Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic.

BACKGROUND: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. OBJECTIVES: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. METHODS: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. RESULTS: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. CONCLUSION: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.

Consequences of canceling elective invasive cardiac procedures during Covid-19 outbreak.

BACKGROUND: During COVID-19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming. OBJECTIVE: The objective of this study was to evaluate the consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID-19 outbreak in Spain. METHODS: The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID-19 pandemic. These patients were followed-up until April 31th. RESULTS: Out of the 2,158 patients, 36 (1.7%) died. Mortality was significantly higher in patients pending on structural procedures (4.5% vs. 0.8%, respectively; p < .001), in those >80 year-old (5.1% vs. 0.7%, p < .001), and in presence of diabetes (2.7% vs. 0.9%, p = .001), hypertension (2.0% vs. 0.6%, p = .014), hypercholesterolemia (2.0% vs. 0.9%, p = .026) [Correction added on December 23, 2020, after first online publication: as per Dr. Moreno's request changes in p-values were made after original publication in Abstract.], chronic renal failure (6.0% vs. 1.2%, p < .001), NYHA > II (3.8% vs. 1.2%, p = .001), and CCS > II (4.2% vs. 1.4%, p = .013), whereas was it was significantly lower in smokers (0.5% vs. 1.9%, p = .013). Multivariable analysis identified age > 80, diabetes, renal failure and CCS > II as independent predictors for mortality. CONCLUSION: Mortality at 45 days during COVID-19 outbreak in patients with chronic cardiovascular diseases included in a waiting list due to cancellation of invasive elective procedures was 1.7%. Some clinical characteristics may be of help in patient selection for being promptly treated when similar situations happen in the future.

Predictive variables of sustained virological response after early discontinuation of triple therapy with telaprevir for genotype-1 HCV infection.

BACKGROUND: Pivotal phase studies of telaprevir (TLV) and boceprevir (BOV) showed 10-56% rates of early treatment interruption. However, there have been no reports on the sustained virological response (SVR) rates of these patients. AIM: To assess the SVR rate in a large cohort of patients who discontinued triple therapy with TLV or BOV for reasons other than stopping rules and to identify variables predicting SVR. MATERIAL AND METHOD: A survey was sent to 15 hospitals in Catalonia asking them to report all TLV/BOV treatments finished by 31 May 2014. Demographic, clinical, laboratory, liver fibrosis and therapeutic data were recorded for treatments with early discontinuation. Logistic regression analysis, ROC curves and prognostic assessment of the variables identified were calculated. RESULTS: Twelve hospitals responded to the survey, representing 467 treatments and 121 (21.2%) early discontinuations, 76 (62.8%) due to stopping rules and 45 (37.2%) for other reasons. Early discontinuation was more frequent with BOV [38.2% (50/131) versus 21.1% (71/336) p<0.005], mainly due to stopping rules [78% (39/50) versus 52.1% (37/71); p=0.004]. SVR was achieved in 21/121 patients (17.4%), 19/71 (26.8%) treated with TLV and 2/50 (4.0%) treated with BOV. In patients discontinuing treatment for reasons other than stopping rules, SVR was achieved in 19/37 (55.9%) treated with TLV and in 2/11 (18.2%) treated with BOV. The SVR rate in patients treated with TLV who discontinued due to a severe adverse event was 61.5% (16/26). A logistic regression analysis was performed only with triple therapy with TLV and early discontinuation. The predictive variables of SVR were undetectable HCV-RNA at treatment week 4 and treatment length longer than 11 weeks. Treatment duration longer than 11 weeks showed the best accuracy (0.794), with a positive predictive value of 0.928. CONCLUSIONS: Early discontinuation of TLV-based triple therapy due to reasons other than stopping rules still have a significant SVR rate (55.9%). Undetectable HVC-RNA at week 4 of treatment and treatment duration longer than 11 weeks are predictive of SVR in this subset of patients.

Hereditary Pancreatitis Related to SPINK-1 Mutation. Is There an Increased Risk of Developing Pancreatic Cancer?

It is thought that many of the idiopathic pancreatitis could have a genetic base. Approximately 50% of them correspond to CFTR (cystic fibrosis transmembrane conductance regulator gene) and SPINK-1 (serine protease inhibitor Kazal type 1) mutations. A recent study compares patients with acute pancreatitis and SPINK-1 mutation with patients with idiopathic acute pancreatitis. The study highlights a 12-fold increased risk of developing pancreatic cancer with SPINK-1 mutation versus the control group. Nonetheless, authors conclude that only specific pN34s mutation is related to pancreatic cancer. This relation is controversial, and international consensus guidelines for the follow-up in chronic pancreatitis with pancreatic cancer still do not recommend follow-up in SPINK-1 p. N34S mutation. We believe that developing prospective studies in which subgroups of patients with SPINK-1 mutation benefit from closer follow-ups would be necessary.

Irreversible Electroporation in Locally Advanced Pancreatic Adenocarcinoma: Aiming to Improve Overall Survival.

Irreversible electroporation (IRE) is a non-thermic ablation therapy which has been proposed for locally advanced pancreatic adenocarcinoma (LAPC) as well as for the local control of other types of tumors (kidney or liver). Its use has been extended in the last few years worldwide. Its advantage over other ablation techniques is that it only affects the lipids bilayer of the cell membrane avoiding vascular damage. Safety and viability have been demonstrated in recent studies. Overall survival seems (OS) to improve when it is combined with chemotherapy compared to chemotherapy with or without radiotherapy. Clinical trials should confirm these encouraging data.

Effects of feeding rice and the degree of starch gelatinisation of rice on nutrient digestibility and ileal morphology of young pigs.

We evaluated the influence of the main cereal of the diet and the degree of heat processing of rice on apparent ileal and total tract digestibility of nutrients and ileum morphology of pigs at 37 d of age. Control pigs were fed a complex diet that contained 500 g/kg cooked and flaked maize with a degree of starch gelatinisation (SG) of 840 g/kg. Experimental groups received the same complex diet in which maize was substituted (w/w) by rice with three different degrees of SG; 110, 520 and 760 g/kg that corresponded to raw rice and cooked rice processed under two different set of conditions. The digestibility of dietary components, except for nitrogen, was greater for the cooked rice--than for the raw rice--and the maize diet (P<0.001). Pigs fed cooked rice had higher villus height to crypt depth ratio (P<0.001) and greater percentage of zigzag-oriented villi and lesser percentage of tongue-oriented villi (P<0.01) than pigs fed other diets. Compared with feeding maize, feeding rice improved dietary component digestibility and ileal morphology in piglets. Mild cooking of rice (SG = 520 g/kg) enhanced diet digestibility and ileum morphology. However, processing the rice to increase SG to 760 g/kg did not increase nutrient digestibility further and in fact impaired ileal morphology.

Melatonin and pinoline prevent aluminium-induced lipid peroxidation in rat synaptosomes.

The serum concentrations of aluminum, a metal potentially involved in the pathogenesis of Alzheimer's disease, increase with age. Also, intense and prolonged exposure to aluminum may result in dementia. Melatonin and pinoline are two well known antioxidants that efficiently reduce lipid peroxidation due to oxidative stress. Herein, we investigated the effects of melatonin and pinoline in preventing aluminum promotion of lipid peroxidation when the metal was combined with FeCl3 and ascorbic acid in rat synaptosomal membranes. Lipid peroxidation was estimated by quantifying malondialdehyde (MDA) and 4-hydroxyalkenal (4-HDA) concentrations in the membrane suspension. Under the experimental conditions used herein, the addition of aluminum (0.0001 to 1 mmol/L) enhanced MDA + 4-HDA formation in the synaptosomes. Melatonin and pinoline reduced, in a concentration-dependent manner, lipid peroxidation due to aluminum, FeCl3 and ascorbic acid in the synaptosomal membranes. These results suggest that the indoleamine melatonin and the beta-carboline pinoline may potentially act as neuroprotectant agents in the therapy of those diseases with elevated aluminum concentrations in the tissues.

Pancreatitis autoinmune: diagnóstico diferencial con adenocarcinoma de páncreas / Autoinmune pancreatitis: Differential diagnosis with pancreatic adenocarcinoma

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Predictive variables of sustained virological response after early discontinuation of triple therapy with telaprevir for genotype-1 HCV infection / Variables pronósticas de respuesta virológica sostenida tras la interrupción precoz del tratamiento triple con telaprevir de la infección por genotipo 1 del virus de la hepatitis C

BACKGROUND: Pivotal phase studies of telaprevir (TLV) and boceprevir (BOV) showed 10-56% rates of early treatment interruption. However, there have been no reports on the sustained virological response (SVR) rates of these patients. AIM: To assess the SVR rate in a large cohort of patients who discontinued triple therapy with TLV or BOV for reasons other than stopping rules and to identify variables predicting SVR. MATERIAL AND METHOD: A survey was sent to 15 hospitals in Catalonia asking them to report all TLV/BOV treatments finished by 31 May 2014. Demographic, clinical, laboratory, liver fibrosis and therapeutic data were recorded for treatments with early discontinuation. Logistic regression analysis, ROC curves and prognostic assessment of the variables identified were calculated. RESULTS: Twelve hospitals responded to the survey, representing 467 treatments and 121 (21.2%) early discontinuations, 76 (62.8%) due to stopping rules and 45 (37.2%) for other reasons. Early discontinuation was more frequent with BOV [38.2% (50/131) versus 21.1% (71/336) p < 0.005], mainly due to stopping rules [78% (39/50) versus 52.1% (37/71); p = 0.004]. SVR was achieved in 21/121 patients (17.4%), 19/71 (26.8%) treated with TLV and 2/50 (4.0%) treated with BOV. In patients discontinuing treatment for reasons other than stopping rules, SVR was achieved in 19/37 (55.9%) treated with TLV and in 2/11 (18.2%) treated with BOV. The SVR rate in patients treated with TLV who discontinued due to a severe adverse event was 61.5% (16/26). A logistic regression analysis was performed only with triple therapy with TLV and early discontinuation. The predictive variables of SVR were undetectable HCV-RNA at treatment week 4 and treatment length longer than 11 weeks. Treatment duration longer than 11 weeks showed the best accuracy (0.794), with a positive predictive value of 0.928. CONCLUSIONS: Early discontinuation of TLV-based triple therapy due to reasons other than stopping rules still have a significant SVR rate (55.9%). Undetectable HVC-RNA at week 4 of treatment and treatment duration longer than 11 weeks are predictive of SVR in this subset of patients

ANTECEDENTES: Los estudios de registro de telaprevir (TLV) y boceprevir (BOV) han mostrado tasas de interrupción precoz del tratamiento del 10-56%, pero no se ha comunicado la respuesta virológica sostenida (RVS) de estos pacientes. OBJETIVOS: Analizar la RVS, y los factores predictivos de esta, en una cohorte extensa de pacientes que pararon precozmente el tratamiento triple con TLV/BOV por causas diferentes a reglas de parada. MATERIAL Y MÉTODO: Se envió a 15 de hospitales de Cataluña un cuestionario relativo a los tratamientos con TLV/BOV finalizados antes del 31 de mayo de 2014, incluyendo información clínica, analítica, elastométrica y terapéutica de aquellos interrumpidos precozmente. Se realizaron análisis de regresión logística, curvas ROC y estimaciones pronósticas de las variables identificadas. RESULTADOS: Contestaron la encuesta 12 hospitales, sumando un total de 467 tratamientos con 121 (21,2%) interrupciones precoces del mismo, 76 (62,8%) por reglas de parada y 45 (37,2%) por otras causas. Hubo más paradas precoces en los tratamientos con BOV (38,2% [50/131] versus 21,1% [71/336]; p < 0,005), principalmente debidas a reglas de parada (78% [39/50] versus 52,1% [37/71]; p = 0,004). Alcanzaron RVS 21/121 pacientes (17,4%), 19/71 (26,8%) tratados con TLV y 2/50 (4,0%) tratados con BOV. En los pacientes que pararon el tratamiento por causas distintas a reglas de parada se alcanzó la RVS en 19/37 (55,9%) tratados con TLV y en 2/11 (18,2%) tratados con BOV. Los pacientes tratados con TLV que pararon el tratamiento por efecto adverso grave tuvieron una tasa de RVS del 61,5% (16/26). El análisis de regresión logística se hizo solo con los tratamientos triples con TLV parados precozmente. Las variables predictivas de RVS fueron el ARN-VHC indetectable en semana 4 y la duración del tratamiento mayor de 11 semanas. El mejor valor pronóstico (0,794) lo tuvo la duración total del tratamiento mayor de 11 semanas, con un VPP de 0,928. CONCLUSIONES: Los pacientes que paran precozmente el tratamiento triple con TLV por causas diferentes a reglas de parada conservan una tasa de RVS relevante (55,9%) en esta cohorte. El ARN-VHC indetectable en semana 4 y la duración del tratamiento mayor de 11 semanas son predictivas de RVS de este subgrupo de pacientes

Rotura espontánea de músculo papilar con coronarias angiográficamente normales / Spontaneous Papillary Muscle Rupture in the Absence of Coronary Artery Disease

La rotura de músculo papilar es una afección poco frecuente, normalmente secundaria a una complicación mecánica del infarto agudo de miocardio o a un traumatismo torácico. Presentamos el caso clínico de una paciente que presentó una rotura espontánea completa de músculo papilar posteromedial e insuficiencia mitral severa secundaria, por necrosis aislada del papilar, sin lesiones coronarias angiográficas, que evolucionó a shock cardiogénico, requiriendo cirugía emergente de sustitución valvular mitral, realizada con éxito. Se ha revisado la escasa bibliografía clínica e histopatológica al respecto y se comentan los posibles mecanismos de dicha rotura. (AU)

Práctica de la lactancia materna exclusiva y su relación con el nivel de conocimientos de la madre: Centro de Salud del Rímac - Villacampa / Its relation with the level of knowledge of the mother practices of exclusive the maternal lactancia and: Center of Health of the Rímac - Villacampa

La lactancia materna exclusiva, o hecho de alimentar sin adicionar ninguna otra sustancia o alimento, que debe durar hasta los 6 meses de edad, en la teoría tiene muy buena aceptación, pero en la práctica es bastante difícil su cabal cumplimiento. La investigación sobre características de la lactancia materna exclusiva y conocimientos de las madres se hizo en el Centro de Salud de Villacampa - Rímac; en 12 madres de niños de 0 meses hasta un año de edad. Entre los resultados, se verifica que la lactancia materna exclusiva administrada al niño de 6 meses y menos constituye sólo el 9,5 por ciento. Lo más vigente es la lactancia mixta . Los conocimientos de las madres respecto a lo que es la lactancia materna exclusiva y como lograrla, es el aspecto más deficiente en el saber materno; la exploración respectiva evidencia predominio de nivel medio. Se afirma que es factor influyente los conocimientos maternos sobre lactancia materna exclusiva; porque al relacionar ambas variables se aprecia asociación estadísticamente significativa: las madres con nivel alto de conocimientos practican en su mayoría lactancia exclusiva; las de nivel bajo mixta. El tipo de conocimiento sobre concepto de exclusividad y la práctica, muestran influencia recíproca entre las madres con conocimientos correctos e incorrectos. El nivel de educación no es un factor influyente en la práctica de la lactancia exclusiva; y el estado civil se evidencia como variable independiente, no mostrando influencia tanto en el nivel de conocimiento como en la práctica. La conducta materna que refleja su parecer y saber, se corrobora al relacionar su respuesta a la pregunta: ¿ Interrumpiría la lactancia a su hijo?. Entre las madres que respondieron si ninguna practicaba la forma exclusiva en los menores de 6 meses; las que respondieron No, si practican la forma exclusiva en la casi totalidad de menores de 6 meses.