Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients.

(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.

Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes.

We aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p = 0.021) and higher number of passes (3 vs. 2; p < 0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p < 0.001] and lower percentage of monocytes [9.18% vs.17.34%, p < 0.001] in comparison to successful MT cases. The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson's r = 0.35, p = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9-42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment.

Intensive 90-day textile wearable Holter monitoring: an alternative to detect paroxysmal atrial fibrillation in selected patients with cryptogenic stroke.

We aimed to demonstrate the feasibility of 90-day cardiac monitoring with an external Holter device and to find a target population able to benefit from such a technique. Cryptogenic stroke patients were continuously monitored for 90 days with a textile wearable Holter (TWH). Compliance and quality of the monitoring were assessed by the number of hours of ECG stored per month. Mean predictors of pAF, including age, gender, stroke severity, and atrial size (LAVI), were evaluated. One-year follow-up assessed pAF detection outside per protocol monitoring. Out of 224 patients included in 5 stroke centers, 163 patients (72.76%) fulfilled the criteria for the protocol. Median monitoring time was similar among the three months. Per protocol pAF detection reached 35.37% at 90 days. The age (OR 1.095; 95% CI 1.03-1.14) and the LAVI (OR 1.055; 95% CI 1.01-1.09) independently predicted pAF. The cut-off point of 70 years (AUC 0.68) (95% CI 0.60-0.76) predicted pAF with a sensitivity of 75.8% and specificity of 50.5%. The LAVI cut-off point of 28.5 (AUC 0.67) (95% CI 0.56-0.77) had a sensitivity of 63.6% and a specificity of 61.8% to detect pAF. The combination of both markers enhanced the validity of pAF detection sensitivity to 89.6%, with a specificity of 27.59%. These patients had increased risk of pAF during the 90-day monitoring HR 3.23 (χ2 7.15) and beyond 90 days (χ2 5.37). Intensive 90-days TWH monitoring detected a high percentage of pAF. However, a significant number of patients did not complete the monitoring. Patients older than 70 years and with enlarged left atria benefitted more from the protocol.

Blood-Based Biomarkers to Search for Atrial Fibrillation in High-Risk Asymptomatic Individuals and Cryptogenic Stroke Patients.

Background: Atrial fibrillation (AF) increases the risk of ischemic stroke in asymptomatic individuals and may be the underlying cause of many cryptogenic strokes. We aimed to test the usefulness of candidate blood-biomarkers related to AF pathophysiology in two prospective cohorts representative of those populations. Methods: Two hundred seventy-four subjects aged 65-75 years with hypertension and diabetes from the AFRICAT cohort, and 218 cryptogenic stroke patients aged >55 years from the CRYPTO-AF cohort were analyzed. AF was assessed by 4 weeks of monitoring with a wearable Holter device (NuuboTM™). Blood was collected immediately before monitoring started. 10 candidate biomarkers were measured by automated immunoassays (Roche, Penzberg) in the plasma of all patients. Univariate and logistic regression analyses were performed in each cohort separately. Results: Atrial fibrillation detection rate was 12.4% (AFRICAT cohort) and 22.9% (CRYPTO-AF cohort). 4 biomarkers were significantly increased in asymptomatic individuals with AF [Troponin-T, Angiopoietin-2 (Ang-2), Endocan, and total N-terminal pro-B type natriuretic peptide (NT-proBNP)] and 7 biomarkers showed significantly higher concentrations in cryptogenic stroke patients with AF detection [growth differentiation factor 15, interleukin 6, Troponin-T, Ang-2, Bone morphogenic protein 10, Dickkopf-related protein 3 (DKK-3), and total NT-proBNP]. The models including Ang-2 and total NT-proBNP [AUC 0.764 (0.665-0.863)], and Ang-2 and DKK-3 [AUC = 0.733 (0.654-0.813)], together with age and sex, showed the best performance to detect AF in high-risk asymptomatic individuals, and in cryptogenic stroke patients, respectively. Conclusion: Blood-biomarkers, in particular, total NT-proBNP, DKK-3, and Ang-2, were associated with AF reflecting two mechanistically different pathways involved in AF pathophysiology (AF stretch and vascular changes). The combination of these biomarkers could be useful in AF screening strategies in the primary care setting and also for searching AF after cryptogenic stroke.

Efficacy and Safety of Lithium Treatment in SARS-CoV-2 Infected Patients.

At the beginning of the pandemic, we observed that lithium carbonate had a positive effect on the recovery of severely ill patients with COVID-19. Lithium is able to inhibit the replication of several types of viruses, some of which are similar to the SARS-CoV-2 virus, increase the immune response and reduce inflammation by preventing or reducing the cytokine storm. Previously, we published an article with data from six patients with severe COVID-19 infection, where we proposed that lithium carbonate could be used as a potential treatment for COVID-19. Now, we set out to conduct a randomized clinical trial number EudraCT 2020-002008-37 to evaluate the efficacy and safety of lithium treatment in patients infected with severe SARS-CoV-2. We showed that lithium was able to reduce the number of days of hospital and intensive care unit admission as well as the risk of death, reduces inflammatory cytokine levels by preventing cytokine storms, and also reduced the long COVID syndromes. We propose that lithium carbonate can be used to reduce the severity of COVID-19.

Proteins and pathways in atrial fibrillation and atrial cardiomyopathy underlying cryptogenic stroke.

Background: Atrial fibrillation (AF) is one of the most prevalent causes of cryptogenic stroke. Also, apart from AF itself, structural and remodelling changes in the atria might be an underlying cause of cryptogenic stroke. We aimed to discover circulating proteins and reveal pathways altered in AF and atrial cardiomyopathy, measured by left atrial volume index (LAVI) and peak atrial longitudinal strain (PALS), in patients with cryptogenic stroke. Methods: An aptamer array (including 1310 proteins) was measured in the blood of 20 cryptogenic stroke patients monitored during 28 days with a Holter device as a case-control study of the Crypto-AF cohort. Protein levels were compared between patients with (n = 10) and without AF (n = 10) after stroke, and the best candidates were tested in 111 patients from the same cohort (44 patients with AF and 67 without AF). In addition, in the first 20 patients, proteins were explored according to PALS and LAVI values. Results: Forty-six proteins were differentially expressed in AF cases. Of those, four proteins were tested in a larger sample size. Only DPP7, presenting lower levels in AF patients, was further validated. Fifty-seven proteins correlated with LAVI, and 270 correlated with PALS. NT-proBNP was common in all the discovery analyses performed. Interestingly, many proteins and pathways were altered in patients with low PALS. Conclusions: Multiple proteins and pathways related to AF and atrial cardiomyopathy have been revealed. The role of DPP7 as a biomarker for stroke aetiology should be further explored. Moreover, the present study may be considered hypothesis-generating.

Monocyte-to-Lymphocyte Ratio in Clot Analysis as a Marker of Cardioembolic Stroke Etiology.

The aim of the study was to find markers of high-risk cardioembolic etiology (HRCE) in patients with cryptogenic strokes (CS) through the analysis of intracranial clot by flow cytometry (FC). A prospective single-center study was designed including patients with large vessel occlusion strokes. The percentage of granulocytes, monocytes, lymphocytes, and monocyte-to-lymphocyte ratio (MLr) were analyzed in clots extracted after endovascular treatment (EVT) and in peripheral blood. Large arterial atherosclerosis (LAA) strokes and high-risk cardioembolic (HRCE) strokes were matched by demographics and acute reperfusion treatment data to obtain FC predictors for HRCE. Multilevel decision tree with boosting random forest classifiers was performed with each feature importance for HRCE diagnosis among CS. We tested the validity of the best FC predictor in a cohort of CS that underwent extensive diagnostic workup. Among 211 patients, 178 cases underwent per-protocol workup. The percentage of monocytes (OR 1.06, 95% CI 1.01-1.11) and MLr (OR 1.83, 95% CI 1.12-2.98) independently predicted HRCE diagnosis when LAA clots (n = 28) were matched with HRCE clots (n = 28). Among CS (n = 82), MLr was the feature with the highest weighted importance in the multilevel decision tree as a predictor for HRCE. MLr cutoff point of 1.59 yield sensitivity of 91.23%, specificity of 44%, positive predictive value of 78.79%, and negative predictive value of 68.75 for HRCE diagnosis among CS. MLr ≥ 1.6 in clot analysis predicted HRCE diagnosis (OR, 6.63, 95% CI 1.85-23.71) in a multivariate model adjusted for age. Clot analysis by FC revealed high levels of monocyte-to-lymphocyte ratio as an independent marker of cardioembolic etiology in cryptogenic strokes.

Resveratrol as an anti-asthmatic agent: could this stilbenoid help against COVID-19 in any way? a meta-analysis / Resveratrol como agente antiasmático: ¿podría este estilbenoide ayudar contra el COVID-19 de alguna manera? un metaanálisis

Resveratrol is a phenolic phytoconstituent found in many plants. This molecule has always caught the attention of scientists because of biological potentials such as inhibition of inflammation, oxidative stress and platelet aggregation as well as to prevent/protect against cardiovascular and neurodegenerative disease/disorders. Literature search have been conducted over resveratrol in covid-19 and asthma studies published in Pubmed and Google Scholars until 30 September 2020. The criteria used in the literature review were determined and were reviewed works on resveratrol including 368 articles and 47 articles on covid-19 and asthma, respectively. As a result of meta-analysis, TNF-α values of the studies showed a significant difference (heterogeneity) of I2=68.39% from each other in total (Cohran Q:6.33, p<0.0423). This study shows that resveratrol would have a potential to reduce ARDS symptoms, by suppressing the cytokine storm and severe inflammation caused by SARS-CoV-2, and by showing strong activity against various types of DNA/RNA viruses.

El resveratrol es un fitoconstituyente fenólico que se encuentra en muchas plantas. Esta molécula siempre ha llamado la atención de los científicos debido a sus potenciales biológicos como la inhibición de la inflamación, el estrés oxidativo y la agregación plaquetaria, así como para prevenir/proteger contra enfermedades/trastornos cardiovasculares y neurodegenerativos. Se han realizado búsquedas bibliográficas sobre resveratrol en covid-19 y estudios sobre asma publicados en Pubmed y Google Scholars hasta el 30 de septiembre de 2020. Se determinaron los criterios utilizados en la revisión bibliográfica y se revisaron trabajos sobre resveratrol que incluyen 368 artículos y 47 artículos sobre covid-19 y asma, respectivamente. Como resultado del metanálisis, los valores de TNF-α de los estudios mostraron una diferencia significativa (heterogeneidad) de I2=68,39% entre sí en total (Cohran Q: 6,33, p<0,0423). Este estudio muestra que el resveratrol podría reducir los síntomas del ARDS al suprimir la tormenta de citocinas y la inflamación severa causada por el SARS-CoV-2, y al mostrar una fuerte actividad contra varios tipos de virus de ADN/ARN.

Adoptees facing adolescence: What accounts for their psychological well-being?

INTRODUCTION: In accordance with the "resilience paradigm", this study was aimed at exploring the role of the parent-child relationship in supporting internationally adopted adolescents' ability to develop a strong adoptive identity and a feeling of satisfaction with their own life. METHODS: Participants were 105 Italian adopted adolescents (13-17 years) asked to complete a self-report questionnaire. RESULTS: Results showed that adolescents generally feel fairly comfortable discussing adoption-related issues (especially with their mothers), have a medium-high level of adoptive identity, and appear to be quite satisfied with their life. Moreover, while adoptive identity mediates the association between openness in communication regarding adoption and adoptees' well-being with mothers, father-child communication openness has a direct influence on well-being. CONCLUSIONS: Findings highlighted that the quality of mother-child and father-child relationship plays a crucial role in guiding the process of adoptees' identity formation and influencing their well-being. Recommendations for professionals working with adoptive families were discussed.

Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP.

The aim of the study was to determine markers of atrial dysfunction in patients with cryptogenic stroke to predict episodes of paroxysmal atrial fibrillation with high risk of embolization (HpAF). We classified patients included in the Crypto-AF study, Cryptogenic Stroke registry, to detect paroxysmal atrial fibrillation (pAF) with wearable Holter, according to the longest episode of pAF in three groups: without pAF detection, episodes of pAF shorter than 5 h, and episodes of pAF longer than 5 h (HpAF). Atrial dysfunction surrogates were evaluated: EKG pattern, Holter record and echocardiography parameters (left atria volume (LAVI), and peak atrial longitudinal and contraction strain (PALS and PACS). The level of N-terminal pro b-type natriuretic peptide (NT-proBNP) was determined. All patients were followed for 2 years to detect pAF and stroke recurrence. From 308 patients, 253 patients with high quality Holter analysis were selected. The distribution was No pAF 78.6% (n = 199), pAF < 5 h 7.9% (n = 20), and HpAF > 5 h 13.4% (n = 34). Age of the patients and combination of PALS and NT-proBNP independently predicted HpAF OR 1.07 (1.00; 1.15) and OR 3.05 (1.08; 8.60) respectively. The validity of PALS and NT-proBNP to detect patients at risk of HpAF was higher than the validity of age (AUC 0.82, sensitivity 78.95%, specificity 63%). Patients with PALS < 25% and NT-proBNP > 283 pg/ml had more detection of pAF during follow-up 35% vs. 5.1% OR 2.33 (1.05-5.13) (p < 0.001). Multimodal assessment of atrial dysfunction with PALS and NT-proBNP improved the prediction of pAF episodes with high embolic risk in patients with cryptogenic stroke.

Nutritional preconditioning by marine omega-3 fatty acids in patients with ST-segment elevation myocardial infarction: A METOCARD-CNIC trial substudy.

BACKGROUND: Marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiomyocyte membranes, partially displacing the omega-6 arachidonic acid (AA). Whereas AA is a substrate for pro-inflammatory eicosanoids, the release of EPA from cell membranes generates anti-inflammatory lipid mediators, contributing to the infarct-limiting effect observed experimental models. Clinical data are lacking. METHODS: In this observational study conducted in 100 patients with a reperfused anterior ST-elevation myocardial infarction (STEMI), at hospital admission we quantified by gas-chromatography the red blood cell proportions of AA, EPA, and the AA:EPA ratio, a valid surrogate for cardiomyocyte membrane content. Patients underwent cardiac magnetic resonance imaging in the acute phase (one week post-STEMI), and at long-term (6 months) follow-up. Infarct size (delayed gadolinium enhancement) and cardiac function (left ventricular ejection fraction [LVEF]) were correlated with exposures of interest by multivariate regression analysis. RESULTS: AA:EPA ratio directly related to acute infarct size (coefficient [95% CI]: 6.19 [1.68 to 10.69], P = 0.008) and inversely to long-term LVEF (coefficient [95% CI]: − 4.02 [− 7.15 to − 0.89], P = 0.012). EPA inversely related to acute infarct size (coefficient [95% CI]: − 6.58; [− 11.46 to − 1.70]; P = 0.009), while a direct association with LVEF at follow-up (coefficient [95% CI]: 3.67 [0.25 to 7.08]; P = 0.036) was observed. CONCLUSIONS: A low AA:EPA ratio in red blood cells at the time of STEMI is associated with smaller acute infarct size and preserved long-term ventricular function. Our results are consistent with prior work in experimental models and add to the notion of omega-3 fatty acids as a healthy fat. TRIAL REGISTRATION: http://www.clinicaltrials.gov/NCT01311700

Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction).

OBJECTIVES: The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events. BACKGROUND: Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI). METHODS: The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with Killip class ≤II anterior STEMI presenting early after symptom onset (<6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up. RESULTS: Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 ± 9.9% vs. 45.0 ± 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval [CI]: 0.44% to 6.55%; p = 0.025). The occurrence of severely depressed LVEF (≤35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, p = 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol group (7% vs. 20%, p = 0.012). At a median follow-up of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol group versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; p = 0.065. Heart failure admission was significantly lower in the IV metoprolol group (HR: 0.32; 95% CI: 0.015 to 0.95; p = 0.046). CONCLUSIONS: In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700).

Análisis de los factores relacionados con la sobreestadificación y la positividad del ganglio centinela en las pacientes con diagnóstico inicial de carcinoma ductal in situ / Analysis of factors related to upstaging and sentinel node positivity in the initial diagnosis of ductal carcinoma in situ

Objetivo. Determinar el porcentaje de pacientes con diagnóstico inicial de carcinoma ductal in situ (CDIS) que presentó infiltración tras la excisión quirúrgica e identificar los factores relacionados tanto con la sobreestadificación como con la positividad del ganglio centinela (GC) en el estudio definitivo. Material y métodos. Análisis retrospectivo de 135 pacientes diagnosticadas mediante biopsia core de CDIS a las que se les realizó biopsia selectiva del GC de forma consecutiva de 2003 a 2011. La técnica fue mixta en el período inicial y posteriormente mediante administración intraperilesional de radiocoloides. En 2009 se introdujo una gammacámara portátil y se inició el estudio intraoperatorio molecular mediante amplificación de ácido nucleico de un solo paso. Resultados. Se produjo sobreestadificación en 45 de las 135 pacientes (33,3%), de las que 30 (22,2%) presentaron CDIS con microinfiltración y 15 (11,1%) carcinoma infiltrante. Los CDIS con microinfiltración mostraron mayor tamaño, mayor porcentaje de alto grado, de HER2 positivo y de Ki-67 alto que los CDIS (p < 0,001, p < 0,001, p = 0,002 y p = 0,031, respectivamente). Los porcentajes de positividad del GC fueron del 3,6% en el CDIS, del 6,9% en el CDIS con microinfiltración y del 20% en los carcinomas infiltrantes, correspondiendo a 8 pacientes, de las cuales 6 presentaron HER2 positivo y Ki-67 alto. Conclusiones. El porcentaje global de infraestimación fue alto, principalmente debido a la presencia de microinfiltración. Tanto esta como la afectación metastásica del GC mostró relación con el HER2 positivo y el Ki-67 alto, por tanto, disponer de estos datos en la biopsia percutánea podría ser relevante para establecer la indicación de realización de biopsia selectiva del GC en el CDIS

Objective. To determine the percentage of patients with ductal carcinoma in situ (DCIS) with infiltration after surgical excision and to identify the factors related to both upstaging and sentinel node (SN) positivity in the final study. Material and methods. A retrospective analysis was performed in 135 patients diagnosed with DCIS by core biopsy who subsequently underwent sentinel lymph node biopsy from 2003 to 2011. In the first period of the study, the technique was mixed and subsequently consisted of intra-perilesional radiocolloid administration. In 2009, a portable gamma camera was introduced and we began to use intraoperative one-step nucleic acid amplification. Results. Upstaging occurred in 45 of the 135 patients (33.3%), of which 30 (22.2%) had DCIS with microinfiltration and 15 (11.1%) had invasive carcinoma. Compared with DCIS, DCIS with microinfiltration were larger and showed a higher percentage of high grade, HER2 positivity and high Ki-67 (P < .001, P < .001, P = .002 and P = .031, respectively). SN positivity rates were 3.6% in DCIS, 6.9% in DCIS with microinfiltration, and 20% in invasive carcinomas, corresponding to 8 patients, of whom 6 showed HER2-positivity and high Ki-67. Conclusions. Overall underestimation was high, mainly due to the presence of microinfiltration. Both microinfiltration and metastatic SN involvement were associated with HER2-positivity and high Ki-67. Therefore, the availability of this information in core needle biopsy could be relevant in establishing the indication for sentinel lymph node biopsy in DCIS

Linfoma de tejido linfoide asociado a mucosas primario de mama con infiltración de la piel / Primary mucosa-associated lymphoid tissue lymphoma of the breast with cutaneous involvement

El linfoma de células B extranodal de la zona marginal del tejido asociado a mucosas es de bajo grado de malignidad y representa el 0,04-0,53% de todos los tumores malignos de la mama y el 2,2% de los linfomas malignos extranodales. Se asocia a enfermedades autoinmunes. En la mama se presenta habitualmente como un tumor único, indoloro y de rápido crecimiento. En algunos casos existe compromiso de la piel y adenopatías axilares. Presentamos el caso de una mujer de 39 años con artritis reumatoide de 20 años de evolución, que presenta desde hace 5 meses una tumoración palpable en la mama izquierda de 4 cm y lesiones eritematosas cambiantes en la piel de ambas mamas. Los hallazgos radiológicos fueron similares a los del resto de las tumoraciones malignas, por lo que para su diagnóstico fue necesario un estudio anatomopatológico, inmunohistoquímico y molecular (AU)

Mucosa-associated lymphoid tissue lymphoma is a low-grade malignant tumor representing 0.04 to 0.53% of all malignant breast tumors and 2.2% of extranodal malignant lymphomas. This entity is associated with autoimmune diseases. In the breast, mucosa-associated lymphoid tissue lymphomas usually appear as a single, painless, and fast growing tumor. Some patients also have cutaneous involvement and axillary lymphadenopathy. We present a case of a 39-year-old woman with a 20-year history of rheumatoid arthritis and a 5-month history of a palpable 4 cm lump in the left breast and erythematous skin lesions on both breasts. Radiological findings were similar to those of other malignant tumors. Consequently, histopathological, immunohistochemical and molecular studies were required for diagnosis (AU)

Colesterol, triglicéridos y otros factores de riesgo en pacientes con edema macular diabético / Cholesterol, triglycerides and other factors of risk in patients with diabetic macular edema

La retinopatía diabética y sus complicaciones es la causa principal de disminución de la agudeza visual en la población, debido a los factores de riesgo y a un deficiente control metabólico de la enfermedad, su diagnóstico constituye un reto para los oftalmólogos en su actuar diario.Objetivo: determinar la presencia de dislipidemias y otros factores de riesgo en pacientes con edema macular diabético.Métodos: se realizó un estudio observacional descriptivo de corte transversal en pacientes con edema macular diabético que acudieron a la consulta de retina del Centro Oftalmológico Carlos J Finlay desde octubre 2011 a octubre 2012. El universo estuvo constituido por 100 pacientes y la muestra no probabilística estuvo formada por 80 pacientes que cumplieron los criterios de inclusión. Se les aplicó un formulario para recoger los datos. Los resultados se relacionaron con las siguientes variables: tiempo de evolución de la diabetes mellitus, tratamiento farmacológico, valores de colesterol y de triglicéridos, alteraciones de la microperimetría. Para la realización de la microperimetría se utilizó el protocolo automático para la mácula de 12 grados, 45 puntos maculares.Resultados: se presentaron en mayor número los pacientes con edema macular clínicamente significativo, con más de 10 años de evolución de la diabetes, los tratados con insulina y los que presentaron cifras elevadas de colesterol y triglicéridos, el mayor número de pacientes presentaron alteraciones en la microperimetría.Conclusiones: se presentaron en mayor número los pacientes con edema macular en la clasificación referida. Se demostró la estrecha relación entre edema macular diabético y factores como: el tiempo de evolución de la diabetes, el tratamiento farmacológico y los valores de colesterol y triglicéridos...

Diabetic retinopathy and its complications is the main cause of the decrease of visual acuity of people, owing to the factors of risk and to a poor metabolic control of the disease; its diagnosis is a daily challenge for ophthalmologists.Objective: to determine the presenceof dyslipemias and other factors of risk in patients with diabetic macular edema.Methods: a cross-sectional, observational, descriptive study was conducted in patients with diabetic macular edema that assisted to the consultation of retina at the Carlos J. Finlay Ophthalmologic Center from October, 2011 to October, 2012. The universe was composed of 100 patients and the non-probabilistic sample included 80 patients that matched the criteria of inclusion. The patients had to fill in a form to get information about them. The results were related to the next variables: time of evolution of the diabetes mellitus, pharmacological treatment, cholesterol and triglycerides levels, and alterations in the microperimetry. For making the microperimetry, the automatic protocol for the 12-degrees macula, 45 macular points, was used.Results: most of the patients that assisted to the consultation presented a clinically significant macular edema, with diabetes of more than ten years of evolution. Patients treated with insulin and those that presented high levels of cholesterol and triglycerides also assisted to the consultation. The greater number of patients presented alterations in the microperimetry.Conclusions: the greater number of the patients that assisted to the consultation presented macular edema in a referred classification. The close relation that exist between the diabetic macular edema and factors like the time of evolution of the diabetes, the pharmacological treatment and the cholesterol and triglycerides levels, was showed...

Colesterol, triglicéridos y otros factores de riesgo en pacientes con edema macular diabético / Cholesterol, triglycerides and other factors of risk in patients with diabetic macular edema

Fundamento: la retinopatía diabética y sus complicaciones es la causa principal de disminución de la agudeza visual en la población, debido a los factores de riesgo y a un deficiente control metabólico de la enfermedad, su diagnóstico constituye un reto para los oftalmólogos en su actuar diario.Objetivo: determinar la presencia de dislipidemias y otros factores de riesgo en pacientes con edema macular diabético.Métodos: se realizó un estudio observacional descriptivo de corte transversal en pacientes con edema macular diabético que acudieron a la consulta de retina del Centro Oftalmológico Carlos J Finlay desde octubre 2011 a octubre 2012. El universo estuvo constituido por 100 pacientes y la muestra no probabilística estuvo formada por 80 pacientes que cumplieron los criterios de inclusión. Se les aplicó un formulario para recoger los datos. Los resultados se relacionaron con las siguientes variables: tiempo de evolución de la diabetes mellitus, tratamiento farmacológico, valores de colesterol y de triglicéridos, alteraciones de la microperimetría. Para la realización de la microperimetría se utilizó el protocolo automático para la mácula de 12 grados, 45 puntos maculares.Resultados: se presentaron en mayor número los pacientes con edema macular clínicamente significativo, con más de 10 años de evolución de la diabetes, los tratados con insulina y los que presentaron cifras elevadas de colesterol y triglicéridos, el mayor número de pacientes presentaron alteraciones en la microperimetría.Conclusiones: se presentaron en mayor número los pacientes con edema macular en la clasificación referida. Se demostró la estrecha relación entre edema macular diabético y factores como: el tiempo de evolución de la diabetes, el tratamiento farmacológico y los valores de colesterol y triglicéridos(AU)

Background: diabetic retinopathy and its complications is the main cause of the decrease of visual acuity of people, owing to the factors of risk and to a poor metabolic control of the disease; its diagnosis is a daily challenge for ophthalmologists.Objective: to determine the presenceof dyslipemias and other factors of risk in patients with diabetic macular edema.Methods: a cross-sectional, observational, descriptive study was conducted in patients with diabetic macular edema that assisted to the consultation of retina at the Carlos J. Finlay Ophthalmologic Center from October, 2011 to October, 2012. The universe was composed of 100 patients and the non-probabilistic sample included 80 patients that matched the criteria of inclusion. The patients had to fill in a form to get information about them. The results were related to the next variables: time of evolution of the diabetes mellitus, pharmacological treatment, cholesterol and triglycerides levels, and alterations in the microperimetry. For making the microperimetry, the automatic protocol for the 12-degrees macula, 45 macular points, was used.Results: most of the patients that assisted to the consultation presented a clinically significant macular edema, with diabetes of more than ten years of evolution. Patients treated with insulin and those that presented high levels of cholesterol and triglycerides also assisted to the consultation. The greater number of patients presented alterations in the microperimetry.Conclusions: the greater number of the patients that assisted to the consultation presented macular edema in a referred classification. The close relation that exist between the diabetic macular edema and factors like the time of evolution of the diabetes, the pharmacological treatment and the cholesterol and triglycerides levels, was showed(AU)

Effect of early metoprolol on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial.

BACKGROUND: The effect of ß-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS: Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean ± SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6 ± 15.3 versus 32.0 ± 22.2 g; adjusted difference, -6.52; 95% confidence interval, -11.39 to -1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was -8.13 (95% confidence interval, -13.10 to -3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). CONCLUSIONS: In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01311700. EUDRACT number: 2010-019939-35.

Valoración funcional y prescripción de ejercicio en pacientes con cardiopatía / Functional evaluation and exercise prescription in patients with cardiopathy

La práctica de ejercicio físico es pieza fundamental en los programas de Rehabilitación Cardíaca. La prescripción de ejercicio debe ser individualizada, de forma que se consiga el máximo beneficio con el mínimo riesgo. En los cardiópatas el ejercicio no consigue una mejoría tan manifiesta a nivel central, debido a la limitación que supone la patología cardiaca, pero en cambio se mantiene la mejoría a nivel periférico. En este artículo se realiza una revisión sobre la valoración funcional y la prescripción de ejercicio en las cardiopatías. Comienza con un pequeño repaso de los efectos del entrenamiento sobre el miocardio. Más adelante se comparan dos herramientas de trabajo muy distintas pero igualmente interesantes para la valoración funcional como son el test de la marcha de 6 minutos y la prueba de esfuerzo. Se hace un recuerdo de su metodología y las ventajas e inconvenientes que presenta cada uno. Finalmente se especifican las recomendaciones sobre la prescripción de ejercicio en cardiopatías, recordando la importancia de la clasificación del riesgo, las interferencias farmacológicas y cuál será el test de valoración funcional más adecuado encada caso y el uso que se dará. Se presentan recomendaciones específicas en relación a la cardiopatía isquémica, la insuficiencia cardiaca y la miocardiopatía hipertrófica, tres de las cardiopatías más frecuentes, adaptando las recomendaciones a sus peculiaridades fisiopatológicas. Se concluye que la adecuada coordinación entre todos los profesionales participantes en los programas de rehabilitación es muy importante en la consecución de su éxito, así como la correcta dosificación de la actividad (AU)

The practice of physical exercise is fundamental for Cardiac Rehabilitation Programs. The prescription of exercise should be individualized for each patient, in order to obtain maximum benefit with minimum risk. In cardiac patients exercise does not give such an evident central level improvement, due to the limitation posed by heart disease, but instead a peripheral level improvement is obtained. This article is a review on the functional evaluation and exercise prescription in heart disease patients. It starts with a brief review of the effects of training on the myocardium. Later, two very different work tools, but equally interesting for functional evaluation; Six-Minute Walk Test and Exercise Testing, are compared. A reminder of their methodologies and advantages and disadvantages is carried out for each one. Finally, recommendations on exercise prescription in heart diseases are specified, emphasizing the importance of risk classification, pharmacological interference and which functional evaluation test will be the most appropriate in each case, along with the specific use of it. We present specific recommendations in relation to ischemic heart disease, heart failure and hypertrophic cardiomyopathy, three of the most common heart disease, adapting the recommendations to their pathophysiological peculiarities. We conclude that proper coordination between all professionals involved in rehabilitation programs is very important in achieving success, as well as the proper dosage of activity (AU)

Intravítrea de triamcinolona en pacientes con rubeosis del iris: presentación de un caso / Intravitreal triamcinolone in patients with rubeosis of iridis: a case report

La rubeosis de iris es la complicación más frecuente y precoz de muchas enfermedades vasculares del segmento posterior. El manejo de la neovascularización se divideen dos aspectos: el tratamiento de la enfermedad subyacente responsable de la rubeosis y el tratamiento del incremento de la presión intraocular, si está presente. Objetivo: demostrar la efectividad de una opción terapéutica, dada por los pobres resultados con los tratamientos habituales para estas complicaciones. Caso clínico: se presenta un paciente con rubeosis de iris asociado a retinopatía diabética proliferativa; se evaluó mediante examen de mejor agudeza visual corregida, biomiscroscopia del segmento anterior y posterior, tonometría, oftalmoscopia indirecta, gonioscopia. Se realizó la clasificación de la rubeosis de iris en grados según elnúmero de cuadrantes afectados por los neovasos, grado I a grado IV, y grado V, cuando se presentó hifema, además de neovasos en todos los cuadrantes. El examen fundoscópico y la biomicroscopia del segmento posterior, fue diferido por opacidad total del cristalino que impidió ver detalles del fondo. La biomicroscopia del segmento anterior clasificó al paciente en grado V,al presentar inyección cilio conjuntival, edema corneal, hifema de 3mm coagulado, sangre fresca y neovasos en todos los cuadrantes. Conclusiones: el paciente fue tratado con inyección de intravítrea de triamcinolona, con mejoría de los síntomas y signos

Rubeosis of iris is the most frequent and precocious of many vascular diseases of the posterior segment complication. Neovascularization management is divided into twoaspects: the treatment of the subjacent disease responsible for rubeosis and the treatment of intraocular pressure increase, if present. Objective: to demonstrate the effectiveness of atherapeutic option given by poor results of usual treatments for these complications. Clinical case: a patient with rubeosis of iridis associated with proliferative diabetic retinopathy ispresented; the patient was assessed through the best corrected visual acuity examination, biomiscroscopy of the anterior and posterior segment, indirect ophthalmoscopy, tonometry andgonioscopy. Classification of rubeosis of iridis was performed in degrees according to the number of quadrants affected by neovessels, grade I to grade IV, and grade V, when hyphemawas presented, besides neovessels in all quadrants. The ophthalmoscopic examination and the posterior segment biomicroscopy were disallowed by total opacity of the lens which preventeddetails of the fundus. The anterior segment biomicroscopy ranked patient in grade V, presenting cilioconjunctival injection, and corneal edema, hyphema of 3 mm coagulated, fresh blood andneovessel in all quadrants. Conclusions: the patient was treated with intravitreal triamcinolone injection with symptoms and signs improvement