de hidronefrosis severa se confirmó una causa orgánica. Se concluye que la hidronefrosis leve puede ser considerada una situación normal, ya que las variaciones en este rango parecen se más bien funcionales que anatómicas y presentan bajo riesgo de progresión o infección. No es lo mismo con las dilataciones superiores a los 10 mm, en las cuales a medida que aumenta la dilatación se verifican más causas obstructivas que variantes anatómicas o reflujo. Además, en estos grupos se presentan infecciones postnatales en hasta un 30 por ciento de los casos

North-South twinning in paediatric haemato-oncology: the La Mascota programme, Nicaragua.

We describe the La Mascota twinning programme between La Mascota paediatric hospital in Managua, Nicaragua, and hospitals in Monza and Milan, Italy, and Bellinzona, Switzerland. The programme was based on the belief that an attempt to reduce the gap in mortality from cancer in childhood between developed and less developed countries should become an integral part of the care and research activity of a haemato-oncological department of a developed country and not simply an exercise in solidarity. This programme for acute lymphoblastic leukaemia shows that intellectual, organisational, and financial resources can be generated by a twinning programme. What is vital for such programmes is a long-term commitment to a comprehensive and holistic strategy that incorporates supply of drugs, training and supervision of health professionals, and the care of the children and of their parents.

The role of priority programmes in the provision of health services in the state of Oaxaca, Mexico.

An assessment of the performance of five priority health programmes (basic sanitation, tuberculosis, vaccination, acute respiratory infections and acute diarrheal diseases) was carried out using ethnographic techniques in the region of La Cañada in the state of Oaxaca, Mexico. The region presents a large percentage of Indian and peasant population living in extreme poverty and health care is mainly provided by the Ministry of Health. Both characteristics of the population and the health services are used to analyze the performance of the programmes. With access to abundant resources, vaccination and diarrheal disease programmes have been highly successful in involving the population and achieving their operative targets. Consequently this capacity to concentrate resources results in a lack of resources for other programmes. Despite partial successes, all programmes face serious operational difficulties demonstrating, in turn, the lack of capacity of health services to respond to the specific demands of local populations. The information presented is relevant for the discussion of selective versus comprehensive PHC.

[Radionuclide bone scanning in patients with breast carcinoma. Study of lesions by stages, locations and diagnostic assessment]. / Gammagrafía ósea en pacientes con carcinoma de mama. Estudio de las lesiones por estadios, localizaciones y valoración diagnóstica.

The aim of this study was to evaluate the diagnostic role of bone scan in patients with breast carcinoma. With this purpose, we have studied 591 patients (4 males). In 261 of them, we were able to establish the stage of disease: 33 in stage I, 137 in stage II, 71 in stage III y 20 in stage IV. Metastatic lesions were detected in 6% of patients in stage I, 8.8% in stage II, 12.7% in stage III y 50% in stage IV. Altogether, 71 from 591 patients (12%) had metastatic lesions. In 4 patients (5.3%) we obtained a false positive result. The bone lesions found in the scintigraphic studies were classified as not metastatic lesions in 236 patients (39.9%) but 26 of them were malignant (11%). Another 193 patients (32.6%) presented scintigraphic studies considered as equivocal for metastasis and 33 of them were also malignant (17%). In 150 patients scintigraphic studies did not present lesions during the follow up. In other 156 patients isolated lesions were detected and 24 of them (15.4%) were malignant. Only 4 <> lesions were detected and not any <> image was observed in this study.

Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua.

We observed a child with acute promyelocytic leukemia (APL) who, at the onset, had extremely severe hemorrhagic and septic complications. According to our experience in Nicaragua, there was a very high risk of early death. The patient was successfully treated with a program that included all-trans retinoic acid (ATRA) followed by cytotoxic chemotherapy. ATRA has two important features: it is effective in initial treatment of APL and it is inexpensive. Because of the high cost and the need for extensive supportive care, optimal myeloablative therapy used in patients with various types of acute myeloid leukemia generally cannot be given in developing countries. ATRA treatment for APL is affordable everywhere.

[Organ transplantation as a health priority in developing countries]. / Transplante de órganos como una prioridad de salud en paises en desarrollo.

The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.