Adhesion pathway proteins and risk of atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: The cellular adhesion pathway has been suggested as playing an important role in the pathogenesis of atrial fibrillation (AF). However, prior studies that have investigated the role of adhesion pathway proteins in risk of AF have been limited in the number of proteins that were studied and in the ethnic and racial diversity of the study population. Therefore we aimed to study the associations of fifteen adhesion pathway proteins with incident AF in a large, diverse population. METHODS: Multi-Ethnic Study of Atherosclerosis participants from four races/ethnicities (n = 2504) with protein levels measured were followed for incident AF (n = 253). HGF protein was measured on Exam 1 samples (N = 6669; AF n = 851). Cox proportional hazards regression was used to assess the association of AF with 15 adhesion pathway proteins. Bonferroni correction was applied to account for multiple comparisons. RESULTS: After adjusting for potential confounding variables (age, sex, race/ethnicity, height, body mass index, systolic blood pressure, antihypertension therapy, diabetes status, current smoker, current alcohol use, and total and HDL cholesterol), and accounting for multiple testing (P < 0.05/15 = 0.0033), circulating levels of the following proteins were positively associated with a higher risk of AF: MMP-2 (HR per standard deviation increment, 1.27; 95% CI 1.11‒1.45), TIMP-2 (HR 1.28; 95% CI 1.12‒1.46), VCAM-1 (HR 1.32; 95% CI 1.16‒1.50), and SLPI (HR 1.22; 95% CI 1.07‒1.38). The association between proteins and AF did not differ by race/ethnicity. CONCLUSIONS: Circulating levels of MMP-2, TIMP-2, VCAM-1, and SLPI were positively associated with an increased risk of incident AF in a diverse population. Our findings suggest that adhesion pathway proteins may be important risk predictors of AF.

Recurrence rate of localized prostate cancer after radical prostatectomy according to D'amico risk classification in a tertiary referral hospital: association study.

OBJETIVO: Determinar la tasa de recurrencia del cáncer de próstata localizado después de la prostatectomía radical según la clasificación D'Amico. MÉTODOS: Estudio de cohorte retrospectivo comparativo de 5 años. Se obtuvieron datos de registros clínicos de pacientes con cáncer de próstata localizado, que se sometieron a prostatectomía radical y se evaluó la tasa de recurrencia de la enfermedad. Se analizó con pruebas estadísticas descriptivas y comparativas. Una p < 0.05 se consideró significativo. RESULTADOS: Se analizó 108 pacientes, la edad promedio 65.3 años. Acerca de la clasificación de riesgo de D'Amico, 33.33% de bajo riesgo, 55.56% riesgo intermedio y 11.11% alto riesgo. La tasa de recurrencia de APE fue 14,81%. Los pacientes de bajo riesgo tuvieron recurrencia del 13.89%, riesgo intermedio 18.33% y alto riesgo no tuvieron recurrencia. Sobre piezas quirúrgicas, el 25.93% presentaron características adversas. La escala de Gleason postoperatoria muestra un aumento de 44.44% en bajo riesgo, 26.67% en riesgo intermedio y 41.67% en alto riesgo. CONCLUSIONES: La prostatectomía radical ofrece un control adecuado del cáncer de próstata localizado. La tasa de recurrencia del APE fue menor que otros informes internacionales. Asimismo, la recurrencia bioquímica del riesgo bajo, intermedio y alto fue similar a la tendencia global. OBJECTIVE: The objective of the study was to determine the recurrence rate of localized prostate cancer after radical prostatectomy according to the D'Amico classification. METHODS: This was a observational and 5-year comparative retrospective cohort study. Data were obtained from clinical records of patients with localized prostate cancer who underwent radical prostatectomy and the recurrence rate of the disease was evaluated. It was analyzed with descriptive and comparative statistical tests, p<0.05 was considered significant. RESULTS: One hundred and eight patients were analyzed, and the average age was 65.3 years. About D'Amico's risk classification, 33.33% low risk, 55.56% intermediate risk, and 11.11% high risk. The prostate-specific antigen (PSA) recurrence rate was 14.81%. Low-risk patients had recurrence of 13.89%, intermediate risk 18.33%, and high risk had no recurrence. Regarding surgical pieces, 25.93% presented adverse characteristics. The post-operative Gleason scale shows an increase of 44.44% in low risk, 26.67% in intermediate risk, and 41.67% in high risk. CONCLUSIONS: Radical prostatectomy offers adequate control of localized prostate cancer. The PSA recurrence rate was lower than other international reports. Likewise, the biochemical recurrence of low, intermediate, and high risk was similar to the global trend.

Cognitive Decline in Adults Aged 65 and Older in Cumbayá, Quito, Ecuador: Prevalence and Risk Factors.

Objective To assess the prevalence of and risk factors for cognitive decline and dementia in individuals greater than 65 years of age in Cumbayá, Quito, Ecuador. Methods This is a cross-sectional observational study that was carried out in adults over age 65. The Mini Mental State Examination (MMSE), Ascertain Dementia Eight-Item Informant Questionnaire (AD8), and Mini Nutritional Assessment (MNA) were used to assess the cognitive status and nutritional habits of this population. Results A total of 144 patients (mean age 75.3 years, 77.1% female) participated in this study. Forty percent of patients had AD8 and MMSE scores consistent with cognitive impairment and possible dementia. Age (p < 0.01), lower educational level (p < 0.01), history of stroke (p < 0.01), history of intracerebral hemorrhage (p < 0.01), diabetes mellitus (p < 0.01), and malnutrition (p < 0.01) were statistically significant risk factors for cognitive impairment. Exercise was found to be protective against cognitive decline in our study group (p < 0.03). Gender, ethnicity, location, head trauma, Parkinson disease, hypercholesterolemia, myocardial infarction, thyroid disease, depression, anxiety, and family history of dementia were not found to be associated with cognitive decline in this population. Conclusions The prevalence of cognitive impairment and possible dementia is 18-21% at age 65 and 54-60% at age 85 in Cumbayá, Quito, Ecuador. The major risk factors for cognitive impairment in this population are age, low educational level, malnutrition, prior stroke, prior intracerebral hemorrhage, and diabetes. Protective factors for cognitive decline include exercise and possibly modest consumption of alcohol.

Principal atrial fibrillation discharges by the new ACC/AHA/ESC classification.

BACKGROUND: The American College of Cardiology, American Heart Association, and European Society of Cardiology Board (ACC/AHA/ESC) 2001 guidelines for management of patients with atrial fibrillation (AF) include a new classification system consisting of 4 categories: first-detected episode; recurrent paroxysmal (self-terminating); recurrent persistent (requiring cardioversion); and permanent. The frequency of hospital discharges within these categories has not been reported. METHODS: The new classification system was applied to 135 consecutive hospital discharges with a principal diagnosis of AF. RESULTS: Classification of AF in these discharged patients included 74 (55%) with first-detected episode; 28 (21%) with recurrent paroxysmal AF; 17 (13%) with recurrent persistent AF; and 16 (12%) with permanent AF. Hypertension (n = 48; 35%) was the most common primary cause of AF, followed by alcohol related (n = 23; 17%), coronary artery disease (n = 20; 15%), and valvular heart disease (n = 17; 12%). For the 102 patients with first-detected and recurrent paroxysmal AF, 71 (69%) converted spontaneously to normal sinus rhythm within 48 hours of admission. Of the 48 patients with a discharge diagnosis of AF, 32 (67%) were receiving anticoagulation therapy. CONCLUSIONS: Most hospital discharges with a principal diagnosis of AF represent the first-detected episode. Diverse causes contribute to AF, and to examine them would help direct therapy. Importantly, in our analysis, 69% of those patients with first-detected or recurrent paroxysmal AF converted spontaneously to normal sinus rhythm within 48 hours of admission.

Toxina botulínica del tipo A en el tratamiento de la hiperreflexia del detrusor (informe preliminar) / Type A botulinum toxin for the treatment of detrussor hyperreflexia (preliminary report)

Se estudiaron 12 pacientes con lesión medular traumática completa, los cuales cursaban con hiperreflexia del detrusor. Se les realizó la aplicación de 100 UI de toxina botulínica del tipo A mediante inyección endoscópica submucosa en cuatro sitios (techo, suelo y paredes laterales de la vejiga). Los pacientes cursaban con una capacidad vesical máxima inicial promedio de 379.3 ml, y una presión del detrusor de 53.8 cm H2O. Durante el primer control subsecuente a la aplicación de toxina (cuatro a seis semanas) se observó una mejoría del 15.87 por ciento, con incremento de la capacidad vesical máxima promedio de 60.2 ml y disminución de la presión del detrusor en 55.54 por ciento, con una presión de 23.9 cm H2O. Durante el segundo control (8 a 10 semanas) se incremento aun más la mejoría, que fue de 39.9 por ciento para la capacidad vesical máxima (151.7 ml) y la presión del detrusor mejoró en 82.3 por ciento al disminuir a 9.5 cm H2O. Se concluye que la aplicación única de toxina botulínica de tipo A es una alternativa favorable para el tratamiento de la hiperreflexia del detrusor, con buena respuesta hasta las 10 semanas de seguimiento de estos pacientes; sin embargo, se requiere aún de seguimiento de estos pacientes para lograr identificar el tiempo de respuesta máxima a este tratamiento innovador

Morbilidad consultada por adolescentes en atención primaria / Consulted morbidity by adolescents in primary care

Se analiza la estructura de los grupos de diagnósticos y dianósticos específicos, en las consultas realizadas por una población de 15 a 19 años, durante un año, en 5 consultorios del Servicio de Salud Metropolitana Occidente. Estas anteciones de salud corresponden a 6,1% del total otorgado en el programa del adulto con un rango de 10% a 2,8%. Las consultas disminuyen de los 15 a los 19 años de 20% a 16%. Los adolescentes consultan principalmente por enfermedades infecciosas y parasitarias, respiratorias, y mentales, osteomusculares, digestivas. No se observan diferencias importantes en cada edad. Las causas específicas más frecuentes corresponden a neurosis, virosis respiratorias, bronquitis, discopatías y colon irritable. En este análisis conviene tener presente que el enfoque anamnéstico, diagnóstico y terapéutico es diferente si la atención del adolescente la realiza un médico de adultos o un pediatra, y ello debe influir en la estructura de las consultas por causas