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INTRODUCTION AND OBJECTIVES: Only about 1 out of every 3 patients with acute myocardial infarction (AMI) achieve low-density lipoprotein cholesterol (LDL-C) values <55mg/dL in the first year. The present study aims to evaluate the impact of early intensive therapy on lipid control after an AMI. METHODS: An independent, prospective, pragmatic, controlled, randomized, open-label, evaluator-blinded clinical trial (PROBE design) will analyze the efficacy and safety of an oral lipid-lowering triple therapy: high-potency statin+bempedoic acid (BA) 180mg+ezetimibe (EZ) 10mg versus current European-based guidelines (high-potency statin±EZ 10mg), in AMI patients. LDL-C will be determined within the first 48hours. Patients with LDL-C ≥ 115mg/dL (without previous statin therapy), ≥ 100mg/dL (with previous low-potency or high-potency statin therapy at submaximal dose), or ≥ 70mg/dL (with previous high-potency statin therapy at high dose) will be randomly assigned 1:1 between 24 and 72hours post-AMI to the BA/EZ combination or to statin±EZ, without BA. The primary endpoint is the proportion of patients reaching LDL-C <55mg/dL at 8 weeks after treatment. RESULTS: The results of this study will provide novel information for post-AMI LDL-C control by evaluating the usefulness of an early intensive lipid-lowering strategy based on triple oral therapy. CONCLUSIONS: Early intensive lipid-lowering triple oral therapy vs the treatment recommended by current clinical practice guidelines could facilitate the achievement of optimal LDL-C levels in the first 2 months after AMI (a high-risk period). IDENTIFICATION NUMBER: EudraCT 2021-006550-31.
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BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in the elderly population. Coronary artery disease, heart failure, and peripheral artery disease constitute the prevailing conditions. Cardiac rehabilitation (CR) represents a cornerstone in the secondary prevention of cardiovascular disease, since it has been associated with significant cardiovascular benefits in the above-mentioned conditions, by significantly reducing cardiovascular outcomes and improving functional independence and quality of life. Besides, CR offers the background for optimizing the control of cardiovascular risk factors and implementing physical exercise, also providing psychological and social support. SUMMARY: The prevalence of cardiovascular disease increases with age, associating high morbidity and mortality. In addition, comorbidities, frailty, and other geriatric conditions, entities that also entail poor prognosis, are often present in elderly patients. Indeed, frailty is recommended to be systematically addressed in elderly patients with cardiovascular disease, and there is growing evidence regarding the benefits of CR programs in this setting, also associated with lower adverse events during follow-up. However, elderly patients are less often referred to CR after a cardiovascular event when compared to their younger counterparts. In this review, we summarized the benefits of CR programs in the elderly population with established cardiovascular disease, proposing a comprehensive framework that integrates personalized care strategies. KEY MESSAGES: Cardiovascular disease is the leading cause of morbimortality, especially in the elderly. The management of cardiovascular disease in elderly patients poses unique challenges, since they represent a heterogeneous group and evidence is low. CR can provide significant benefits in older patients, encompassing physical training and specific management of geriatric syndromes.
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The exchange of information and social interactions on broad spatial scales between human groups in the past can be studied through the provenance of key indicators of distant origin recorded at archaeological sites. The remains of shells of mollusk species, especially when crafted as elements of personal ornaments, express aspects of the behaviors and valuations for the populations that selected, transformed, and exchanged such items. In the southern cone of South America, past hunter-gatherer groups traveled long distances and interacted with communities distributed throughout the territory to acquire goods for technological use, visual display or considered highly valued materials. When recorded at distant locations, these goods of extra local origin are very informative regarding the differences between commonly used home ranges and the occasional access to remote spaces. We present the results of the analysis of the archaeomalacological assemblage of the Baño Nuevo 1 site, a cave with exceptional preservation conditions in Central West Patagonia. This site has yielded a diverse group of artifacts made of shells with origins from multiple distances, as well as evidence of the use of marine, freshwater, and terrestrial species. Its deposits, which extend over the last 11,000 years, reveal an antiquity of at least the middle Holocene for the acquisition, manufacture, use and transport of goods as personal ornaments from shells in the macroregion.
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Arqueología , Humanos , Animales , Historia Antigua , Exoesqueleto/anatomía & histología , América del Sur , Cuevas , Fósiles , ArgentinaRESUMEN
The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.
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A 70-year-old woman consulted us for dyspnea. Echocardiography revealed moderate aortic regurgitation secondary to ascending aorta dilatation. Study was completed with aortic angiography computed tomography, showing stenosis and dissection of several visceral arteries. There were no abnormal inflammatory or autoimmune markers, nor fluorine-18-fluorodeoxyglucose positron emission tomography uptake. Segmental arterial mediolysis was diagnosed.
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PURPOSE OF REVIEW: Heart failure (HF) is one of the most frequent causes of hospital admission in elderly patients, especially in women, who present a high prevalence of geriatric syndromes like frailty. Studies have suggested that frailty and its impact may also differ between males and females. Understanding how frailty may differently affect HF patients depending on sex is therefore imperative for providing personalized care. The aim of this review is to summarize the role of sex in the prognostic impact of frailty in HF patients. RECENT FINDINGS: Numerous studies have identified frailty as a significant predictor of all-cause mortality and hospital readmissions. A recent study of elderly HF out-patients demonstrated that while women had a higher prevalence of frailty, it was an independent predictor of mortality and readmission only in men. Moreover, another study revealed that physical frailty was associated with time to first clinical event among men but not among women. These results raise the question about why frailty affects differently HF prognosis in men and women. Women with HF present a higher prevalence of frailty, especially when it is considered as physical decline. Nevertheless, frailty affects differently HF prognosis in men and women. Women with HF present lower mortality than men and frailty is related with prognosis only in men. The different severity of HF between men and women and other hormonal, psychosocial, and clinical factors might be involved in this fact.
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Fragilidad , Insuficiencia Cardíaca , Masculino , Anciano , Humanos , Femenino , Fragilidad/epidemiología , Insuficiencia Cardíaca/complicaciones , Anciano Frágil , Hospitalización , Readmisión del Paciente , PronósticoRESUMEN
Resumen Objetivo: Determinar los factores asociados al nivel de autoeficacia en las mujeres lactantes de la UMF No. 47, IMSS, Tabasco. Material y Métodos: Estudio observacional, transversal y analítico, en una muestra de 197 mujeres lactantes, que cumplieron los criterios de inclusión. Se aplicó un cuestionario sociodemográfico y obstétrico diseñado por el investigador, y la escala de autoeficacia de lactancia materna en su forma corta (BSES-SF), de 14 ítems, con alfa de Cronbach de 0.92. El análisis incluyo estadística descriptiva, así como estadística inferencial donde se utilizó la prueba chi cuadrada de Pearson. Se obtuvo la magnitud de asociación, con los riesgos de prevalencia (tablas de 2x2), y valor de p≤0.05 con prueba exacta de Fisher. Los datos fueron procesados en el programa estadístico SPSS 25 y STATA 6. Resultados: Edad mínima 17 y máxima 40, predominó el grupo de 21- 25 años con 31.5% (X2 =109.944a , gl=8, p<.001, RP 7.87, prueba exacta de Fisher p<0.001), unión libre con 46.2% (X2 =71.736a , gl=6, p<.001, RP 6.51, prueba exacta de Fisher p<0.001), preparatoria con 41.1% (X2 =18.252a , gl=6, p<.006, RP 1.51, prueba exacta de Fisher p<0.04), nivel socioeconómico medio con 52.8% (X2 =38.784a , gl=4, p<.001, RP 3.42, prueba exacta de Fisher p<0.001), con 2 hijos el 35% (X2 =44.647a , gl=6, p<.001, RP 4.65, prueba exacta de Fisher p<0.001) y si recibió orientación con 94.9% (X2 =5.175a , gl=2, p=.075, RP .910, prueba exacta de Fisher p<0.03). Conclusiones: Los factores como la edad, estado civil, escolaridad, nivel socioeconómico, paridad y la orientación recibida, se asociaron al nivel de autoeficacia de lactancia materna, mientras que la ocupación y tipo de parto no se asociaron.
Abstract Objective: To determine the factors associated with the level of self-efficacy in lactating women from UMF No. 47, IMSS, Tabasco. Material and Methods: Observational, cross-sectional and analytical study, in a sample of 197 lactating women, who met the inclusion criteria. A sociodemographic and obstetric questionnaire designed by the researcher was applied, as well as the breastfeeding self-efficacy scale in its short form (BSES-SF), of 14 items, with Cronbach's alpha of 0.92. The analysis included descriptive statistics, as well as inferential statistics where Pearson's chi-square test was used. The magnitude of association was obtained, with the prevalence risks (2x2 tables), and value of p≤0.05 with Fisher's exact test. The data were processed in the statistical program SPSS 25 and STATA 6. Results: Minimum age 17 and maximum 40, the group of 21-25 years predominated with 31.5% (X2 =109.944a , gl=8, p<.001, RP 7.87, Fisher's exact test p<0.001), free union with 46.2% (X2 =71.736a , gl=6, p<.001, RP 6.51, Fisher's exact test p<0.001), preparatory with 41.1% (X2 =18.252a , gl=6, p<.006, RP 1.51, Fisher's exact test p<0.04), medium socioeconomic level with 52.8% (X2 =38.784a , gl=4, p<.001, RP 3.42 , Fisher's exact test p<0.001), with 2 children 35% (X2 =44.647a , gl=6, p<.001, RP 4.65, Fisher's exact test p<0.001) and if they received guidance with 94.9 % (X2 =5.175a , gl=2, p=.075, RP .910, Fisher's exact test p<0.03). Conclusions: Factors such as age, marital status, education, socioeconomic level, parity and the orientation received, were associated with the level of self-efficacy in breastfeeding, while occupation and type of delivery were not associated.
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PURPOSE OF REVIEW: Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS: Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.
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BACKGROUND: Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. SUMMARY: The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. KEY MESSAGES: In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment.
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Insuficiencia Cardíaca , Humanos , Anciano , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Volumen Sistólico , Tetrazoles/uso terapéutico , Valsartán/farmacología , Pronóstico , Combinación de Medicamentos , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Arritmias Cardíacas/tratamiento farmacológico , Arritmias Cardíacas/prevención & control , Arritmias Cardíacas/inducido químicamente , Compuestos de Bifenilo/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antagonistas de Receptores de Angiotensina/farmacologíaRESUMEN
Introducción: El síndrome nefrótico es una patología que afecta el complejo glomerular del riñón, se caracteriza por una proteinuria mayor 3500 mg/d. De acuerdo a la respuesta de los esteroides se puede clasificar en síndrome nefrótico en esteroide resistente o esteroide sensible. Objetivo: Determinar la relación que existe entre la proteinuria y las variantes del síndrome nefrótico en adultos. Métodos: Se realizó un estudio descriptivo, retrospectivo, tipo serie de casos, con una población de 28 pacientes. Se recolectaron y se procesaron los datos a través del software Epi-Info 7,2TM; la frecuencia simple, la media estadística, prueba t de Student, y el coeficiente de correlación de Pearson. Resultados: En el análisis combinatorio de los fármacos adyuvantes para síndrome nefrótico, el grupo que utilizó antiproteinúricos pero no estatinas, demostró una diferencia estadísticamente significativa entre la proteinuria postratamiento media del grupo de síndrome nefrótico esteroideo resistente (6202 mg/d) vs síndrome nefrótico esteroideo sensible (65,9 mg/d) (valor de p 0,418). Existe una correlación negativa entre los niveles proteinuria postratamiento y el nivel de albúmina sérica postratamiento (r = - 0,7 valor de p < 0,00001). Conclusiones: Se demostró la ausencia de asociación entre la proteinuria inicial y las variantes de síndrome nefrótico esteroide sensible y esteroide resistente (valor de p = 0,8)(AU)
Introduction: Nephrotic syndrome is a pathology that affects the glomerular complex of the kidney, characterized by proteinuria greater than 3500 mg/d. According to the response to steroids, nephrotic syndrome can be classified as steroid-resistant or steroid-sensitive. Objective: To determine the relationship between proteinuria and the variants of the nephrotic syndrome in adults. Methods: A descriptive, retrospective, case series type study was carried out with a population of 28 patients. The data was collected and processed through Epi-Info 7.2TM software; simple frequency, statistical mean, student's t-test, and Pearson's correlation coefficient. Results: The statistically significant difference was obtained in the antiproteinuric and non-statin group, between the mean post-treatment proteinuria of the steroid resistant nephrotic syndrome group (6202 mg/d) in comparison to steroid sensitive nephrotic syndrome (65.9 mg/d) (p value 0.0418). There is negative correlation between post-treatment proteinuria levels and post-treatment serum albumin level (r= -0.7 p value <0.00001). Conclusions: The absence of association between initial proteinuria and steroid-sensitive and steroid-resistant variants of nephrotic syndrome was demonstrated (p value=0.8)(AU)
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Humanos , Masculino , Femenino , Proteinuria , Esteroides , Albuminuria , Enfermedades Renales/epidemiología , Síndrome Nefrótico/epidemiología , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent type of acute coronary syndrome in the elderly. Antithrombotic therapy is the cornerstone of pharmacological therapy in the setting of an acute ischemic event, a clinical scenario in which thrombotic and bleeding risks ought to be considered, particularly in older patients. In this article, specific aspects of antithrombotic therapy in elderly patients with NSTEMI are reviewed, including pharmacokinetic and pharmacodynamic characteristics and different clinical situations. The role of frailty and other common geriatric conditions, that are associated with worse prognosis in elderly patients with cardiovascular disease, is also addressed.
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The current pandemic generated by SARS-CoV-2 has led to mass vaccination with different biologics that have shown wide variations among human populations according to the origin and formulation of the vaccine. Studies evaluating the response in individuals with a natural infection before vaccination have been limited to antibody titer analysis and evaluating a few humoral and cellular response markers, showing a more rapid and intense humoral response than individuals without prior infection. However, the basis of these differences has not been explored in depth. In the present work, we analyzed a group of pro and anti-inflammatory cytokines, antibody titers, and cell populations in peripheral blood of individuals with previous SARS-CoV-2 infection using BNT162b2 biologic. Our results suggest that higher antibody concentration in individuals with an earlier disease could be generated by higher production of plasma cells to the detriment of the presence of memory B cells in the bloodstream, which could be related to the high baseline expression of cytokines (IL-6 and IL-10) before vaccination.
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COVID-19 , Vacunas Virales , Vacuna BNT162 , COVID-19/prevención & control , Humanos , Interleucina-10 , Interleucina-6 , Receptores CCR7 , SARS-CoV-2 , VacunaciónRESUMEN
Introduction: Frailty is common among patients with heart failure (HF). Our aim was to address the role of frailty in the management and prognosis of elderly men and women with HF. Methods and results: Prospective multicenter registry that included 499 HF outpatients ≥75 years old. Mean age was 81.4 ± 4.3 years, and 193 (38%) were women. Compared with men, women were older (81.9 ± 4.3 vs. 81.0 ± 4.2 years, p = 0.03) and had higher left ventricular ejection fraction (46 vs. 40%, p < 0.001) and less ischemic heart disease (30 vs. 57%, p < 0.001). Women had a higher prevalence of frailty (22 vs. 10% with Clinical Frailty Scale, 34 vs. 15% with FRAIL, and 67% vs. 46% with the mobility visual scale, all p-values < 0.001) and other geriatric conditions (Barthel index ≤90: 14.9 vs. 6.2%, p = 0.003; malnutrition according to Mini Nutritional Assessment Short Formulary ≤11: 55% vs. 42%, p = 0.007; Pfeiffer cognitive test's errors: 1.6 ± 1.7 vs. 1.0 ± 1.6, p < 0.001; depression according to Yesavage test; p < 0.001) and lower comorbidity (Charlson index ≥4: 14.1% vs. 22.1%, p = 0.038). Women also showed worse self-reported quality of life (6.5 ± 2.1 vs. 6.9 ± 1.9, on a scale from 0 to 10, p = 0.012). In the univariate analysis, frailty was an independent predictor of mortality in men [Hazard ratio (HR) 3.18, 95% confidence interval (CI) 1.29-7.83, p = 0.012; HR 4.53, 95% CI 2.08-9.89, p < 0.001; and HR 2.61, 95% CI 1.23-5.43, p = 0.010, according to FRAIL, Clinical Frailty Scale, and visual mobility scale, respectively], but not in women. In the multivariable analysis, frailty identified by the visual mobility scale was an independent predictor of mortality (HR 1.95, 95% CI 1.04-3.67, p = 0.03) and mortality/readmission (HR 2.06, 95% CI 1.05-4.04, p = 0.03) in men. Conclusions: In elderly outpatients with HF frailty is more common in women than in men. However, frailty is only associated with mortality in men.
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INTRODUCTION AND OBJECTIVES: Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS: Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS: We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS: In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.
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Fragilidad , Insuficiencia Cardíaca , Humanos , Femenino , Anciano , Anciano de 80 o más Años , Masculino , Fragilidad/epidemiología , Volumen Sistólico , Anciano Frágil , Síndrome , Función Ventricular Izquierda , Estudios Prospectivos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Pronóstico , Enfermedad Crónica , Evaluación GeriátricaRESUMEN
OBJECTIVES: To assess the value of sirolimus-eluting magnesium bioresorbable scaffolds (MgS) in the treatment of patients with in-stent restenosis (ISR). The better option for the treatment of patients with ISR remains unsettled. Bioresorbable vascular scaffolds represent an interesting strategy in this setting to avoid another permanent metal layer. The novel MgS is an attractive option to treat these challenging patients. METHODS: We present the results of the first prospective series of consecutive patients with ISR treated with MgS under optical coherence tomography (OCT) guidance. RESULTS: A total of 14 patients (15 lesions) were prospectively included. The mean age was 67 ± 9 years and six patients (40%) presented with an acute coronary syndrome. In 10 patients (67%), underlying neoatherosclerosis was disclosed by OCT. An excellent MgS expansion was obtained in all but two patients who showed persistent suboptimal expansion in heavily calcified vessels. Minor residual malapposition ( n = 5) and angiographically silent minor edge dissections ( n = 8) were readily recognized by OCT. After a median clinical follow-up of 30 (range, 20-54) months, no patient required repeated revascularization, suffered a myocardial infarction or device thrombosis. CONCLUSIONS: These preliminary results suggest a potential role for the MgS in selected patients presenting with ISR.
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Reestenosis Coronaria , Stents Liberadores de Fármacos , Implantes Absorbibles , Anciano , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Reestenosis Coronaria/terapia , Humanos , Magnesio , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Sirolimus , Tomografía de Coherencia Óptica/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. METHODS: Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. RESULTS: Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. CONCLUSIONS: MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.
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Staphylococcus aureus Resistente a Meticilina/patogenicidad , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/patogenicidad , Adolescente , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Colombia/epidemiología , Femenino , Hospitalización , Humanos , Lactante , Masculino , Meticilina/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacosRESUMEN
Age is associated with increased cardiovascular risk factors and cardiovascular disease, which constitutes the leading cause of morbidity and mortality in elderly population. In this text we thoroughly review current evidence regarding the impact on cardiovascular disease of the most important cardiovascular risk factors, especially prevalent and common in the elderly population. Diagnosis and treatment approaches are also addressed, also highlighting the importance of adequate primary and secondary prevention and management. Also, the relationship between cardiovascular disease and some comorbidities and geriatric conditions, such as frailty, particularly common in the elderly, is reviewed, together with some other issues, less often addressed but closely related to ageing, such as genetics, structural and electrical heart changes and oxidative stress. All such questions are of great importance in the comprehensive approach of risk factors and cardiovascular disease in the elderly.
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Ischemic heart disease constitutes the leading cause of death in Western countries. The general incidence of acute coronary syndromes (ACS), especially non-ST segment elevation myocardial infarction (NSTEMI), is growing. Advanced age is both a strong risk factor for ACS and an independent predictor of poorer clinical outcomes. Management of this entity is often complex in the elderly, while special attention should be focused on comorbidities and geriatric conditions. This article aims to review clinical presentation, identification and management of NSTEMI in the elderly population.
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Síndrome Coronario Agudo , Isquemia Miocárdica , Infarto del Miocardio sin Elevación del ST , Infarto del Miocardio con Elevación del ST , Anciano , Humanos , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Infarto del Miocardio sin Elevación del ST/epidemiología , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/epidemiologíaRESUMEN
Heart failure (HF) is a clinical syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac filling pressures at rest or during stress. HF is a major public health problem with high prevalence and incidence, involving both high morbidity and mortality, but also high economic costs. The incidence of HF progressively increases with age, reaching around 20% among people over 75 years old. Indeed, HF represents the leading cause of hospitalization in patients older than 65 years in Western countries. Hence, some authors even consider HF a geriatric syndrome, entailing worse prognosis and high residual disability, and often associating some complex comorbidities, common in older population, that may further complicate the course of the disease. On the other hand, however, clinical course and prognosis may be often difficult to predict. In this article, main pathophysiological issues related to the aging heart are addressed, together with key aspects related to both diagnosis and prognosis in elderly patients with HF. Besides, main geriatric conditions, common in the elderly population, are reviewed, highlighting the importance of a comprehensive and multidisciplinary approach.