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PURPOSE: The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document addresses sexual health management in patients with gynaecological cancer after pelvic radiotherapy. METHODS: A modified two-round online Delphi study was conducted, where GINECOR members were surveyed on the diagnosis, treatment, and follow-up of sexual health problems. An expert panel of radiation oncologists, nurses and a gynaecologist participated in the Delphi study to reach a consensus, applying GRADE criteria to establish the level of agreement. RESULTS: The consensus recommendations cover both diagnosis and treatment, with an emphasis on patient-reported outcome measures (PROMs). They highlight recommendations such as the systematic assessment of genitourinary, gastrointestinal, and sexual symptoms, and the use of several treatments after radiotherapy. Recommendations include pharmacological options like vaginal lubricants and hormone therapy, and mechanical interventions such as vaginal dilators and vibrators. These suggestions stem from both scientific evidence and clinical expertise. CONCLUSION: This consensus statement describes a comprehensive, multidisciplinary approach developed to address the sexual needs and enhance the quality of life of patients with gynaecological tumours after pelvic radiotherapy. It offers specific recommendations for managing sexual issues, emphasizing the importance of specialized care and regular assessment. The document underscores the significance of proactive, patient-centered sexual health management in gynaecological cancer patients.
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BACKGROUND: The COVID-19 pandemic has resulted in great incertitude and overwhelming changes in healthcare that have had a direct impact on antibiotic prescription. However, the influence of this pandemic on antibiotic consumption in patients undergoing surgery has not yet been analysed. The goal of this study was to analyse antimicrobial consumption and prescription in the same period of 2019 (pre-COVID-19), 2020 (beginning of the COVID-19 pandemic) and 2021 (established COVID-19) according to the DDD system in surgical patients at a tertiary-level hospital. METHODS: A prospectively maintained database was analysed. All patients who underwent elective or emergency gastrointestinal surgery during the same period (2019, 2020 and 2021) were included. Those who received at least 1 of the 10 most frequently prescribed antimicrobials during those periods were analysed. RESULTS: A total of 2975 patients were included in this study. In 2020, the number of procedures performed decreased significantly (653 versus 1154 and 1168 in 2020 versus 2019 and 2021, respectively; Pâ=â0.005). Of all patients who underwent surgery during these periods, 45.08% received at least one of the antimicrobials studied (45.8% in 2020 versus 22.9% and 22.97% in 2019 and 2021, respectively; Pâ=â0.005). Of these, 22.97% of the patients received a combination of these antimicrobials, with ceftriaxone/metronidazole being the most frequent. Hepato-Pancreato-Biliary and Liver Transplant, Emergency Surgery and Colorectal Surgery units had higher antibiotic consumption. CONCLUSIONS: The COVID-19 pandemic has resulted in a significant decrease in surgical activity and higher post-operative antimicrobial prescription compared with previous and subsequent years.
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The aim of this study was to highlight the importance of measuring blood pressure (BP) to identify new, known, and treated individuals with hypertension and to raise awareness in the general population about the importance of good BP control. In Paraguay, 3663 individuals aged ≥18 years of both sexes were recruited from May to November 2021 as part of the May Measurement Month (MMM) campaign, which was initiated by the International Society of Hypertension in 2017. Volunteers of 18 regional health teams applied the questionnaire provided by the MMM 2021 organization throughout the country. Due to COVID-19 constraints, the majority of the questionnaires (52.2%) were administered in health centres of the Ministry of Health and concluded with three BP and pulse readings using OMRON-automated BP measurement devices. Hypertension was defined as a systolic BP ≥ 140â mmHg or as a diastolic BP ≥ 90â mmHg or taking antihypertensive medication. We found that 57.4% of screenees were hypertensive and 72.9% of these (82.3% of women and 59.4% of men) had known hypertension. Of patients with hypertension, 70.1% were on antihypertensive medication, and 40.9% had controlled BP (<140/90â mmHg). Among hypertensives detected, 79.7% of women were on antihypertensive medication and 44.1% had controlled BP, while 56.4% of men were on treatment and 34.3% had controlled BP. In summary, we found high levels of hypertension with high rates of awareness and treatment particularly among women, although control rates were low particularly among men. This may be because most screening was conducted predominately in hospital settings.
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To compare effectiveness and safety of the Cook's balloon with vaginal dinoprostone to induce labor in patients with previous cesarean section. Observational, and retrospective study that included pregnant women at ≥ 37 weeks' gestation, with unfavorable cervix, singleton pregnancy, intact membranes, and a previous cesarean section, who had undergone labor induction in the period 2014-2019. 170 patients (86 balloon-84 dinoprostone) were analyzed. The proportion of women achieving vaginal delivery within 24 h was higher in the dinoprostone than in double-balloon group (RR, 3.24; 95% CI, 1.36-7.72). No significant differences were detected in the first 48 h in vaginal deliveries (P = .749) or in cesarean section rates (P = .634). Nor were there differences in maternal or fetal safety profiles. A body mass index > 35 increased the risk of cesarean section by 1.53 times (P = .017) and a Bishop's test score < 3 by 1.91 times (P = .009). A vaginal delivery following a cesarean section decreased the probability of another cesarean section by 0.46 times (P = .039). Labor induction with vaginal dinoprostone achieves better vaginal delivery rates in the first 24 h vs Cook's balloon. While the difference in uterine rupture rate did not reach significance, this was higher in women receiving prostaglandin.
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Importance: Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries. Objective: To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD. Design, Setting, and Participants: Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models. Results: Between August 2016 and May 2022, a total of 13â¯696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12â¯967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41â¯478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors. Conclusions and Relevance: Mortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.
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Causas de Muerte , Hospitalización , Cardiopatía Reumática , Humanos , Cardiopatía Reumática/mortalidad , Cardiopatía Reumática/complicaciones , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios Prospectivos , Hospitalización/estadística & datos numéricos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/complicaciones , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Endocarditis/mortalidad , Fiebre Reumática/complicaciones , Fiebre Reumática/mortalidad , Países en Desarrollo , Modelos de Riesgos Proporcionales , MorbilidadRESUMEN
Tropical forests on karstic relief (tropical karst forest) are among the most species-rich biomes. These forests play pivotal roles as global climate regulators and for human wellbeing. Their long-term conservation could be central to global climate mitigation and biodiversity conservation. In Mexico, karst landscapes occupy 20% of the total land surface and are distributed mainly in the southeast of the country, along the eastern slope, and in the Yucatan Peninsula. Within each of these areas, the following types of karst occur: coastal karst, plain karst, hill karst, and mountain karst (low, medium, high). Mountain karst cover 2.07% of Mexico's land surface and are covered by tropical rainforests, montane cloud forests, and tropical deciduous forests. These are probably one of the most diverse biomes in Mexico. However, the mountain karst forests of Mexico have received little attention, and very little is known about their diversity. Here, we evaluated the vascular plant species richness within the mountain karst forests of Mexico. We assembled the first, largest, and most comprehensive datasets of Mexican mountain karst forest species, from different public databases (CONABIO, GBIF, IBdata-UNAM), which included a critical review of all data. We compiled a list of the families, genera, and species present within the mountain karst forests of Mexico. Taxa that best characterize these forests were identified based on their spatial correlation with this biome. We explored biodiversity patterns, identifying areas with the highest species richness, endemism centers, and areas of relatively low sampling intensity. We found that within the mountain karst forests of Mexico there are representatives of 11,771 vascular plant species (253 families and 2,254 genera), ca. 50% of the Mexican flora. We identified 372 species endemic to these forests. According to preliminary IUCN red list criteria, 2,477 species are under some category of conservation risk, of which 456 (3.8%) are endangered. Most of the Mexican mountain karst forests have been extensively explored and six allopatric, species-rich areas were identified. Compared to other regions in the world, the mountain karst forests of Mexico are one of the most diverse biomes. They contain more species than some entire montane systems in Mexico such as Sierra Madre Oriental, and Sierra Madre del Sur. Also, the mountain karst forests of Mexico are most diverse than similar forests of South America and Asia, even if considering the effect of different sampling areas. The fact that mountain karst forests are embedded in areas of high biotic diversity, probably contributes to their great floristic diversity. Thus, the mountain karst forests of Mexico are an important source of diversity and shelters a large percentage of the Mexican flora.
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Bosques , Tracheophyta , Humanos , México , Ecosistema , BiodiversidadRESUMEN
Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials. Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-ß-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation: The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics. Funding: The study was funded by the Innovative Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE).
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The aim of this study was to highlight the importance of measuring blood pressure (BP) and to identify and reduce the BPs of those people who require intervention to lower their BP according to current guidelines. A total of 7782 individuals aged ≥18 years were recruited during the 3 years of the May Measurement Month (MMM) campaign (2017: 1196, 2018: 2285, 2019: 4301). Recruitment was through opportunistic sampling at a variety of screening sites distributed throughout the country. Each participant underwent a pre-specified questionnaire with questions on risk factors concluding with three BP measurements at 1â min intervals and measurement of weight and height. Hypertension was defined as a systolic BP ≥140â mmHg or diastolic BP ≥90â mmHg or those receiving antihypertensive therapy. Of all 7782 participants, 3323 had hypertension (42.7%) of whom 61.8% were aware and 50.4% were not receiving antihypertensive medication. Of those treated (49.6%), 43.8% had controlled BP (<140/90â mmHg). Among all hypertensive patients (with and without medication), 21.7% had controlled BP. In relation to previous surveys carried out in the country, awareness of hypertension increased two-fold, with no change in the proportion of hypertensive patients on treatment and the proportion of hypertensive patients with controlled BP which remained low.
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Neutralizing antibodies targeting the receptor-binding domain (RBD) of SARS-CoV-2 are among the most promising strategies to prevent and/or treat COVID-19. However, as SARS-CoV-2 has evolved into new variants, most of the neutralizing antibodies authorized by the US FDA and/or EMA to treat COVID-19 have shown reduced efficacy or have failed to neutralize the variants of concern (VOCs), particularly B.1.1.529 (Omicron). Previously, we reported the discovery and characterization of antibodies with high affinity for SARS-CoV-2 RBD Wuhan (WT), B.1.617.2 (Delta), and B.1.1.529 (Omicron) strains. One of the antibodies, called IgG-A7, also blocked the interaction of human angiotensin-converting enzyme 2 (hACE2) with the RBDs of the three strains, suggesting it may be a broadly SARS-CoV-2 neutralizing antibody. Herein, we show that IgG-A7 efficiently neutralizes all the three SARS-CoV-2 strains in plaque reduction neutralization tests (PRNTs). In addition, we demonstrate that IgG-A7 fully protects K18-hACE2 transgenic mice infected with SARS-CoV-2 WT. Taken together, our findings indicate that IgG-A7 could be a suitable candidate for development of antibody-based drugs to treat and/or prevent SARS-CoV-2 VOCs infection.
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BACKGROUND: Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS: We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA2DS2VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm2, left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis. RESULTS: Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, -76 days; 95% confidence interval [CI], -121 to -31; P<0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, -72 days; 95% CI, -117 to -28). No significant between-group difference in the rate of major bleeding was noted. CONCLUSIONS: Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.).
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Anticoagulantes , Fibrilación Atrial , Inhibidores del Factor Xa , Cardiopatía Reumática , Rivaroxabán , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/etiología , Ecocardiografía , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/diagnóstico por imagen , Rivaroxabán/efectos adversos , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento , Vitamina K/antagonistas & inhibidores , Warfarina/efectos adversos , Warfarina/uso terapéuticoRESUMEN
This report describes the discovery and characterization of antibodies with potential broad SARS-CoV-2 neutralization profiles. The antibodies were obtained from a phage display library built with the VH repertoire of a convalescent COVID-19 patient who was infected with SARS-CoV-2 B.1.617.2 (Delta). The patient received a single dose of Ad5-nCoV vaccine (Convidecia™, CanSino Biologics Inc.) one month before developing COVID-19 symptoms. Four synthetic VL libraries were used as counterparts of the immune VH repertoire. After three rounds of panning with SARS-CoV-2 receptor-binding domain wildtype (RBD-WT) 34 unique scFvs, were identified, with 27 cross-reactive for the RBD-WT and RBD Delta (RBD-DT), and seven specifics for the RBD-WT. The cross-reactive scFvs were more diverse than the RBD-WT specific ones, being encoded by several IGHV genes from the IGHV1 and IGHV3 families combined with short HCDR3s. Six cross-reactive scFvs and one RBD-WT specific scFv were converted to human IgG1 (hIgG1). Out of the seven antibodies, six blocked the RBD-WT binding to angiotensin converting enzyme 2 (ACE2), suggesting these antibodies may neutralize the SARS-CoV-2 infection. Importantly, one of the antibodies also recognized the RBD from the B.1.1.529 (Omicron) isolate, implying that the VH repertoire of the convalescent patient would protect against SARS-CoV-2 Wildtype, Delta, and Omicron. From a practical viewpoint, the triple cross-reactive antibody provides the substrate for developing therapeutic antibodies with a broad SARS-CoV-2 neutralization profile.
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The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.
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BACKGROUND: Rheumatic heart disease (RHD) is a neglected disease affecting 33 million people, mainly in low and middle income countries. Yet very few large trials or registries have been conducted in this population. The INVICTUS program of research in RHD consists of a randomized-controlled trial (RCT) of 4500 patients comparing rivaroxaban with vitamin K antagonists (VKA) in patients with RHD and atrial fibrillation (AF), a registry of 17,000 patients to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. This paper describes the rationale, design, organization and baseline characteristics of the RCT and a summary of the design of the registry and its sub-study. Patients with RHD and AF are considered to be at high risk of embolic strokes, and oral anticoagulation with VKAs is recommended for stroke prevention. But the quality of anticoagulation with VKA is poor in developing countries. A drug which does not require monitoring, and which is safe and effective for preventing stroke in patients with valvular AF, would fulfill a major unmet need. METHODS: The INVestIgation of rheumatiC AF Treatment Using VKAs, rivaroxaban or aspirin Studies (INVICTUS-VKA) trial is an international, multicentre, randomized, open-label, parallel group trial, testing whether rivaroxaban 20 mg given once daily is non-inferior (or superior) to VKA in patients with RHD, AF, and an elevated risk of stroke (mitral stenosis with valve area ≤2 cm2, left atrial spontaneous echo-contrast or thrombus, or a CHA2DS2VASc score ≥2). The primary efficacy outcome is a composite of stroke or systemic embolism and the primary safety outcome is the occurrence of major bleeding. The trial has enrolled 4565 patients from 138 sites in 23 countries from Africa, Asia and South America. The Registry plans to enroll an additional 17,000 patients with RHD and document their treatments, and their clinical course for at least 2 years. The pregnancy sub-study will document the clinical course of pregnant women with RHD. CONCLUSION: INVICTUS is the largest program of clinical research focused on a neglected cardiovascular disease and will provide new information on the clinical course of patients with RHD, and approaches to anticoagulation in those with concomitant AF.
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Fibrilación Atrial/tratamiento farmacológico , Embolia/prevención & control , Inhibidores del Factor Xa/uso terapéutico , Cardiopatía Reumática/tratamiento farmacológico , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/prevención & control , Vitamina K/antagonistas & inhibidores , Adulto , Anciano , Fibrilación Atrial/complicaciones , Inhibidores del Factor Xa/efectos adversos , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Cardiopatía Reumática/complicaciones , Rivaroxabán/efectos adversosRESUMEN
La dilatación de la aurícula izquierda (AI) se considera un predictor ecocardiográfico para la remodelación auricular y la fibrilación auricular. Por ende, hemos investigado la correlación existente entre la dilatación de la AI con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). En este estudio observacional y prospectivo hemos investigado las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos y no hipertensos ambulatoria y hospitalizados que acuden a un hospital terciario entre marzo a septiembre del 2018. Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El diámetro promedio de la AI fue significativamente mayor (p=0,03) en pacientes hipertensos que los no hipertensos (37±8 mm vs. 34±5 mm). Se encontró una asociación significativa entre hipertensión y la aurícula izquierda dilatada (>40 mm) (p= 0,026 OR: 3,25 IC95%: 1,01-11,02). La dilatación de la AI tuvo una especificidad de 73% y un valor predictivo negativo de 98% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Se encontró asociación entre la hipertensión arterial y la dilatación de la aurícula izquierda. La dilatación de la aurícula izquierda tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dispersión de la onda P, y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial(AU)
Dilation of the left atrium (LA) is considered an echocardiographic predictor for atrial remodeling and atrial fibrillation. Therefore, we have investigated the correlation between dilatation of the LA with cardiac arrhythmias and conduction system disorders in patients with systemic arterial hypertension. In this observational and prospective study we have investigated electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 as outpatients and inpatients. One hundred four patients were studied, 65 known to be hypertensive and 39 non-hypertensive subjects as control group. The diameter of the LA ââhad a mean value of 37±8 in hypertensive patients, while in non-hypertensive patients was 34±5 ââ(p = 0.03). A significant association was found between hypertension and increased diameter of the LA (p = 0.04 OR: 2.6 CI 0.88-7.7). Dilatation of the LA had a specificity of 73% and a negative predictive value of 98% related to the presence of conduction system disorders and cardiac arrhythmias in patients with hypertension. A significant relationship between arterial hypertension and dilatation of the left atrium was observed. The dilatation of the left atrium has a high specificity and a high negative predictive value in the detection of the presence of prolongation of the QT interval, widening of the QRS complex, dispersion of the P wave, and disorders of the conduction system and cardiac arrhythmias in patients with hypertension(AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas , Trastorno del Sistema de Conducción Cardíaco , Hipertensión , Dilatación , Atrios CardíacosRESUMEN
RESUMEN Introducción: La hipertensión arterial puede producir cambios auriculares que generan arritmias auriculares. La dispersión de la onda P (PWD) se considera un marcador electrocardiográfico no invasivo para la remodelación auricular y un predictor para el desarrollo de fibrilación auricular. Nuestro objetico es estudiar la correlación entre la dispersión de la onda P con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). Metodología: Estudio observacional y prospectivo en el que estudiamos las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos que acuden a un hospital terciario desde marzo del 2018 a septiembre del 2018 en forma ambulatoria y a internados. Resultados: Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El valor promedio de la dispersión de la onda P en hipertensos fue de 37±8 ms, y en el grupo control fue de 27±13 ms, P <0,001. Además se encontró una diferencia significativa entre estos dos grupos en la duración máxima de la onda P (p<0,05), y el diámetro de la aurícula izquierda (p<0,05). La PWD posee una especificidad de 72% y un valor predictivo negativo de 78% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Además, la PWD posee una especificidad de 73% y un valor predictivo negativo de 83% relacionado con la presencia de ensanchamiento del complejo QRS. Conclusiones: Existe una mayor alteración significativa en la dispersión de la Onda P, la Onda P máxima, y la dilatación de la aurícula izquierda en HTA. También se observó una correlación significativa entre la dispersión de la onda P y el riesgo de desarrollar arritmias auriculares. La dispersión de la onda P tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dilatación de la aurícula izquierda y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial. Palabras clave: Dispersión de la Onda P; Hipertensión arterial; Arritmias cardiacas.
Introduction:High blood pressure can produce atrial changes that generate atrial arrhythmias. P wave dispersion (PWD) is considered a noninvasive electrocardiographic marker for atrial remodeling and a predictor for the development of atrial fibrillation. Our objective is to study the correlation between the dispersion of the P wave with cardiac arrhythmias and conduction system disorders in patients with arterial hypertension (AHT). Methodology:Observational and prospective study in which we studied the electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 on an outpatient basis. Results:104 patients were studied, 65 known hypertensive patients and, 39 non-hypertensive as control group. The average value of the P wave dispersion in hypertensive patients was 37±8 ms, and in the control group it was 27±13 ms, P <0.001. In addition, a significant difference between these two groups was found in the maximum duration of the P wave (p <0.05), and the diameter of the left atrium (p <0.05). The PWD has a specificity of 72% and a negative predictive value of 78% related to the presence of disorders of the conduction system and cardiac arrhythmias in patients with hypertension. In addition, the PWD has a specificity of 73% and a negative predictive value of 83% related to the presence of the widening of the QRS complex. Conclusion:There is a greater significant alteration in the P Wave dispersion, the maximum P Wave, and the dilatation of the left atrium in AHT. A significant correlation was also observed between the dispersion of the P wave and the risk of developing atrial arrhythmias. The P wave dispersion has a high specificity and a high negative predictive value in the detection of the presence of QT interval prolongation, widening of the QRS complex, dilatation of the left atrium and disorders of the conduction system and cardiac arrhythmias in patients with arterial hypertension. Key words: P wave dispersion Arterial Hypertensión Cardiac arrhythmias