Adherencia a tratamiento de prevención secundaria post síndrome coronario agudo, en pacientes adultos ingresados al Hospital Hernán Henríquez Aravena / Adherence to secondary prevention after acute coronary syndromes: experience in a chilean general hospital

Antecedentes: En prevención secundaria cardiovascular, el control de los factores de riesgo es deficiente y la falta de adherencia terapéutica parece ser uno de los factores causales. El cumplimiento terapéutico se asocia a un 20% de disminución del riesgo de enfermedad cardiovascular y un 38% de disminución de mortalidad por cualquier causa. Sin embargo, la adherencia a los fármacos preventivos ronda el 50% al año después del alta hospitalaria, lo que multiplica por 3 el riesgo de mortalidad. Objetivos: Describir la adherencia a mediano plazo a tratamiento de prevención secundaria post síndrome coronario agudo de los pacientes adultos ingresados al Hospital Hernán Henríquez Aravena durante el año 2018. Determinar las características clínicas y sociodemográficas de la población y explorar las posibles causas asociadas a la falta de adherencia terapéutica en este grupo de pacientes. Métodos y Resultados: Se evaluaron 396 pacientes con síndrome coronario agudo en el Hospital Hernán Henríquez Aravena de Temuco durante el año 2018. La adherencia a terapia farmacológica se evaluó mediante el cuestionario de Morisky-Green de ocho ítems, aplicado vía telefónica. Se evaluó la asociación de variables clínicas y sociodemográficas con el nivel de adherencia mediante regresión ordinal y análisis de correspondencias. Resultados: Un 41.9% de los pacientes mantuvieron adherencia a la terapia a 2 años de seguimiento. Variables sociodemográficas como el bajo nivel educacional, la ruralidad, y la presencia de 1 o 2 apellidos mapuche se asociaron con baja adherencia a terapia farmacológica. Conclusión: La adherencia a medidas de prevención secundaria después del tratamiento por un síndrome coronario aguda es baja. Los principales factores relacionados a la falta de adherencia fueron el bajo nivel educacional y la ruralidad.

Background: a lack of therapeutic adherence to secondary prevention measures after acute coronary events leads to a poor control of risk factors. Adherence to treatment is associated with a reduction of 20% in the risk of cardiovascular disease and 38% reduction in all-cause mortality long term. However, adherence to drug therapy is about 50% a year after hospital discharge, which leads to an approximately three fold increase in mortality. Objectives: to describe the medium-term adherence to secondary prevention treatment following an acute coronary syndrome in adult patients admitted to a general hospital during 2018. In addition, to relate clinical and sociodemographic characteristics related to poor adherence and also to explore possible causes associated with the lack of therapeutic adherence in this group of patients. Methods: 396 patients treated for an acute coronary syndrome were followed after being discharged from the Hernán Henríquez Aravena Hospital in Temuco (Chile) during 2018. Adherence to pharmacological therapy was evaluated using the eight-item Morisky-Green questionnaire applied via phone call. The association of clinical and sociodemographic variables with the level of adherence was evaluated using ordinal regression and correspondence analysis. Results: Only 41.9% of patients maintained adherence to therapy at 2 years of follow-up. Low educational level, rurality, and the presence of 1 or 2 mapuche surnames were associated to poor adherence to drug therapy.

COVID-19 lockdown effects on a coastal marine environment: Disentangling perception versus reality.

COVID-19 lockdown brought to a drastic reduction of anthropic impacts on the environment worldwide, including the marine-coastal system. Earth-Observation (EO) data have the potential to monitor and diagnose the effects of the lockdown in terms of water quality. Here we connect the dots among some coastal environmental changes that occurred during the Italian COVID-19 lockdown by using EO data, also seeking to assess connectivity between inland and marine systems. We present a holistic analysis of spatial and temporal variability of environmental parameters in the North Adriatic Sea, Mediterranean basin, exploiting the synergy of different satellite sensors, as well as hydrologic data from in situ observations. Our analysis indicates a favourable interplay of environmental variability that resulted in negative anomalies of Chlorophyll-a concentration, with respect to the climatologic values. Peculiar meteo-oceanographic and hydrological conditions made hard to disentangle potential anthropogenic effects. However, a multi-year hierarchical cluster analysis of riverine remote sensing reflectances groups together the optical properties of inland waters during the lockdown. This emergent cluster highlights the possibility of a second-order, anthropogenic effect that, superimposed to the (first-order) environmental natural causes, may have enhanced water quality during the lockdown.

First Evaluation of PRISMA Level 1 Data for Water Applications.

This study presents a first assessment of the Top-Of-Atmosphere (TOA) radiances measured in the visible and near-infrared (VNIR) wavelengths from PRISMA (PRecursore IperSpettrale della Missione Applicativa), the new hyperspectral satellite sensor of the Italian Space Agency in orbit since March 2019. In particular, the radiometrically calibrated PRISMA Level 1 TOA radiances were compared to the TOA radiances simulated with a radiative transfer code, starting from in situ measurements of water reflectance. In situ data were obtained from a set of fixed position autonomous radiometers covering a wide range of water types, encompassing coastal and inland waters. A total of nine match-ups between PRISMA and in situ measurements distributed from July 2019 to June 2020 were analysed. Recognising the role of Sentinel-2 for inland and coastal waters applications, the TOA radiances measured from concurrent Sentinel-2 observations were added to the comparison. The results overall demonstrated that PRISMA VNIR sensor is providing TOA radiances with the same magnitude and shape of those in situ simulated (spectral angle difference, SA, between 0.80 and 3.39; root mean square difference, RMSD, between 0.98 and 4.76 [mW m-2 sr-1 nm-1]), with slightly larger differences at shorter wavelengths. The PRISMA TOA radiances were also found very similar to Sentinel-2 data (RMSD < 3.78 [mW m-2 sr-1 nm-1]), and encourage a synergic use of both sensors for aquatic applications. Further analyses with a higher number of match-ups between PRISMA, in situ and Sentinel-2 data are however recommended to fully characterize the on-orbit calibration of PRISMA for its exploitation in aquatic ecosystem mapping.

Satellite sensor requirements for monitoring essential biodiversity variables of coastal ecosystems.

The biodiversity and high productivity of coastal terrestrial and aquatic habitats are the foundation for important benefits to human societies around the world. These globally distributed habitats need frequent and broad systematic assessments, but field surveys only cover a small fraction of these areas. Satellite-based sensors can repeatedly record the visible and near-infrared reflectance spectra that contain the absorption, scattering, and fluorescence signatures of functional phytoplankton groups, colored dissolved matter, and particulate matter near the surface ocean, and of biologically structured habitats (floating and emergent vegetation, benthic habitats like coral, seagrass, and algae). These measures can be incorporated into Essential Biodiversity Variables (EBVs), including the distribution, abundance, and traits of groups of species populations, and used to evaluate habitat fragmentation. However, current and planned satellites are not designed to observe the EBVs that change rapidly with extreme tides, salinity, temperatures, storms, pollution, or physical habitat destruction over scales relevant to human activity. Making these observations requires a new generation of satellite sensors able to sample with these combined characteristics: (1) spatial resolution on the order of 30 to 100-m pixels or smaller; (2) spectral resolution on the order of 5 nm in the visible and 10 nm in the short-wave infrared spectrum (or at least two or more bands at 1,030, 1,240, 1,630, 2,125, and/or 2,260 nm) for atmospheric correction and aquatic and vegetation assessments; (3) radiometric quality with signal to noise ratios (SNR) above 800 (relative to signal levels typical of the open ocean), 14-bit digitization, absolute radiometric calibration <2%, relative calibration of 0.2%, polarization sensitivity <1%, high radiometric stability and linearity, and operations designed to minimize sunglint; and (4) temporal resolution of hours to days. We refer to these combined specifications as H4 imaging. Enabling H4 imaging is vital for the conservation and management of global biodiversity and ecosystem services, including food provisioning and water security. An agile satellite in a 3-d repeat low-Earth orbit could sample 30-km swath images of several hundred coastal habitats daily. Nine H4 satellites would provide weekly coverage of global coastal zones. Such satellite constellations are now feasible and are used in various applications.

Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review.

PURPOSE: To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS: Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS: Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION: With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults.

Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review

PURPOSE: To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS: Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS: Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION: With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults. .

Función renal y síndrome coronario agudo en un hospital general / Renal function and acute coronary syndrome in a general hospital

OBJETIVO. Evaluar la prevalencia de la insuficiencia renal en los pacientes con síndrome coronario agudo (SICA) y comparar las características clínicas, tratamiento y resultados intrahospitalarios de los pacientes con y sin insuficiencia renal. MATERIAL y MÉTODOS: Estudio observacional, analítico, retro-prospectivo, en pacientes con SICA del Hospital Nacional Arzobispo Loayza de Lima, del 2000 al 2006. Se calculó la tasa de filtración glomerular (TFG) utilizando la fórmula MDRD. La población fue clasificada según la TFG: función renal preservada (FRP), si la TFG mayor igual 60 mL/min/1 ,73ml²,y función renaldisminuida (FRD), si la TFG menor que 60 mL/min/1,73m². RESULTADOS. De 709 pacientes con SICA, 202 (28,6%) tuvieron FRD. Este grupo tuvo: mayor edad, predominancia de sexo femenino, mayor prevalencia de hipertensión arterial, menor tasa de tabaquismo y mayor uso de medicamentos al momento del ingreso; menor presión arterial sistólica (118,75 más menos 38,0,6 vs.127,64 más menos 33,06 mm Hg,p = 0,029) y diastólica (70,69 más menos 21,75 vs. 77,27 más menos 17,79,p = 0,002) y mayor frecuencia cardiaca(89,22 más menos 28,34 vs. 81,05 más menos 20,42 lat/min, p = 0,007). También, SICA STNE predominante (60,4 por ciento, p menor que, 0,001); creatinina sérica mayor(1,69 más menos 0,85 mg/dL vs. 0,89 más menos 0,19 mg/dL,p = 0,0001) y TFG menor (42,67 más menos 12,7 mL/min/1,73m² vs. 93,64 más menos 57,84 mL/min/1,73m², p menor que 0,001). El grupo FRD tuvo: hemoglobina fmenor (12,0,5 más menos 2,67 vs. 13,32 más menos 1,96 g/dL, p menor que 0,001), niveles de CPK MB más altos (164,69 más menos 196,58 U/L vs. 105,79 más menos 133,22, p = 0,001), mayor frecuencia de disfunciónventricular izquierda (fracción de eyección menor que 40 por ciento vs. 37,4 por ciento vs. 18,7 por ciento, p menor que 0,001) y regurgitación mitral moderada a severa (27,1 por ciento vs.11,9 por ciento, p menor que 0,001); más eventos fatales(11,9 por ciento vs. 5,1 por ciento...

OBJECTIVE. To assess the prevalence of renal insufficiency in patients with acute coronary syndrome (ACS) and compare the clinical characteristics, treatment and intrahospital outcome of patientswith and without renal insufficiency. MATERIAL AND METHODS. An observational, analytic, retro prospective study was done in patientswith ACS that entered to the Hospital Nacional Arzobispo Loayza, Lima, from 2000 to 2006. The glomerular filtration rate (GFR) was estimated with the MDRD formula. The patients were classified according; to the GFR: preserved renal function (PRF) if GFR more equal 60, mL/min/1,73 m² and decreased renal function (DRF) if the GFR less 60 mL/min/1,73m². RESULTS. In 709 patients with ACS, 202 (28,6 per cent) had a DRF. Patients of this group were older, had more female, higher prevalence of hypertension, lower rates of smoking and increased use of medications at admission. Also, it had lower systolic blood pressure (118,75 more less 38,06 vs.127,64 more less 30,06 mmHg,p = 0,029) diastolic (70,69 more less 21,75 vs. 77,27 more less 17,79,p = 0,002) and increased heart rate (89,22 more less 28,34 vs. 81,05 more less 20,42 beats/min, p= 0,007). Besides, NSTE ACS was prevalent (60,4 per cent; p less than 0,001); higher serum creatinine (1,69 more less 0,85 mg/dl vs. 0,89 more less 0,19 mg/dl,p less than 0.001), lower GFR(42,67 more less 12,7 vs. ml/min/1,73 m². 93,64 more less 57,84 mL/min/1,73 m², p less than 0,001); lower hemoglobin (12,05 more less 2,67 vs. 13,32 more less 1,96 g/dL, p less than 0,001); higher CPK MB (164,69)....

Indice de masa corporal, circunferencia abdominal y su impacto en los niveles de presion arterial / Body mass index, abdominal circumference and its impact on blood pressure levels

Introducción: La masa corporal y la circunferencia abdominal elevadas están asociadas al desarrollo de hipertensión arterial; sin embargo en el Perú no existe información sobre su impacto en los niveles de presión arterial. Objetivos: Determinar el efecto de las variaciones de la masa corporal y la circunferencia abdominal sobre los valores de presión arterial. Métodos: Se reclutaron 1023 individuos mayores de 18 años entre enero y abril del 2005. Se calculó el IMC y el valor de la circunferencia abdominal (CA). Se registró la presión arterial, el sexo, edad y el antecedente de HTA. Se analizó mediante regresión lineal la relación entre circunferencia abdominal e índice de masa corporal vs. Presión arterial. Resultados: Se encontró que un incremento de una unidad de IMC se asociaba a un incremento de 1.3 y 0.8 mmHg. Y 1.2 mmHg, para la presión sistólica (PAS) y diastólica (PAD) para los varones, y de 1.3 y 0.8 mmHg, para las mujeres. Así mismo por cada incremento de 5 centímetros, en la CA, la presión arterial se incrementaba en 2.4 mmHg, para la PAS y 2.0 mmHg, para la PAD en los varones. En las mujeres este incremento fue de 2.9 y 1.5 mmHg, respectivamente. Conclusiones: Los niveles de presión arterial se incrementaron en relación directa al incremento del índice de masa corporal y de la circunferencia abdominal en todo el rango de valores de estas variables.

Características clínicas y seguimiento a 30 días de pacientes con síndrome isquémico coronario agudo / Clinical characteristics and 30 day follow up of patients with the acute coronary ischemic syndrome

Objetivo: Determinar las características clínicas y la evolución a 30 días de los pacientes con síndrome isquémico coronario agudo. Materiales y métodos: Estudio retrospectivo-prospectivo realizado en pacientes con síndrome isquémico coronario agudo (SICA) EN LA Unidad de Cuidados Coronarios (UCIC) del Hospital Loayza de Lima, en el periodo 2000-2006. Se consignó variables clínicas y de laboratorio al ingreso y de evolución a 30 días. Resultados: Se presentaron 701 casos de SICA. La proporción de SICA con STE (ST elevado) fue muy similar al de SICA STNE (ST no elevado), (50.8 por ciento vs. 47.9 por ciento9. El 63.1 por ciento fue del sexo masculino. La edad promedio fue de 6412.8 años, siendo mayor en la mujer (68,33 ± 12,36 vs. 61,47 ± 12.37, p menor que 0,001). Como antecedentes la hipertensión arterial (HTA) se presentó en el 54, 5 por ciento, dislipidemia 44, 2 por ciento, tabaquismo 33, 5 por ciento, diabetes 17, 3 por ciento, infarto de miocardio previo 9,2, bypass coronario 2,0 por ciento y angioplastía en 0,7 por ciento. Los fármacos más frecuentes consumidos al ingreso fueron: IECA (27.2 por ciento) y antiplaquetarios (17.8 por ciento). El 43 por ciento no recibía ninguna medicación previa. El tiempo de hospitalización promedio en la UCIC fue de 6.3359 días. La hora de ingreso fue mayor a partir de las 9 horas con un pico máximo a las 13:00 horas. Los valores de CPK y triponina-T se incrementaron dentro del espectro del SICA de 99.4 por ciento U/L a 1855.8 U/l para el CPK total; de 29.2 U/L a 246.8 U/L para el CPK-MB; y de 0.04 ng/Ml A 3.94 ng/ml para la troponina T. se halló leucocitos en el 43.7 por ciento, hiperglicemia 60.2 por ciento y disfunción renal 59.1 por ciento con valores predictivos para el desarrollo de eventos adversos (p menor que 0.001): OR de 2.88 (IC 1.90-4.39), 2.59 (IC 1.46-4.61) y 6.49 (IC 3.57-11.86), respectivamente. E 21.3 por ciento presentó FE menor al 40 por ciento...

Objective: To determine the clinical characteristics and evolution of patients with acute ischemic coronary syndrome at 30-day follow-up. Material and Methods: It was done a retrospective and prospective study of patients with diagnosis of acute ischemic coronarysyndrome in the coronary ICU of the Hospital Loayza of Lima in the period 2000-2006. Results: It included 701 patients. The proportion of elevated-ST segment was very similar to the non-elevated ST segment (50,8 per cent vs. 47,9 per cent), where non-Q AMI was the most frequent (25.7 per cent). The majority of patients were male, 63,1 per cent. The mean age was of 64 + 12,8 years, and women were older (68,33 ±12,36 vs. 61,47 ± 12,37, p menor que 0,001). Past history of arterial hypertension was in 54,5 per cent, dislipidemia 44,2 per cent, smoking 33,5 per cent, diabetes 17,3 per cent, previous myocardium infarction 9,2 per cent, coronary bypass 2,0 per cent and angioplasty in 0,7 per cent. The most frequent consumed drugs at admission were ACEs (27,2 per cent) and antiplatelet drugs (17,8 per cent).No previous medication in 43 per cent. Mean hospitalization time was of 6,33 + 5,9 days. Admissions increased from the 9.00 hours with a maximum peak at 13,00 hours. The values of CPK and troponin-T increased within the acute coronary syndrome spectrum from 99,4 U/L to 1 855,8 U/L for total CPK; from 29,2 U/L to 246,8 U/L for CPKMB; and, from 0,04 ng/mL to 3,94 ng/mL for the troponin-T. Leucocytosis was found in 43,7 per cent, hyperglycemia 60,2 per cent and renal dysfunction 59,1 per cent with predictive values for the development of adverse events: (p minor 0,001) with OR of 2,88 (1,90-4,39 CI), 2,59 (1,46-4,61 CI) and 6,49 (3,57-11,86 CI), respectively. An EF minor 40 per cent...

Comparación del índice de performance miocßrdico por doppler pulsado de flujo y doppler pulsado tisular / Comparison of the index of performance myocardial for doppler touched of flow and doppler touched tisular

OBJETIVO: Demostrar que el índice de performance miocßrdico (IPM) obtenido por doppler pulsado tisular (DT) y doppler pulsado de flujo (DF) son métodos comparables. ANTECEDENTES: El IPM, también llamado índice de Tei, es una herramienta de inestimable utilidad para la evaluación ventricular sistólica y diastólica y es un indicador de mal pronóstico en varias enfermedades cardiovasculares cuando su valor es elevado. Clßsicamente se mide mediante el DF mitral y del tracto de salida de VI. Recientemente se ha propuesto medir el índice de Tei mediante el DT con la ventaja de medir los intervalos en un solo ciclo cardiaco a diferencia del método clßsico donde es necesario medir intervalos en diferentes ciclos por lo que puede alterarse con fluctuaciones de la frecuencia cardiaca. Sin embargo hay pocos trabajos que evalúan la correlación y concordancia entre ambos métodos que es el objetivo de este estudio MATERIALES Y METODOS: Se realiza un estudio prospectivo en pacientes adultos que acuden al laboratorio de cardiología para una evaluación ecocardiogrßfica midiendo el IPM por medio del DF y por medio del DT. En la comparación de los métodosse usa grßficos de Bland-Altman y el anßlisis de Passing-Bablok. RESULTADOS: Se estudiaron 80 pacientes con edad promedio de 60 a±os, 36 hombres y 44 mujeres. Al comparar las mediciones entre los dos métodos se encuentra que hay diferencia significativa en todas las mediciones con una p < 0.05. Así el intervalo ôaõ (intervalo entre el fin de la onda A y el inicio de la onda E del siguiente ciclo) medido por DT (453.38ms) es mayor que el medido por el método tradicional (432.82 ms), el intervalo ôbõ (intervalo entre el inicio y fin del flujo aortico) por DT (294.43 ms) es menor que el método clßsico (300.77 ms). La suma del tiempo decontracción isovolumétrica mas el tiempo de relajación isovolumétrica es mayor medido por el DT (158.96 ms) que el DF (132.05 ms). El IPM es mayor por DT (0.56) que el medido por DF ...

OBJECTIVE: Our aim was to demonstrate that the myocardial performance index (IPM) obtained by tissue Doppler imaging (DT) and pulsed wave Doppler (DF) are comparable methods. BACKGROUND: The IPM, call also Tei index, is a tool of invaluable utility for the evaluation of the systolic and diastolic ventricular function and it is an indicator of poor prognostic in several cardiovascular illnesses when its value is high. Classically it is measured using the DF mitral and of the outflow tract of the left ventricle. Recently the Tei index is measured using the DT with the advantage of measuring the intervals in a single heart cycle contrary to the classic method where it is necessary to measure intervals in different cycles what can alter with fluctuations of the heart frequency. However there are few studies that evaluate the correlation and agreement between both methods that is our objective. MATERIALS AND METHODS: A prospective study is made in adult patients with echocardiography measuring the IPM using the DF and using the DT. In the comparison of the methods it is used graphics of Bland-bltman and the analysis of Passing-Bablok. RESULTS: Eighty patients were studied with age average 60 year-old, 36 men and 44 women. When it is compared the mensurations among the two methods a significant difference it exists in all the mensurations with p <0.05. This way the interval ôaõ (interval among the end of the A wave and the beginning of the E wave of the following cycle) measured by DT (453.38 ms) is greater than by the traditional method (432.82 ms), the interval ôbõ (interval between the beginning and end of the aortic flow) for DT (294.43 ms) it is smaller than the classic method (300.77 ms). The sum of the time of isovolumic contraction and the relaxation isovolumic by the DT (158.96 ms) is greater than using the DF (132.05 ms). The IPM for DT (0.56) is greater than by DF (0.45). The correlation between both methods are of 0.85. ...