Coronary atherosclerotic burden in veteran athletes: The relationship between cardiovascular risk and volume of exercise.

INTRODUCTION AND OBJECTIVES: The association between exercise and coronary atherosclerosis still remains unclarified. We aimed to analyze the prevalence of high coronary atherosclerotic burden in veteran athletes, considering cardiovascular (CV) risk and volume of exercise. METHODS: A total of 105 asymptomatic male veteran athletes (48±5.6 years old) were studied. A high coronary atherosclerotic burden was defined as one of the following characteristics in coronary computed tomography angiography: calcium score >100, >75th percentile, obstructive plaques, involving left main, three-vessels or two-vessels including proximal anterior descending artery, segment involvement score >5 or CT-adapted Leaman score ≥5. CV risk was stratified by SCORE2 and volume of exercise by metabolic equivalent task score. RESULTS: Most athletes (n=88) were engaged in endurance sports for 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] metabolic equivalent of tasks/hour/week. The mean Systematic Coronary Risk Evaluation 2 was 2.8±1.5%; 76.9% of athletes had a low-moderate risk and none a very high risk. High coronary atherosclerotic burden was present in 25.7% athletes. Athletes with high cardiovascular risk and high exercise volume (above the median) showed significantly high coronary atherosclerotic burden compared to those with low-moderate risk and high volume (50.0% vs. 15.6%; p=0.017). Among athletes with low to moderate risk, a high volume of exercise tended to be protective, while in those with low volume, there was similar rate of high coronary atherosclerotic burden, regardless of CV risk. CONCLUSIONS: A combination of higher volume of exercise and high cardiovascular risk revealed the worst association with coronary atherosclerosis in veteran athletes. The relationship between these variables is controversial, but integrating exercise characteristics and risk assessment into preparticipation evaluation is essential.

Evaluating the reliability of DNA Barcoding for Central American Pacific shallow water echinoderms identification: a molecular taxonomy and database accuracy analysis / Evaluando la fiabilidad del Código de Barras de ADN para la identificación de equinodermos en aguas poco profundas del Pacífico de América Central: un análisis de taxonomía molecular y precisión de bases de datos

Abstract Introduction: Molecular divergence thresholds have been proposed to distinguish recently separated evolutive units, often displaying more accurate putative species assignments in taxonomic research compared to traditional morphological approaches. This makes DNA barcoding an attractive identification tool for a variety of marine invertebrates, especially for cryptic species complexes. Although GenBank and the Barcode of Life Data System (BOLD) are the major sequence repositories worldwide, very few have tested their performance in the identification of echinoderm sequences. Objective: We use COI echinoderm sequences from local samples and the molecular identification platforms from GenBank and BOLD, in order to test their accuracy and reliability in the DNA barcoding identification for Central American shallow water echinoderms, at genus and species level. Methods: We conducted sampling, tissue extraction, COI amplification, sequencing, and taxonomic identification for 475 specimens. The 348 obtained sequences were individually enquired with BLAST in GenBank as well as using the Identification System (IDS) in BOLD. Query sequences were classified depending on the best match result. McNemar's chi-squared, Kruskal-Wallis's and Mann-Whitney's U tests were performed to prove differences between the results from both databases. Additionally, we recorded an updated list of species reported for the shallow waters of the Central American Pacific. Results: We found 324 echinoderm species reported for Central American Pacific shallow waters. Only 118 and 110 were present in GenBank and BOLD databases respectively. We proposed 325 solved morphology-based identities and 21 provisional identifications in 50 putative taxa. GenBank retrieved 348 molecular-based identifications in 58 species, including twelve provisional identifications in tree taxa. BOLD recovered 170 COI identifications in 23 species with one provisional identification. Nevertheless, 178 sequences retrieved unmatched terms (in 34 morphology-based taxa). Only 86 sequences (25 %) were retrieved as correct identifications and 128 (37 %) as identification errors in both platforms. We include 84 sequences for eleven species not represented in GenBank and 65 sequences for ten species in BOLD Echinoderm COI databases. The identification accuracy using BLAST (175 correct and 152 incorrect identifications) was greater than with IDS engine (110 correct and 218 identification errors), therefore GenBank outperforms BOLD (Kruskal-Wallis = 41.625, df = 1, p < 0.001). Conclusions: Additional echinoderm sample references are needed to improve the utility of the evaluated DNA barcoding identification tools. Identification discordances in both databases may obey specific parameters used in each search algorithm engine and the available sequences. We recommend the use of barcoding as a complementary identification source for Central American Pacific shallow water echinoderm species.

Resumen Introducción: Se han propuesto los umbrales de divergencia molecular para distinguir unidades evolutivas recientemente separadas, que a menudo muestran asignaciones de especies putativas más precisas en la investigación taxonómica en comparación con los enfoques morfológicos tradicionales. Esto hace que los Códigos de Barras de ADN sean una herramienta de identificación atractiva para una variedad de invertebrados marinos, especialmente para complejos de especies crípticas. Aunque GenBank y Barcode of Life Data System (BOLD) son los principales repositorios de secuencias en todo el mundo, muy pocos han probado su desempeño en la identificación de secuencias de equinodermos. Objetivo: Utilizamos secuencias de equinodermos COI de muestras locales y las plataformas de identificación molecular de GenBank y BOLD, para probar su precisión y confiabilidad en la implementación de códigos de barras de ADN para equinodermos de aguas someras de Centroamérica, a nivel de género y especie. Métodos: Realizamos muestreo, extracción de tejido, amplificación de COI, secuenciación e identificación taxonómica de 475 especímenes. Las 348 secuencias obtenidas fueron consultadas individualmente con BLAST en GenBank así como utilizando el Sistema de Identificación (IDS) en BOLD. Las secuencias consultadas se clasificaron según el mejor resultado de coincidencia. Se realizaron las pruebas chi-cuadrado de McNemar, Kruskal-Wallis y U de Mann-Whitney para comprobar diferencias entre los resultados de ambas bases de datos. Además, registramos una lista actualizada de especies reportadas para las aguas someras del Pacífico Centroamericano. Resultados: Encontramos 324 especies de equinodermos reportadas para aguas someras (< 200 m) del Pacífico centroamericano. Sólo 118 y 110 estaban presentes en las bases de datos GenBank y BOLD respectivamente. Propusimos 325 identidades resueltas basadas en morfología y 21 identificaciones provisionales en 50 taxones putativos. GenBank recuperó 348 identificaciones de base molecular en 58 especies, incluidas doce identificaciones provisionales en tres taxones. BOLD recuperó 170 identificaciones de COI en 23 especies con una identificación provisional. Sin embargo, 178 secuencias recuperaron términos no coincidentes (en 34 taxones basados en morfología). Sólo 86 secuencias (25 %) se recuperaron como identificaciones correctas y 128 (37 %) como errores de identificación en ambas plataformas. Incluimos 84 secuencias para once especies no representadas en GenBank y 65 secuencias para diez especies ausentes en las bases de datos BOLD Echinoderm COI. La precisión de la identificación usando BLAST (175 identificaciones correctas y 152 incorrectas) fue mayor que con el motor IDS (110 correctas y 218 errores de identificación), por lo tanto, GenBank supera a BOLD (Kruskal-Wallis = 41.625, df = 1, p < 0.001). Conclusiones: Se necesitan muestras adicionales de equinodermos de referencia para mejorar la utilidad de las herramientas de identificación de códigos de barras de ADN evaluadas. Las discordancias de identificación en ambas bases de datos pueden obedecer a parámetros específicos utilizados en cada algoritmo de búsqueda y a las secuencias disponibles. Recomendamos el uso de códigos de barras como fuente de identificación complementaria para las especies de equinodermos de aguas someras del Pacífico centroamericano.

Ant Community Is Not Influenced by the Addition of Olive Mill Pomace Compost in Two Different Olive Crop Managements.

Industrial production of olive oil generates large amounts of solid waste called 'alperujo'. Its compost can fertilize many crops, especially olives. Furthermore, superintensive orchards are increasing their surface globally due to higher production and savings in different costs. Ants are considered an important part of the arthropod community in olive orchards and could even play a significant role in pest control. The tree canopy and ground were sampled to compare the ant assemblage in plots fertilized with compost and mineral products in two groves with different types of crop management (superintensive and traditional) over two years. The numbers of ants in both types of fertilization in each grove were not statistically different (p > 0.05), indicating that the type of fertilization did not have a significant impact on its populations in the ground or in the canopy, but the number of individuals was significantly higher in the superintensive grove than in the traditional grove (both in the ground and in the canopy, p < 0.01). The most frequent species in the ground were Pheidole pallidula, Plagiolepis smitzii and Aphaenogaster senilis (superintensive grove) and Pheidole pallidula, Tetramorium gr semilaeve, Plagiolepis pygmaea, and Tapinoma nigerrimum (traditional grove). In the canopy, the most frequent species were Plagiolepis spp. in both groves. Differences in ant densities and species between the groves could be due to the different management, especially of the soil, but it must be confirmed using more replicas and longer periods of study.

Cardiac remodeling induced by exercise in Caucasian male master athletes: a cross-sectional study.

To describe cardiac remodeling in a population of male master athletes evaluated by transthoracic echocardiography and to analyse its relationship with several exercise-related characteristics. A total of 105 male master athletes aged ≥ 40 years old, mostly involved in endurance sports (81.0%) with a median training-volume of 66 [44; 103] METs/h/week, were studied. Left ventricular end-diastolic and end-systolic volumes were above the references in 84.8% and 75.8% athletes, decreasing in frequency when adjusted for BSA (26.3% and 23.2%). LV geometry was changed in more than half of the athletes (eccentric hypertrophy 28.3%, concentric remodelling 15.2% and concentric hypertrophy 8.1%) and several right ventricular (RV) dimensions were increased. Left atrium was dilated in 53.5% and right atrium in 37.4% athletes; only one athlete had a dilated aorta. Mean LV ejection fraction was 61 ± 7% and global longitudinal strain - 18.3 ± 2.0%. Changes in LV geometry were more common in high intensity sports; LV dilation in athletes exercising > 10 h/week and in high intensity sports; RV dilation in athletes exercising > 66 MET-hour/week and in endurance sports. In multivariate analysis high intensity sports remained an independent predictor of changes in LV geometry. A significant proportion of male master athletes showed altered echocardiographic parameters compared to the reference values, more pronounced in those involved in endurance sports, with high intensity and high volume of exercise. This may correspond to exercise-induced physiological adaptations, reinforcing the concept that the characteristics of exercise are major determinants of cardiac remodeling and should be considered during athletes' evaluation.

Área de conservación Guanacaste Echinoderms, North Pacific of Costa Rica / Equinodermos del Área de Conservación Guanacaste, Pacífico Norte de Costa Rica

Introduction: The study of the marine diversity of the North Pacific of Costa Rica began with isolated foreign expeditions in the 1930s and was systematically developed in the mid-1990s by the Center for Research in Marine Sciences and Limnology, Universidad de Costa Rica, as consequence there are now a total of 1 479 reported species in this region. Objective: Present an update to the echinoderm richness of the Guanacaste Conservation Area. Methods: We sampled 25 localities exhaustively and estimated similarity between sites based on the family richness and environmental heterogeneity. Results: We found 61 taxa, which represent 26 % of the echinoderm reported species for the country's Pacific coast. Of these, 43 species are new records for the Guanacaste Conservation Area, and seven for Costa Rica and Central American Pacific coasts. We found three morpho-species that do not match to available descriptions of the Eastern Tropical Pacific echinoderm species. We also found the holothuroid Epitomapta tabogae, and the ophiuroid Ophioplocus hancocki, previously thought endemic to Panama and the Galapagos Islands, respectively. The proximity of the sampled sites and the redundancy of certain families may explain why we did not find important differences among localities. Conclusions: The echinoderm richness of this conservation area is at least 20 % higher than previously reported, reaching similar levels to those in other high diversity sites of the Eastern Tropical Pacific.

Introducción: El estudio de la diversidad marina del Pacífico Norte de Costa Rica inició con expediciones extranjeras aisladas en la década de 1930, y fue desarrollado sistemáticamente a mediados de la década de 1990 por el Centro de Investigaciones en Ciencias del Mar y Limnología de la Universidad de Costa Rica, como consecuencia ahora se reporta un total de 1 479 especies en esta región. Objetivo: Presentar una actualización de la riqueza de equinodermos del Área de Conservación Guanacaste. Métodos: Realizamos muestreos exhaustivos en 25 localidades y estimamos la similitud entre sitios con base en la riqueaza de familias y la heterogeneidad ambiental. Resultados: Encontramos 61 taxa, que representan el 26% de las especies reportadas para la costa pacífica del país. De estas, 43 especies son nuevos registros para el Área de Conservación Guanacaste y siete para las costas de Costa Rica y el Pacífico centroamericano. Tres morfoespecies no coinciden con las descripciones disponibles para las especies del Pacífico Tropical Oriental. Por último, hallamos un ejemplar del holoturoideo Epitomapta tabogae y otro del ofiuroideo Ophioplocus hancocki, considerados endémicos para Panamá y las Islas Galápagos respectivamente. La proximidad entre los sitios muestreados y la redundancia de ciertas familias pueden explicar por qué no se encontraron diferencias entre las localidades. Conclusiones: La riqueza de equinodermos de esta área de conservación es al menos 20% mayor que la reportada anteriormente, alcanzando niveles similares a los de otros sitios de alta diversidad del Pacífico Tropical Oriental.

New hosts and morphological data for the star pearlfish Carapus mourlani (Ophidiiformes: Carapidae) from collections made in the North Pacific coast of Costa Rica

Introduction: The family Carapidae includes about 40 species of marine fishes distributed in coastal habitats worldwide. The family includes some free-living species, however, most of them are found as commensal inquilines or parasites of marine invertebrates, including several echinoderm species. In the Eastern Tropical Pacific, the biology and host use of the representatives of the Carapidae is relatively poorly known. Objective: The present study reports the occurrence of the Star pearlfish Carapus mourlani within three previously unknown hosts in the region: the sea stars Nidorellia armata, Phataria unifascialis, and the sea cucumber Stichopus horrens. Some ecological implications and considerations regarding such symbiotic relationships are raised and discussed. Additional morphometric and meristic data for the fish and the echinoderms are also provided and discussed. Methods: Echinoderms were collected, from 25 localities along the North Pacific coast of Costa Rica, and were carefully examined searching for commensal/parasitic fishes. Echinoderms and fishes were identified and characterized in accordance with the specialized literature. Results: A total of 497 echinoderms, including about 60 species, were collected and examined. Commensal/parasitic fish (a single species represented by 13 specimens) were found in three echinoderm specimens/species. Conclusions: The list of echinoderm hosts for this carapid fish, through its whole distribution range, rises to 12 species (six sea stars and six sea cucumbers) and that could be a consequence of its wide geographic distribution, its generalist feeding habits and opportunistic commensal behavior.

Introducción: La familia Carapidae está compuesta por alrededor de 40 especies de peces marinos, presentes en hábitats costeros alrededor de todo el mundo. Se incluyen dentro de esta familia algunas especies de vida libre, no obstante, la mayoría de carápidos son inquilinos oportunistas o parásitos de algunos grupos de invertebrados marinos, incluyendo varias especies de equinodermos. En el Pacífico Tropical Oriental (PTO), se sabe relativamente poco sobre la biología de estos peces, así como de las diversas asociaciones existentes y de los hospederos utilizados. Objetivo: En este trabajo reportamos la ocurrencia del Pez perla estrella Carapus mourlani en tres nuevos hospederos: las estrellas de mar Nidorellia armata y Phataria unifascialis, y el pepino de mar Stichopus horrens. También se discuten algunas implicaciones y consideraciones ecológicas relacionadas a estas asociaciones simbióticas. Además, se proveen y discuten datos morfométricos y merísticos de los peces y sus hospederos. Métodos: Se realizaron recolectas de equinodermos, entre 2018 y 2019, en un total de 25 localidades distribuidas al norte de la costa Pacífico de Costa Rica, los cuales fueron cuidadosamente revisados en búsqueda de peces comensales/parásitos. Los equinodermos y los peces fueron identificados y caracterizados de acuerdo con la literatura especializada. Resultados: Se recolectaron y examinaron un total de 497 equinodermos, incluyendo alrededor de 60 especies, de los cuales solo tres individuos-especies estuvieron ocupados por peces comensales/parásitos. Conclusiones: La lista de hospederos equinodermos de C. mourlani a lo largo de su ámbito de distribución geográfico llega a 12 especies (seis estrellas de mar y seis pepinos de mar), lo cual podría ser un reflejo de su amplia distribución geográfica, de sus hábitos de alimentación generalistas y de su comportamiento oportunista en lo relativo al uso de hospederos.

Coronary atherosclerotic burden in veteran male recreational athletes with low to intermediate cardiovascular risk.

INTRODUCTION: Although there is evidence that a significant proportion of veteran athletes have coronary atherosclerotic disease (CAD), its prevalence in recreational athletes with low to intermediate cardiovascular (CV) risk is not established. This study aimed to characterize the coronary atherosclerotic burden in veteran male recreational athletes with low to intermediate CV risk. METHODS: Asymptomatic male athletes aged ≥40 years with low to intermediate risk, who exercised >4 hours/week for >5 years, underwent cardiac computed tomography (CT) for coronary artery calcium (CAC) scoring and CT angiography. High coronary atherosclerotic burden was defined as at least one of the following: CAC score >100; CAC score ≥75th percentile; obstructive CAD; disease involving the left main, three vessels or two vessels including the proximal left anterior descending artery; segment involvement score >5; or CT Leaman score ≥5. Athletes were categorized by tertiles of exercise volume, calculated by metabolic equivalent of task (MET) scores. RESULTS: A total of 105 athletes were included, all with SCORE <4%, mainly engaged in high-dynamic sports. Median exercise volume was 66 (44-103) METs/hour/week, with 8±5 hours training/week and 17±10 years of exercise. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes. Ten (9.5%) athletes had CAC score >100, 13 (12.4%) had CAC score ≥75th percentile and six (5.7%) had obstructive lesions. The extent and severity of coronary plaques did not differ according to exercise volume. CONCLUSIONS: The prevalence of subclinical CAD detected by cardiac CT in veteran male recreational athletes with low to intermediate CV risk was high. Up to a quarter of our cohort had a high coronary atherosclerotic burden.

Subclinical coronary artery disease in veteran athletes: is a new preparticipation methodology required?

OBJECTIVE: Preparticipation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current preparticipation methodology used to identify veteran athletes with high coronary atherosclerotic burden. METHODS: A total of 105 asymptomatic male athletes aged ≥40 years old, with low to moderate CV risk (Systematic Coronary Risk Estimation <5%) who trained ≥4 hours/week for at least 5 years, were studied. The screening protocol included clinical evaluation, ECG, transthoracic echocardiogram and exercise testing. Cardiac CT was performed to detect CAD, defined as a high atherosclerotic burden according to coronary artery calcium score and coronary CT angiography. RESULTS: The majority of the athletes (n=88) engaged in endurance sports, with a median volume of exercise of 66 (44; 103) metabolic equivalent task score/hour/week. Exercise testing was abnormal in 13 (12.4%) athletes, 6 (5.7%) with electrocardiographic criteria for myocardial ischaemia and 7 (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of whom 11 (40.7%) had CV risk factors and 6 had abnormal exercise tests, including 3 who were positive for myocardial ischaemia. CONCLUSIONS: Conventional methodology used in preparticipation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes.

Myocardial deformation and volume of exercise: a new overlap between pathology and athlete's heart?

Regular physical exercise induces cardiac adaptations that can overlap pathological conditions. Controversy still persists about the variability of myocardial deformation in different types and intensity of exercise. The aim of this study was to assess myocardial longitudinal deformation in athletes with different level of exercise. Two groups of young athletes involved in endurance sports characterized by high intensity dynamic component were enrolled. According to the level and the number of exercise training hours/week, two groups were defined: Group 1-high level (national/international and ≥ 20 training-hours/week; N = 60); Group 2-low level (recreational/regional and < 10 training-hours/week; N = 48). A comprehensive transthoracic echocardiogram including evaluation of global longitudinal strain (GLS) assessed by 2D speckle-tracking was performed. Athletes in Group 1 showed more pronounced cardiac remodeling and enhanced diastolic function. No significant differences were evident in left ventricle ejection fraction (LVEF) between groups. Overall, GLS (absolute values) was 18.0 ± 2.5%, but significantly lower in Group 1 compared to Group 2 (17.3 ± 2.6% vs. 18.9 ± 2.1%; p = 0.001). Thirty-three (31%) athletes had GLS below 17%, more frequently in Group 1 (79% vs. 45%; p = 0.001), with higher LV and left atrium volumes, lower E wave and A wave peak velocities and E/e' ratio. In a multivariate analysis to belong to Group 1 was the only independent variable associated with GLS < 17% (OR 6.5; 95% CI 2.4-17.4; p < 0.001). The athletes with a GLS < 17% were all men, more frequently involved in high level exercise, with higher chamber volumes and lower E/e' ratio. Left ventricular global myocardial longitudinal deformation evaluated by GLS was significantly lower in athletes with higher level of exercise. Although GLS in athletes overlap several pathological conditions, these lower values are associated with an enhanced diastolic performance that allows discrimination between physiologic adaptations and pathology.

Comparison of Three Criteria for Interpretation of Electrocardiogram in the Military.

BACKGROUND: Screening of competitive athletes and other individuals exposed to regular and intense physical exercise, such as military personnel, can lead to an early and preclinical identification of cardiac conditions associated with a higher risk for sudden cardiac death. The electrocardiogram (ECG) has been recommended for the precompetitive screening, but its interpretation remains controversial. The aim of this study was to compare three different standardized criteria for interpretation of athletes' ECG applied in military. METHODS: Prospective study of 1,380 consecutive healthy military, 249 (18%) also involved in competitive sport, screened with clinical history, physical examination, and ECG. The ECG was interpreted according to the European Society of Cardiology (ESC) recommendations, the Seattle Criteria (SC), and the Refined Criteria (RC). FINDINGS: Independently of the criteria used, the majority of the individuals included had ECG changes, mainly physiological: ESC 55.1%, SC 63.6%, and RC 64.4%. The rate of pathological ECGs was significantly higher with the ESC criteria when compared to SC and RC (ESC 14.8%, SC 5.0% and RC 4.5%; p < 0.001). A significant cardiac abnormality was diagnosed with additional investigations in 4 patients (Brugada syndrome Type 1, mitral valve prolapse, bicuspid aortic valve, and Wolff-Parkinson-White pattern). DISCUSSION: Electrical cardiac adaptations are frequent in military personnel, similar to competitive athletes. Some ECG changes, previously considered pathological, could in fact correspond to physiological adaptations. The refinement of the ECG interpretation in this athletic population seems to reduce the rate of false-positive cases. This may have a favorable socioeconomic impact, especially by reducing the health cost burden and number of disability days.

Variability in interpretation of the electrocardiogram in athletes: Another limitation in pre-competitive screening. / Variabilidade na interpretação do eletrocardiograma do atleta: mais uma limitação na avaliação pré­competitiva.

INTRODUCTION: Assessment of the electrocardiogram (ECG) in athletes remains controversial, with lack of standardization and difficulty in applying specific criteria in its interpretation. The purpose of this study was to assess variability in the interpretation of the ECG in athletes. METHODS: Twenty ECGs of competitive athletes were assessed by cardiologists and cardiology residents, 11 of them normal or with isolated physiological changes and nine pathological. Each ECG was classified as normal/physiological or pathological, with or without the use of specific interpretation criteria. RESULTS: The study presents responses from 58 physicians, 42 (72.4%) of them cardiologists. Sixteen (27.6%) physicians reported that they regularly assessed athletes and 32 (55.2%) did not use specific ECG interpretation criteria, of which the Seattle criteria were the most commonly used (n=13). Each physician interpreted 15±2 ECGs correctly, corresponding to 74% of the total number of ECGs (variation: 45%-100%). Interpretation of pathological ECGs was correct in 68% (variation: 22%-100%) and of normal/physiological in 79% (variation: 55%-100%). There was no significant difference in interpretation between cardiologists and residents (74±10% vs. 75±10%; p=0.724) or between those who regularly assessed athletes and those who did not (77±12% vs. 73±9%; p=0.286), but there was a trend for a higher rate of correct interpretation using specific criteria (77±10% vs. 72±10%; p=0.092). The reproducibility of the study was excellent (intraclass correlation coefficient=0.972; p<0.001). CONCLUSIONS: A quarter of the ECGs were not correctly assessed and variability in interpretation was high. The use of specific criteria can improve the accuracy of interpretation of athletes' ECGs, which is an important part of pre-competitive screening, but one that is underused.

Cardiovascular risk profile of young adults: changes over time.

BACKGROUND AND OBJECTIVE: The high prevalence and natural history of atherosclerosis make young people important targets for cardiovascular prevention. This study aimed to analyze changes over time in the cardiovascular risk profile of a population of healthy young adults. METHODS: We studied 923 Portuguese Air Force applicants between 1991 and 2007, divided into two-year periods. In addition to cardiovascular risk factors, the Framingham score and HeartScore were calculated for age 65. Cochran-Armitage and Jonckheere-Terpstra tests for trend were used for categorical and continuous variables, respectively. RESULTS: Mean age was 19.2 ± 2.3 years (p = 0.34) and 55 applicants (6%) were female (p = 0.56). Mean body mass index was 22.4 ± 2.5 kg (p for trend 0.35). The number of smokers decreased over the study period (11.6 vs. 7.0%, p for trend 0.02). Of the total number of applicants, 122 (13.2%) were classified as hypertensive. Mean systolic blood pressure was 127 ± 12 mmHg and increased significantly over time (122 ± 13 vs. 128 ± 11 mmHg, p for trend <0.001). Hypercholesterolemia was found in 108 applicants (11.7%) and total cholesterol showed an improvement (170 ± 35 vs. 155 ± 26 mg/dl, p for trend <0.001). The mean modified Framingham score was 12.6 ± 5.1 and improved over the study period (12.9 ± 5.9% vs. 11.9 ± 4.7%, p for trend 0.006). The mean modified HeartScore was 3.2 ± 1.4 and remained unchanged (p for trend 0.10). CONCLUSIONS: In our population, except for an increase in systolic blood pressure values, there was an overall improvement in cardiovascular risk from 1991 to 2007. Further studies are needed to better assess the situation in Portugal and help devise preventive strategies in young people.

[NT-proBNP for risk stratification of pulmonary embolism]. / NT-proBNP na estratificação de risco no tromboembolismo pulmonar.

INTRODUCTION: Pulmonary embolism (PE) is an entity with high mortality and morbidity, in which risk stratification for adverse events is essential. N-terminal brain natriuretic peptide (NT-proBNP), a right ventricular dysfunction marker, may be useful in assessing the short-term prognosis of patients with PE. AIMS: To characterize a sample of patients hospitalized with PE according to NT-proBNP level at hospital admission and to assess the impact of this biomarker on short-term evolution. METHODS: We performed a retrospective analysis of consecutive patients admitted with PE over a period of 3.5 years. Based on the median NT-proBNP at hospital admission, patients were divided into two groups (Group 1: NT-proBNP

Electrocardiographic presentation of massive and submassive pulmonary embolism.

INTRODUCTION: Acute pulmonary embolism (PE) is a common clinical entity in the emergency department, and remains a diagnostic challenge for physicians. The role of the 12-lead electrocardiogram (ECG) in its diagnosis and assessment of severity and prognosis is not as well defined as for acute coronary syndromes. We report four cases of massive and submassive PE with differing ECG findings admitted to an acute cardiac care unit. We review the role of different ECG abnormalities and also discuss the relevance of transthoracic echocardiographic data in the diagnosis and serial evaluation of patients with PE. Treatment options for PE with hemodynamic compromise and right ventricular dysfunction are also discussed. RESULTS: The ECG is abnormal in over two-thirds of patients with PE. Its main utility is in excluding other conditions, such as acute coronary syndromes. DISCUSSION: Numerous ECG abnormalities have been reported in patients with PE. These often change over time, with worsening or resolution of the embolic event. Although it is the most frequent ECG abnormality, sinus tachycardia lacks specificity. However, ECG findings are more specific in patients with severe PE (such as the classic S1Q3T3 pattern). In the case of massive and submassive PE, anterior and inferior T-wave inversion is the most frequent associated ECG finding. Serial ECG evaluation should be performed in such patients as changes and resolution of abnormalities may have prognostic implications. Transthoracic echocardiography is extremely useful in the initial and serial evaluation of patients with PE because of its accessibility and the data it provides on diagnosis, severity and resolution. Submassive PE is defined by echocardiographic data and could benefit from the same therapeutic options as for massive PE. The use of specific therapeutic strategies such as anticoagulant and thrombolytic therapy in both massive and submassive PE has to be carefully weighed. The bleeding risk and associated comorbidities of patients admitted with PE should always be considered. CONCLUSION: ECG findings have low sensitivity and specificity in the diagnosis of PE. It should be routinely used in serial evaluations, particularly when hemodynamic compromise is present, and should be included in the range of diagnostic strategies available.

Pseudonormalization of transmitral pulsed doppler flow: A/e' ratio during the valsalva maneuver--a new discriminative index.

UNLABELLED: The Valsalva maneuver (VM) has frequently been suggested as a useful method in evaluation of left ventricular (LV) grade II diastolic dysfunction (DDII) through inversion of a pseudonormalized ratio between diastolic transmitral early (E) and late atrial (A) waves assessed by pulsed Doppler. The purpose of our study was to determine the sensitivity and specificity of E/A inversion during VM in LV DDII patients and its correlation with mitral annulus motion evaluated by tissue Doppler imaging (TDI). Using the echocardiographic criteria of the European Society of Cardiology for the diagnosis of diastolic dysfunction, we studied a group of 44 patients, 27 male, aged 59 +/- 14 years, with DDII (DDII-group) and compared them with a control group (N group) composed of 33 healthy individuals, 17 male, aged 36 +/- 9 years. Using transmitral pulsed Doppler analysis, we quantified the peak diastolic velocities of transmitral flow (E and A waves in cm/sec), pulmonary venous systodiastolic flow (PVF: S35 cm/sec) and the first aliasing LV diastolic flow propagation velocity by color M-mode Doppler (PVF <45 cm/sec for LV DDII). Using TDI we measured the peak systolic (s'), and diastolic rapid filling (e') and atrial (a') velocities (Vm in cm/sec) at four points of the mitral annulus: adjacent to the interventricular septum (P4), and the lateral (P2), inferior (P3) and anterior (P4) LV walls. VM was performed by all patients, with repeated measurements of the above parameters (except for PVF) at the point of their maximum shift. RESULTS: Four patients in the DDII-group were excluded due to degradation of the acoustic window during VM. The sensitivity and specificity of E/A inversion during VM in diagnosing LV DDII were respectively 88% and 57%. On ROC curve analysis, the most discriminative index for DDII diagnosis A/e' > 4.06 in P2 during VM (area under ROC curve [AUROC] = 0.883 [0, 78, 0, 94]). There was a significant increase in AUROC (0.74 vs. 0.88, p = 0.006) during VM. For A/e' > 4.06, the sensitivity and specificity for DDII diagnosis were respectively 62% and 78% pre-VM and 85% and 78% during VM. CONCLUSIONS: Inversion of a pseudonormalized pulsed Doppler E/A ratio during VM has high sensitivity, but its low specificity makes it of little clinical use. An A/e' ratio > 4.1 during VM is a new, highly discriminative index that can be used in practice to diagnose LV grade II diastolic dysfunction in the presence of a pseudonormalized pulsed Doppler E/A ratio.

Procesos alérgicos oculares / Allergic ocular disorders (process)

La conjuntivitis alérgica es uno de los padecimientos oculares más comunes y uno de los principales motivos de la consulta médica. El ojo es un órgano que frecuentemente se va afectando por procesos inflamatorios en las reacciones alérgicas locales y sistémicas, involucrando en la mayoría de las casos a la conjuntiva. Los términos de alergia ocular y conjuntivitis alérgica son utilizados indistintamente. En muchos países la conjuntivitis es tratada en sistema de atención primaria y sólo una pequeña proporción de los casos son vistos por especialistas en oftalmología o alergia. Por lo tanto, la mejor comprensión de la fisiopatología dará mayores oportunidades para el tratamiento adecuado de esta enfermedad

Políticas sociales de salud e infancia / Social policy of health and childhood

Contiene: Equidad y reforma en el sector salud; Atención integral a niños y adolescentes en alto riesgo social: problemática y estrategias de intervención con menores trabajadores y menores de la calle

Miastenia grave y anestesia / Miastenia gravis and Anesthesia

La patología muscular es de gran importancia en la actualidad y la miastenia grave ocupa un buen lugar en este capítulo. Hace no muchos años este padecimiento fue muy preocupante para los anestesiólogos de todo el mundo por el uso de los relajantes musculares. Eso los sometió a emplearse algunas veces en forma muy riesgosa usando dosis muy fuertes de anestésicos generales. Los pacientes presentaron muchas complicaciones en recuperación debido al aumento de las secreciones, atelectasias, etc. Existen en la actualidad relajantes musculares de acción intermedia, como el vecuronio y estas complicaciones ahora ya no se presentan tan fácilmente. Sin embargo, lo mejor son las unidades de apoyo actuales, como terapia respiratoria, que mantienen una vigilancia efectiva de estos casos tanto en recuperación como en los servicios a los que pertenecen los enfermos

Prazosin como monoterapia inicial: estudio multicéntrico centroamericano / Prazosin as single initial treatment: Central American multicenter trial

Se realizó un estudio multicéntrico centroamericano con 718 pacientes, con hipertensión leve o moderada, a los cuales se les administró prazosin, como monoterapia inicial. Los resultados obtenidos demuestran la eficacia de prazosin, ya que se logró controlar con muy buen resultado (PAD <- 90 mm Hg) el 97,2% de los pacientes estudiados. Asimismo se demostró la seguridad de la droga en pacientes con enfermedad asociada, tales como diabetes mellitus y asma bronquial. Los efectos colaterales fueron muy pocos y leves y, solamente un pequeño porcentaje (1,8%) de los pacientes ameritaron la suspensión del tratamiento. Este estudio confirma la efectividad y seguridad de prazosin como monoterapia inicial de la hipertensión arterial a dosis bajas, en un número representativo de pacientes del área centroamericana