Rationale and design of the rigorous atrial analysis in advanced interatrial block (ARABIA) prospective study.

BACKGROUND: Advanced interatrial block (IAB) is present in 10% of subjects ≥75 years and is associated with the risk of clinical events. METHODS AND RESULTS: Prospective multicenter study that will include subjects ≥75 years without exclusion criteria (indication for anticoagulation, cardiac devices, severe valve disease, systolic dysfunction, moderate or severe cognitive impairment, poor echocardiographic window, non-sinus rhythm or partial IAB, stroke, and life expectancy <2 years). A total of 356 subjects, 178 patients with advanced IAB (exposed) and 178 matched individuals with normal P-wave (non-exposed) will be included. Electrocardiogram and advanced transthoracic echocardiography will be performed. Two substudies will include magnetic resonance imaging: cardiac (86 subjects, 43 exposed, and 43 non-exposed) and brain (86 subjects, 43 exposed, and 43 non-exposed). The follow-up will be 2 years. Our main objective is to determine the association of advanced IAB, P-wave duration, and atrial imaging parameters (I] atrial global longitudinal strain, II] maximal left atrial volume index, III] left atrial ejection fraction, IV] left atrial fibrosis - % total left atrial area V] inter- and intra-atrial asynchrony/dyssynchrony) with clinical events (atrial fibrillation, stroke, cognitive impairment, and mortality). The secondary objective is to assess the association of the P-wave duration with atrial imaging parameters and of both with cerebral microemboli in magnetic resonance imaging. CONCLUSION: Our study will provide data regarding the association of advanced IAB, P-wave duration, and atrial imaging parameters with clinical events. We will also assess the association P-wave duration-atrial imaging parameters-cerebral microemboli.

Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018-2019. / Desigualdad en las prácticas de lactancia y alimentación complementaria en la Argentina, según nivel de ingresos del hogar en 2018-19.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018-2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018-2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2.a Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.

Amiodarone triggered Kounis syndrome complicated by refractory cardiac arrest rescued with VA-ECMO.

Key Clinical Message: An interesting case that shows an infrequent cause of cardiorespiratory arrest such as coronary vasospasm due to intravenous amiodarone induced Kounis syndrome. It highlights the usefulness of circulatory support with ECMO in the scenario of CPR. Abstract: A patient with atrial fibrillation was admitted for an elective electrical cardioversion. He was given an amiodarone bolus that triggered Kounis syndrome with cardiac arrest due to vasospasm requiring emergency coronary angiography with infusion of nitroglycerin. Due to following refractory shock and severe refractory hypoxemia required mechanical circulatory support with ECMO and inhaled nitric oxide with favorable evolution. Allergy to amiodarone was later confirmed.

Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device.

An 80-year-old woman with mitral valve repair failure was admitted with hemolytic anemia secondary to the impact of a regurgitant jet on the annuloplasty ring. Transcatheter repair to treat both mitral regurgitation and hemolysis was favored because of surgical risk. Transcatheter edge-to-edge repair represents an alternative for treating hemolysis associated with mitral regurgitation. (Level of Difficulty: Advanced.).

Características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico: Serie de casos / Clinical-epidemiologic characteristics of patients with non-alcoholic fatty liver disease: Case series

Fundamento: El hígado graso no alcohólico es la enfermedad hepática por depósito de grasa en ausencia de un consumo significativo de alcohol. La mayoría de los pacientes tienen un nexo epidemiológico común asociado a factores de riesgo metabólico. Objetivo: Describir características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico. Metodología: Se realizó un estudio descriptivo de una serie de casos en la consulta de Gastroenterología del Hospital General Provincial "Camilo Cienfuegos" de Sancti Spíritus, durante el período 6 de mayo de 2019 al 6 de mayo de 2020. Se consideró un total de 1167 pacientes pertenecientes a la provincia Sancti Spíritus; a 346 pacientes se le diagnosticó esteatosis hepática por ultrasonido; la muestra se conformó por 114 pacientes que cumplieron con los criterios de inclusión. Resultados: La mayoría de los pacientes con la enfermedad eran sintomáticos, hombres y tenían comorbilidad como la hipertensión arterial y obesidad, el índice de masa corporal y el índice de cintura abdominal/cadera estaban elevados en el sexo femenino, las alteraciones en la química sanguínea fueron colesterol y triacilglicéridos. Conclusiones: Predominó en el sexo masculino y la comorbilidad con la HTA y la obesidad, y la dislipidemia, además los hábitos alimenticios inadecuados y el sedentarismo; las medidas antropométricas resultaron elevadas en el sexo femenino.

Background: Nonalcoholic fatty liver disease is a resulting from fat accumulation in the absence of significant alcohol consumption. Most patients have a common epidemiologic link associated with metabolic risk factors. Objective: To describe the clinical and epidemiologic characteristics of patients with nonalcoholic fatty liver disease. Methodology: A descriptive study of a series of cases was carried out in the Gastroenterology consultation of the "Camilo Cienfuegos" Provincial General Hospital of Sancti Spíritus, during the period from May 6, 2019 through May 6, 2020. A total of 1167 patients belonging to the province of Sancti Spiritus were included in the study; 346 patients were diagnosed with hepatic steatosis by means of ultrasound; the sample consisted of 114 patients who fulfilled the inclusion criteria. Results: Most patients with the disease were symptomatic, men, and had comorbidities including hypertension and obesity, the body mass index and the waist-to-hip ratio of the abdomen were increased in women., the blood chemistry changes were cholesterol and triacylglycerides. Conclusions: It predominated in the male sex and comorbidity with HBP and obesity and dyslipidemia, in addition to inadequate dietary habits and sedentary lifestyle; in women, the anthropometric measurements were high.

Variabilidad en el tratamiento del síndrome coronario agudo sin elevación del segmento ST y sus consecuencias / Variability in the treatment of non-ST-segment elevation acute coronary syndrome and its consequences

La variabilidad en la asistencia a pacientes que tienen un síndrome coronario agudo se viene detectando desde hace más de 15 años en registros internacionales y nacionales. Dicha variabilidad depende de determinadas características de los pacientes, como el hecho de ser mujer o diabético, pero también de los centros y los médicos encargados de la asistencia. Se ha demostrado repetidamente la paradoja de tratar de forma menos completa o menos acorde con las guías cuanto mayor es el riesgo del paciente. Conocer todas las circunstancias que influyen en la variabilidad y aplicar medidas para minimizarlas, ayudará a mejorar el pronóstico de los pacientes (AU)

Marked variability in the treatment of patients with acute coronary syndrome has been observed in international and single-country studies for more than 15 years. This variability is associated with specific patient characteristics, such as being female or diabetic, but is also influenced by the center providing treatment and the physician in charge of care. It has repeatedly been demonstrated that, paradoxically, patients at a higher risk receive less complete treatment or are treated less in accordance with guidelines. Knowledge of all the factors that influence treatment variability combined with the implementation of measures to minimize them would help improve patient prognosis (AU)

Tratamiento farmacológico en la fase aguda del infarto de miocardio. ¿Qué anticoagulante? ¿Qué antiagregante? ¿Qué otra medicación? / Pharmacological treatment in the acute phase of a myocardial infarction. Which anticoagulant? Which antiplatelet? Which other drugs?

El tratamiento de la cardiopatía isquémica aguda ha evolucionado notablemente en las últimas décadas, lo que ha contribuido a mejorar el pronóstico de los pacientes. Un rápido diagnóstico y un tratamiento precoz en la fase aguda del evento isquémico cardiaco suponen una mayor supervivencia y menor riesgo de desarrollar insuficiencia cardiaca, así como otras complicaciones concomitantes. Así pues, se ha demostrado que la administración de ciertos fármacos anticoagulantes y antiagregantes, así como bloqueadores beta, inhibidores de la enzima de conversión de angiotensina y estatinas, en la fase aguda del infarto, puede ayudar a mejorar la supervivencia y reducir el riesgo de complicaciones. En este artículo se revisa brevemente el tratamiento farmacológico inicial a administrar en las primeras 48 h de un infarto agudo de miocardio con elevación del segmento ST (AU)

The treatment of acute ischemic heart disease has made major progress in recent decades that has contributed to better patient prognosis. Rapid diagnosis and early treatment during the acute phase of an ischemic cardiac event have led to an increased chance of survival and a decreased risk of developing heart failure or another associated complication. Moreover, it has been shown that administering particular anticoagulant and antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors and statins, during the acute phase can help improve the chance of survival and reduce the risk of complications. This article contains a brief overview of the types of pharmacological treatment that can be administered early during the first 48 hours following an ST-segment elevation acute myocardial infarction (AU)